Nonalcoholic fatty liver disease in severe obese patients, subjected to bariatric surgery.
BACKGROUND
Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe) deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis.


OBJECTIVE
The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis.


METHODS
A total of 250 liver biopsies were conducted in the transoperation of the surgeries.


RESULTS
Steatosis was present in 226 (90.4%) of the samples, 76 (30.4%) being classified as mild; 71 (28.4%) as moderate and 79 (31.6%) as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4%) cases, where 120 (48.4%) were mild; 50 (20%) were moderate, and 6 (2.4%) cases were intense. Fibrosis was referred to in 108 (43.2%) biopsies, 95 of which (38%) were mild; 2 (0.8%) were moderate; 7 (2.8%) were intense, and cirrhosis was diagnosed in 4 (1.6%) cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001) and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001). Only 13 (5.2%) samples showed Fe deposits.


CONCLUSIONS
There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease.
Programa de Pós-Graduação em Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto AlegreRS, Brasil.
Alexandre
A
Losekann
Centro de Tratamento da Obesidade, Hospital Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brasil.
Antonio Carlos
AC
Weston
Centro de Tratamento da Obesidade, Hospital Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brasil.
Luis Alberto de
LA
Carli
Centro de Tratamento da Obesidade, Hospital Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brasil.
Marilia Bittencourt
MB
Espindola
Centro de Tratamento da Obesidade, Hospital Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brasil.
Sergio Ricardo
SR
Pioner
Programa de Pós-Graduação em Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto AlegreRS, Brasil.
Gabriela Perdomo
GP
Coral
D000328:Adult; D050110:Bariatric Surgery; D001706:Biopsy; D015992:Body Mass Index; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index