Most patients with severe obesity has liver fibrosis even without Metabolic Syndrome/ A maioria dos pacientes com obesidade grave apresenta fibrose Hepática mesmo sem Síndrome Metabólica

Abstract

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a condition commonly associated with metabolic syndrome (MS). This association is frequently found in people with severe obesity, yet some who are diagnosed with NAFLD do not fulfill the criteria for MS. We aimed to compare the clinical and histological characteristics of NAFLD in patients with obesity with and without MS.METHODOLOGY: Cross-sectional study with patients with severe obesity (BMI ≥35kg/m2) diagnosed with NAFLD on liver biopsy during bariatric surgery between Sep/2014 and May/2015. Patients with a history of chronic alcohol consumption and other liver diseases were excluded. MS diagnosis was based on the International Diabetes Federation criteria. Statistical analyses were performed using Chi-square and t tests. P0.05 were considered significant. RESULTS: The simple included 170 patients with severe obesity with histological diagnosis of NAFLD. The mean BMI (body mass index) was 43.2±5.3 kg/m2; 60% were female and the mean age was 37.1±10.7 years. Dyslipidemia (81.7%) and arterial hypertension (48.2%) were the most frequent NAFLD risk factor associated with obesity in these patients. A total of 75 of them (44.1%) did not meet the criteria for MS. They were younger than those with MS [33.8 (9.9) vs 39.7 (10.8) years; p0.001], and 68.0% (51) of them had nonalcoholic steatohepatitis (NASH) and fibrosis. CONCLUSION: The results reinforce the relevance to evaluate NAFLD in people with severe obesity, even those without MS. Despite not presenting MS, these patients with severe obesity already had NASH with fibrosis and can potentially evolve to cirrhosis.