Nonalcoholic steatohepatitis on preoperative period of gastric bypass: lack of correlation with degree of obesity.
BACKGROUND
Metabolic disorders have high correlation with severe forms of nonalcoholic fatty liver disease. However, there is no non-invasive method that promotes its proper stratification and biopsy remains the ideal diagnostic tool.


OBJECTIVE
To evaluate the prevalence of this disease in obese in preoperative period of Roux-en-Y gastric bypass and metabolic factors correlated with liver histopathology.


METHODS
From a total of 47 patients, 35 were enrolled in the inclusion criteria and 12 excluded due to liver disease and alcohol intake >80 g/week. Were performed clinical and laboratory evaluation before the surgery and intraoperative liver biopsy . The intensity was ranked in grade of steatohepatitis: I (mild to moderate) and II (diffuse inflammation), III ( periportal fibrosis) and IV (cirrhosis). Were compared the following variables: duration of obesity, body mass index, waist-hip ratio, type 2 diabetes mellitus, hypertension and dyslipidemia.


RESULTS
Thirty -five patients (68.6 % women , mean age 37 years) were evaluated. The mean body mass index preoperatively was 53.04 kg/m². Nonalcoholic steatohepatitis was found in 31 patients (88.6 %) and 32.2% were in grade I (n=10), grade II 45.2% (n=14), and 25.6% grade III (n=7). The waist-hip ratio was associated with hepatic steatosis; hypertriglyceridemia was the marker that had best correlation with higher grade; there was no correlation between aminotransferase and intensity of the disease; there was correlation of intensity with factors related to insulin resistance.


CONCLUSIONS
Nonalcoholic steatohepatitis is highly prevalent in morbidly obese patients, but there was no positive correlation between aminotransferases and degree of obesity and liver histopathology. Hypertriglyceridemia and waist-hip ratio were positively correlated with the intensity of disease.
Lucia
L
Cordeiro
Josemberg M
JM
Campos
Patrícia S
PS
de Paula
Lúcio
L
Vilar
Edmundo
E
Lopes
Pedro Carlos Loureiro
PC
de Arruda
Almino
A
Ramos
Álvaro
Á
Ferraz
D000328:Adult; D015992:Body Mass Index; D005234:Fatty Liver / Q000150:complications* / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000150:complications* / Q000378:metabolism / Q000601:surgery*; D057234:Preoperative Period; D015995:Prevalence; D012720:Severity of Illness Index; D049629:Waist-Hip Ratio