Influência do diabetes mellitus tipo 2 sobre a histologia hepática entre indivíduos com obesidade mórbida. Um estudo transversal
Palavras-chave:
Fígado gorduroso, Resistência à insulina, Diabetes mellitus, Cirurgia bariátrica, ObesidadeResumo
CONTEXTO E OBJETIVO: A doença gordurosa não alcoólica do fígado se tornou um problema de saúde pública. Ela compreende um amplo espectro de alterações histológicas e se relaciona intimamente com a resistência insulínica e o diabetes mellitus tipo 2. Este estudo tem por objetivo comparar as alterações histo- lógicas observadas em obesos mórbidos com e sem diabetes submetidos ao bypass gástrico em Y de Roux. TIPO DE ESTUDO E LOCAL: Estudo transversal em um hospital terciário público. MÉTODOS: Este é um estudo transversal que envolveu 197 indivíduos submetidos ao bypass gástrico en- tre 2011 e 2013. A doença gordurosa do fígado foi avaliada através de biópsia hepática. O diabetes mellitus tipo 2 foi diagnosticado através dos critérios da Federação Internacional de Diabetes. RESULTADOS: Indivíduos não diabéticos apresentaram significativamente mais biópsias sem anormali- dades histológicas, em relação a esteatose (42,6% versus 25,5%; P = 0.04), fibrose (60,6% versus 36,2%; P = 0.0042) e esteato-hepatite (27,3% versus 12,8%; P = 0.0495); os diabéticos apresentaram uma frequên- cia significativamente mais alta de formas moderadas de esteatose (36,2% versus 20%; P = 0.0307) e fibrose (23,4% versus 4%; P = 0.0002). DISCUSSÃO: O DM-2 associou-se a formas mais avançadas de doença gordurosa do fígado dentro da população estudada. A doença gordurosa não alcoólica do fígado foi associada previamente com formas graves de doença cardíaca. CONCLUSÃO: A busca e detecção precoce da doença gordurosa em populações de alto risco são impor- tantes para evitar o futuro desenvolvimento de formas graves e a necessidade de transplante hepático.
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Referências
Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis. 2004;24(1):3-20.
Kuppan G, Anjana RM, Deepa M, et al. Inflammatory markers in relation to nonalcoholic fatty liver disease in urban South Indians. Diabetes Technol Ther. 2012;14(2):152-8.
Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142(4):711-725.e6.
Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology. 2010;51(2):679-89.
McCullough AJ. Pathophysiology of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40 Suppl 1:S17-29.
Adams LA, Waters OR, Knuiman MW, Elliott RR, Olynyk JK. NAFLD as a risk factor for the development of diabetes and the metabolic syndrome: an eleven-year follow-up study. Am J Gastroenterol. 2009;104(4):861-7.
Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330-44.
Lattuada G, Ragogna F, Perseghin G. Why does NAFLD predict type 2 diabetes? Curr Diab Rep. 2011;11(3):167-72.
Ortiz-Lopez C, Lomonaco R, Orsak B, et al. Prevalence of prediabetes and diabetes and metabolic profile of patients with nonalcoholic fatty liver disease (NAFLD). Diabetes Care. 2012;35(4):873-8.
Boza C, Riquelme A, Ibañez L, et al. Predictors of nonalcoholic steatohepatitis (NASH) in obese patients undergoing gastric bypass. Obes Surg. 2005;15(8):1148-53.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25(10):1822-32.
Liu X, Lazenby AJ, Clements RH, Jhala N, Abrams GA. Resolution of nonalcoholic steatohepatitis after gastric bypass surgery. Obes Surg. 2007;17(4):486-92.
Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101(2):368-73.
Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg. 2012;22(7):1016-21.
Vargas V, Allende H, Lecube A, et al. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol. 2012;4(12):382-8.
Moretto M, Kupski C, da Silva VD, Padoin AV, Mottin CC. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22(7):1044-9.
Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396-402.
Cazzo E, Jimenez LS, Pareja JC, Chaim EA. Effect of Roux-en-Y gastric bypass on nonalcoholic fatty liver disease evaluated through NAFLD fibrosis score: a prospective study. Obes Surg. 2015;25(6):982-5.
Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S-619S.
International Diabetes Federation. Clinical Guidelines Task Force. Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2012. Available from: https://www.idf.org/sites/default/files/IDF%20T2DM%20Guideline.pdf. Accessed in 2015 (Oct 15).
Shalhub S, Parsee A, Gallagher SF, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54-9.
Simo KA, McKillop IH, McMillan MT, et al. Does a calculated “NAFLD fibrosis score” reliably negate the need for liver biopsy in patients undergoing bariatric surgery? Obes Surg. 2014;24(1):15-21.
Cazzo E, de Felice Gallo F, Pareja JC, Chaim EA. Nonalcoholic fatty liver disease in morbidly obese subjects: correlation among histopathologic findings, biochemical features, and ultrasound evaluation. Obes Surg. 2014;24(4):666-8.
Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846-54.
McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59(9):1265-9.
Qureshi K, Clements RH, Abrams GA. The utility of the “NAFLD fibrosis score” in morbidly obese subjects with NAFLD. Obes Surg. 2008;18(3):264-70.
Pimentel SK, Strobel R, Gonçalves CG, et al. Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery. Arq Gastroenterol. 2010;47(2):170-3.
Bhatt HB, Smith RJ. Fatty liver disease in diabetes mellitus. Hepatobiliary Surg Nutr. 2015;4(2):101-8.
Stefan N, Häring HU. The metabolically benign and malignant fatty liver. Diabetes. 2011;60(8):2011-7.
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221-31.
Fukuda T, Hamaguchi M, Kojima T, et al. The impact of non-alcoholic fatty liver disease on incident type 2 diabetes mellitus in non- overweight individuals. Liver Int. 2015. [Epub ahead of print]
Yamazaki H, Tsuboya T, Tsuji K, Dohke M, Maguchi H. Independent Association Between Improvement of Nonalcoholic Fatty Liver Disease and Reduced Incidence of Type 2 Diabetes. Diabetes Care. 2015;38(9):1673-9.
Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia. 2008;51(11):1947-53.
Mantovani A, Pernigo M, Bergamini C, et al. Nonalcoholic Fatty Liver Disease Is Independently Associated with Early Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes. PLoS One. 2015;10(8):e0135329.
Clark JM, Alkhuraishi AR, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13(7):1180-6.
Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22(3):222-6.
Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137(2):532-40.
Shaker M, Tabbaa A, Albeldawi M, Alkhouri N. Liver transplantation for nonalcoholic fatty liver disease: new challenges and new opportunities. World J Gastroenterol. 2014;20(18):5320-30.
Santos LF, Hernandez G, Puerta AV, et al. Non alcoholic fatty liver disease. The new millennium Pandemia. Rev Col Gastroenterol. 2010;25:373-91.
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