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2016; 62(3):218-226

which this information could be collected. The average

was 106.11 cm (±10.48).

Regarding dyslipidemia, 26 (55%) of the 47 women

studied and 6 (40%) of the 15 men studied were found to

have abnormal HDL cholesterol values. With respect to

the values for triglycerides, 27 (44%) of the 62 patients

evaluated had abnormal values for the parameters of met-

abolic syndrome.

With respect to mean arterial pressure (MAP) a val-

ue compatible with metabolic syndrome was evident in

21 (36%) of the 59 patients, with the maximum values for

systolic blood pressure (SBP) and diastolic blood pres-

sure (DBP) at 200 and 120 mmHg, respectively, and min-

imum values for SBP and DBP at 140 and 90 mmHg, and

a median of 150 x 100 mmHg.

There was an association between metabolic syndrome

and steatosis on USG (p=0.014). Metabolic syndrome was

estimated in 69% of patients with steatosis on USG (95CI

54-81%) and there is evidence that the syndrome affects

the majority of these patients (p=0.005).

Insulin resistance

Insulin resistance (IR) was found in 22 (44%) of the 50 pa-

tients who had homeostatic model assessment (HOMA)

index calculated. There was an association between IR and

metabolic syndrome in 90% of patients with HOMA ≥ 3.5

(p=0.006). There was also evidence of an association be-

tween IR and obesity (p=0.027) and between IR and NASH

(p=0.01). There was no evidence of an association between

IR and waist circumference compared individually (p=0.23).

Presence of NASH

38 of the 62 patients studied (61%) were classified as hav-

ing NASH according to one of the criteria adopted. Of

these 38 patients, 30/62 (48%) were classified as having

probable NASH and 21/62 (34%) as having definitive NASH.

22 of the 30 patients with NASH had HOMA ≥ 3.5

(p=0.032). In these patients, abnormal ALT and AST val-

ues were found in 1 (5%) and 4 (18%) of the patients, re-

spectively. Both enzymes were found to be abnormal in

5 patients (23%).

iscussion

NAFLD has gained epidemiological relevance in recent

years, representing one of the leading causes of chronic

liver disease in the 21

century, and may manifest itself in

different age ranges, ethnic groups and gender. The true

prevalence of NAFLD is underestimated in the general

population, because the disease is asymptomatic and the

majority of patients start investigation due to incidental

findings on USG, increased liver enzymes or check-ups.

Recent studies indicate prevalence at around 20 to 30% in

the general population. In obese patients or with

diabetes

mellitus

it can reach up to 50% of the population.

Most of the available studies on NAFLD include pa-

tients in hospital environments and, therefore, their char-

acteristics may not exactly represent those expected in the

general population. In Brazil, there are not many studies

regarding the prevalence of NAFLD; however, among the

2,232 cases of NAFLD recorded by the Brazilian Society of

Hepatology in 2004, 68% had NASH.

13,14

This case series is

part of the second investigation conducted at several Bra-

zilian centers, documenting this pathology in more detail.

In the present study, there was a predominance of

NAFLD in middle-aged women, as demonstrated in pre-

vious studies.

3,21

However, the actual participation of gen-

der as a determining factor in the development of NAFLD

has not yet been established, given that some studies show

a higher prevalence in men or an equal distribution be-

tween the sexes.

1,3,5,33

With regard to the ethnic groups studied, a higher

prevalence of Caucasians (73%) was found, followed by

Black patients (25%) and only one Asian patient (2%). Such

findings contrast with previous studies that show a high-

er prevalence in the Caucasian group, followed by His-

panics and Asians.

3,5

It is believed that the percentage of

black patients found is due to the high level of miscege-

nation and difficulty in defining races in the group stud-

ied and, possibly, throughout Brazil.

The vast majority of patients with NAFLD diagnosis

is asymptomatic (71%), showing that the disease can prog-

ress insidiously. Nonspecific symptoms such as abdomi-

nal pain, postprandial fullness and fatigue were found in

8, 3 and 2% of patients, respectively. In the physical ex-

amination, 46% of patients had some kind of finding,

with hepatomegaly being the abnormality found most

frequently, as it was present in 21 patients (34%). Periph-

eral signs found more often were: telangiectasia in 7 pa-

tients (11%), palmar erythema in 7 (11%) and jaundice in

3 (5%) patients. Signs of liver decompensation, sugges-

tive of more advanced degrees of disease, were also veri-

fied with the following distribution: ascites in 2 patients

(3%), splenomegaly in 4 patients (6%) and edema of the

lower limbs in 3 patients (5%). Such findings are in agree-

ment with previous studies, characterizing NAFLD as a

disease that has few symptoms and with a nonspecific

clinical presentation.

3,18,45

In relation to medications used by the sample, about

21% of the patients reported using drugs known to be as-

sociated with the induction of hepatic steatosis, such as