RAMB - Maio / Junho 2016

alcoholic

fatty

liver

disease

(NAFLD)

different

populations

: A

clinical

and

epidemiological

study

–

sample

ão

osé

reto

ssoc

ras

2016; 62(3):218-226

221

TABLE 2

Risk factors for NAFLD.

Risk factor

Dyslipidemia

38/61 63

HBP

38/62 61

Physical inactivity

32/62 52

Obesity

28/62 45

Overweight

24/62 39

Increased abdominal waist (AW)

41/47 87

DM 2

17/60 28

HBP: high blood pressure; DM 2: type 2

diabetes mellitus

Abnormal high-density lipoprotein (HDL) cholesterol

and triglycerides (TG) results were found in 52% and 44%

of the 62 patients, respectively. We found changes to both

HDL and TG values in 19 patients (31%). 13 patients (21%)

showed changes to HDL alone, and 8 patients (13%)

showed alterations to the TG values.

Evaluating the blood pressure (BP) measurement of

59 patients, 51% were classified as having some degree of

hypertension: 16 patients (27%) with mild hypertension

(grade 1); 13 patients (22%) with moderate hypertension

(grade 2); and 1 patient (2%) with severe hypertension

(grade 3). Among the normotensive patients, 4 (7%) were

classified as having optimum BP, 16 (27%) as having nor-

mal BP and 9 (15%) as borderline BP.

In the evaluation of physical activity, 30 patients

claimed to be active, 3 of whom (10%) could not inform

the frequency of exercises, 23 (77%) performed physical

activity at least three days a week, 3 (10%) on 2 days of the

week and 1 patient (3%) reported irregular exercise.

With regard tomedication, a total of 94% of the patients

reported use of at least one type of medication. The use of

medication known to be associated with NAFLD was not-

ed in 21% of patients and these drugs are listed in Table 3.

TABLE 3

Medications associated with NAFLD used by the

62 patients.

Medication

Estrogens

11.29

Tamoxifen

4.83

Acetylsalicylic acid (ASA)

3.22

Chloroquine

1.61

Imaging and biopsy methods

Evaluating the imaging methods used in the investiga-

tion, medical ultrasound (USG) was conducted in 62 pa-

tients, and the sole imaging method used for 57 patients

(92%). USG associated with computed tomography (CT)

was conducted in 2 patients (3%), nuclear magnetic res-

onance (NMR) imaging in 1 patient (2%) and in 2 patients

(3%) it was associated with CT and MRI.

Steatosis was not evident on USG in 10 patients (16%).

Steatosis was confirmed by biopsy in 9 of these patients

(15%) and, in just one patient, there was advanced cryp-

togenic cirrhosis subjected to liver transplantation, with

diagnosis made after removal of the cirrhotic organ. Of

52 patients who had some degree of steatosis, 8 (13%) had

grade 1 steatosis, 5 patients (8%) had grade 2 steatosis, 6

patients (10%) had grade 3, and 33 patients (53%) had ste-

atosis that was not graded, with one of the patients pre-

senting focal steatosis.

22 patients (35%) underwent liver biopsy, with ste-

atosis described in all of them. Non-alcoholic steatohep-

atitis (NASH) was found in 21 patients. Other findings

in the biopsies were: hepatocellular ballooning in 16 pa-

tients (72.72%), fibrosis in 16 patients (72.72%), iron over-

load in 13 patients (59.09%), presence of Mallory bodies

in 11 patients (50%) and the presence of a tumor in one

patient (4.54%).

Staging based on the degree of inflammation accord-

ing to Matteoni

was stage 1 in 1 patient (4.76%), 3 in 2

patients (9.53%) and 4 in 19 patients (90.47%).

Staging of the degree of fibrosis according to Brunt

was: absent in 6 patients (27.27%), stage 1 in 4 patients

(18.18%) 2 in 3 patients (13.63%) 3 in one patient (4.54%)

and 4 in 8 patients (36.36%).

Other findings found in the biopsies by order of fre-

quency were: cell retraction figures in 12 biopsies (55%),

nuclear vacuolation in 8 (36%), acidophilus corpuscles in

6 (27%), standard biliary portal reaction in 4 (18%), duc-

tal proliferation in 3 (14%), multifocal large cell hepato-

cellular dysplasia in 2 (9%) and liver cell rosettes associ-

ated with necrosis in 1 biopsy (5%).

Risk factors

Metabolic syndrome

Among the 36 patients in whom metabolic syndrome

could be studied, the condition was found in 70%. In 26

(42%) of the 62 patients, evaluating metabolic syndrome

was not possible due to incomplete data.

3 or more criteria indicating metabolic syndrome

were found in 25 patients (70%), with 3 criteria found in

14 patients (39%), 4 criteria in 9 patients (25%) and 5 cri-

teria in 2 patients (6%). Among the 11 patients (31%) that

did not have 3 or more criteria, 5 patients (14%) had only

2 criteria, 5 patients (14%) had only 1 criterion, and 1 pa-

tient (3%) had none.

Waist circumference (WC) compatible with metabol-

ic syndrome was found in 35 (87%) of the 41 patients in