medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2011, Number 1

<< Back Next >>

Ann Hepatol 2011; 10 (1)

Nonalcoholic fatty liver disease in Brazil. Clinical and histological profile

Cotrim HP, Parise ER, Oliveira CPMS, Leite N, Martinelli A, Galizzi J, ilva RC, Mattos Â, Pereira L, Amorim W, Ivantes C, Souza F, Costa M, Maia L, Pessoa M, Oliveira F

Language: English
References: 20
Page: 33-37
PDF size: 83.35 Kb.


ABSTRACT

Background. The epidemiology and clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in South America are not well known. Brazil is a largest country in this part of the world and the present study aimed to contribute with this information. Methods. This descriptive study included patients from medical centers around Brazil, who had diagnosis of NAFLD. They were selected from chart review and also prospectively in Hepatology out-clinics. Patients with history of alcohol intake and others liver diseases were excluded. Histological diagnosis included: steatosis or steatohepatitis (steatosis, ballooning of hepatocytes or fibrosis). The criteria to perform a liver biopsy was ALT or AST › 1.5 x normal levels. Results. A total of 1280 patients from 16 Brazilian centers and all five regions were included. The mean age was 49.68 ± 13.59 years; 53.3% were males and 85% were asymptomatic. Hyperlipidemia was observed in 66.8% cases, obesity in 44.7%, overweight in 44.4%, diabetes in 22.7%, and toxins exposure in 10%. Metabolic syndrome was observed in 41.3% cases. Elevated levels of ALT, AST and GGT were observed in 55.8%, 42.2% and 63.1% cases, respectively. Liver biopsy performed in 437 cases showed: isolate steatosis in 42% cases, steatohepatitis in 58% and 27% of them also presented fibrosis. Cirrhosis was observed in 15.4% and hepatocellular carcinoma in 0.7%. Conclusions. NAFLD in Brazil is more frequent in asymptomatic males; steatohepatitis with fibrosis and cirrhosis were a significant diagnosis. The genetic predisposition and lifestyle should be influenced in the spectrum; however these findings deserve a future investigation.


REFERENCES

  1. Ong JP, ZM Younossi. Epidemiology and natural history of NAFLD and NASH. Clin Liver Dis 2007; 11: 1-16.

  2. Lazo M, JM Clark. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis 2008; 28: 339-50.

  3. Adams LA, Angulo P. Recent concepts in non-alcoholic fatty liver disease. Diabetes Med 2005; 22: 1129-33.

  4. Bugianesi E, Marchesini G, Arthur J. McCullough Insulin resistance: A metabolic pathway to chronic liver disease. Hepatology 2005; 42(5): 987-1000.

  5. Weston SR, Leyden W, Murphy R, Bass NM, Bell BP, Manos MM, Terrault NA. Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology 2005; 41: 372-9.

  6. Kojima S, Watanabe N, Numata M, et al. Increase in the prevalence of fatty liver in Japan over the past 12 years: analysis of clinical background. J Gastroenterol 2003; 38: 954-964.

  7. Petersen KF, Dufour S, Feng J, Befroy D, Dziura J, Man CD, Cobelli C, Shulman GI. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian- Indian men. Proc Natl Acad Sci USA 2006; 103: 18273-77.

  8. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol 2007; 22: 788-93.

  9. Monteiro CA, Conde WL. A tendência secular da obesidade segundo estratos sociais: Nordeste e Sudeste do Brasil, 1975-1989-1997. Arq Bras Endocrinol Metab 1999; 186-94.

  10. Sichieri R, Coitinho DC, Leão MM, Recine E, Everhart JE. High temporal, geographic, and income variation in body mass index among adults in Brazil. Am J Public Health 1994; 84: 793-8.

  11. Seidell JC, Flegal KM. Assessing obesity: classification and epidemiology. Br Med Bull 1997; 53(2): 238-52.

  12. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and b-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-9.

  13. Guidorizzi de Siqueira AC, Cotrim HP, Rocha R, et al. Nonalcoholic fatty liver disease and insulin resistance: importance of risk factors and histological spectrum. Eur J Gastroenterol Hepatol 2005; 17(8): 837-41.

  14. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). J Am Med Assoc 2001; 285: 2486-97.

  15. Freitas LA & Cotrim HP. Atlas NASH: Esteato-Hepatite Não Alcoólica. São Paulo: Zambon; 2006, p. 1-80.

  16. Falck-Ytter Y, Younossi ZM, Marchesini G, et al. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001; 21: 17-26.

  17. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40: 1387-95.

  18. Caldwell SH, Harris DM, Patrie JT, Hespenheide EE. Is NASH underdiagnosed among African Americans? Am J Gastroenterol 2002; 97: 1496-500.

  19. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003; 98: 960-7.

  20. Sundborn G, Metcalf PA, Gentles D, Scragg RK, Schaaf D, Dyall L, et al. Ethnic differences in cardiovascular disease risk factors and diabetes status for Pacific ethnic groups and Europeans in the Diabetes Heart and Health Survey (DHAH) 2002–2003 Auckland New Zealand. NZ Med J 2008; 121: 28-39.




2020     |     www.medigraphic.com