ASSOCIATION OF THE NUTRITIONAL PROFILE WITH HISTOLOGICAL FINDINGS OF PATIENTS WITH GENOTYPE 1 CHRONIC HEPATITIS C INFECTION

Background - Different factors are responsible for the progression of hepatic fibrosis in chronic infection with hepatitis C virus, but the role of nutritional factors in the progression of the disease is not clearly defined. This study aimed to evaluate the nutritional status and dietary profile among patients with chronic hepatitis C who were candidates for treatment and its association with histopathological features. Methods - A crossectional study was conducted on treatment-naïve patients with chronic hepatitis C genotype 1, between 2011 and 2013. The following assessments were performed before treatment: liver biopsy, anthropometric measurements and qualitative/quantitative analysis of food intake. Results - Seventy patients were studied. The majority of patients was classified as obese (34%) or overweight (20%) according to body mass index [BMI] and as at risk for cardiovascular diseases by waist circumference (79%). Unhealthy food intake was presented by 59% according to qualitative parameters and several patients showed an insufficient intake of calories (59%), excessive intake of protein (36%) and of saturated fat (63%), according to quantitative analysis. With respect to histology, 68% presented activity grade ≥2, 65% had steatosis and 25% exhibited fibrosis stage >2. Comparative analysis between anthropometric parameters and histological features showed that elevated waist circumference was the only variable associated to hepatic steatosis ( P =0.05). There was no association between qualitative and quantitative food intake parameters with histological findings. Conclusion - In this study, most of the patients with hepatitis C presented inadequate qualitative food intake and excessive consumption of saturated fat; in addition, excess of abdominal fat was associated to hepatic steatosis. Therefore, nutritional guidance should be implemented prior to treatment in patients with chronic hepatitis C, in order to avoid nutritional disorders and negative impact on the management of patients.

Contexto - Diferentes fatores são responsáveis pela progressão da fibrose na infecção crônica pelo vírus da hepatite C, mas o papel dos fatores nutricionais na progressão da doença não está definido. Este estudo teve como objetivo avaliar o estado nutricional e o perfil dietético de pacientes com hepatite C crônica candidatos a tratamento e sua associação com achados histopatológicos. Métodos - Foi conduzido um estudo transversal em pacientes com hepatite C crônica genótipo 1 virgens de tratamento, entre 2011 e 2013. Foram analisados, antes do tratamento, os seguintes aspectos: biópsia hepática, medidas antropométricas e análise qualitativa e quantitativa do consumo alimentar. Resultados - Setenta pacientes foram estudados. A maioria dos pacientes apresentava obesidade (34%) ou sobrepeso (20%) de acordo com índice de massa corporal e risco para doenças cardiovasculares de acordo com a circunferência da cintura elevada (79%). Na análise qualitativa do consumo alimentar, 59% apresentavam uma dieta inadequada. Conforme análise quantitativa, 59% tinham consumo insuficiente de calorias, 36% consumo excessivo de proteínas e 63% consumo excessivo de gorduras saturadas. Com relação à histologia, 68% apresentavam grau de atividade inflamatória ≥2, 65% mostraram esteatose hepática e 25% possuíam grau de fibrose >2. Na análise comparativa entre as medidas antropométricas e achados histológicos, somente a circunferência da cintura elevada mostrou associação com esteatose hepática ( P =0,05). Não houve associação entre consumo alimentar qualitativo e quantitativo com parâmetros histológicos. Conclusão - A maioria dos pacientes apresentava consumo alimentar inadequado de acordo com parâmetros qualitativos e consumo excessivo de gordura saturada, além de excesso de gordura abdominal, que esteve associada à esteatose hepática. Portanto, aconselhamento nutricional deveria ser implementado em pacientes candidatos a tratamento para hepatite C crônica visando evitar distúrbios nutricionais que podem impactar negativamente no manejo dos pacientes.

Nonalcoholic fatty liver disease in menopausal women / Doenca hepatica gordurosa nao alcoolica em mulheres menopausadas

Context Nonalcoholic Fatty Liver Disease (NAFLD) is common in postmenopausal women. It is associated with metabolic syndrome. However, the influence of hormone replacement therapy in NAFLD development in these women needs to be investigated. This study aimed to describe the clinical characteristics of NAFLD in postmenopausal women, and the relationship between hormone replacement therapy and this disease. Methods From April 2009 to April 2011, 292 postmenopausal women from National Health System from Northeast of Brazil were selected, and 251 were included in this study. Menopause was defined as the absence of menstruation for 12 consecutive months in otherwise healthy women. Criteria to NAFLD included: presence of steatosis on abdominal ultrasound; history of alcohol consumption less than 20 g/day and exclusion of other liver diseases. All women underwent a clinical evaluation. Standard univariate and multivariate analyses were performed to evaluate the results. Results The mean age was 56.5 ± 6.7 years. Hormone replacement therapy was referred by 21.1% (53) women and 78.9% (198) was not. Prevalence of NAFLD was 37.1% (93/251) in postmenopausal women, 26,4% (14/53) in the group with hormone replacement therapy and 39,9% (79/198) without hormone replacement therapy. Gamma-glutamyl transpeptidase (P = 0.001), alanine transaminase (P<0.01), ferritin (P<0.001) and insulin resistance (homeostatic model assessment of insulin resistance ≥3) (P<0.001) were higher in the group of women with NAFLD diagnosis who did not referred the use of hormone replacement therapy. Metabolic syndrome was also more frequent in women with NAFLD, who did not refer hormone replacement therapy. Conclusion In conclusion this data suggests elevated prevalence of NAFLD in postmenopausal women; negative association of hormone replacement therapy and NAFLD. .

Contexto A doença hepática gordurosa não alcoólica (DHGNA) é comum em mulheres na pós-menopausa. Esta condição está associada à síndrome metabólica. No entanto, a influência da terapia de reposição hormonal no desenvolvimento da DHGNA nessas mulheres necessita ser investigada. Este estudo teve como objetivo descrever as características clínicas da DHGNA em mulheres na pós-menopausa e, a relação entre terapia de reposição hormonal e esta doença. Métodos De abril de 2009 a abril de 2011, 292 mulheres pós-menopausadas do Sistema Único de Saúde foram selecionados, e 251 foram incluídas neste estudo. A menopausa foi definida como a ausência de menstruação durante 12 meses consecutivos em mulheres saudáveis. Os critérios para diagnostico da DHGNA foram: presença de esteatose na ultra-som abdominal, história de consumo de álcool menor que 20 g/dia e exclusão de outras doenças hepáticas. Todas as mulheres foram submetidas a uma avaliação clínica. Para a obtenção dos resultados foram realizadas as análises uni e multivariada. Resultados A média de idade foi de 56,5 ± 6,7 anos. O uso de terapia de reposição hormonal foi referido por 21,1% (53) das mulheres e 78,9% (198) negaram seu uso. A prevalência de DHGNA foi de 37,1% (93/251) nas mulheres pós-menopausadas, sendo de 26,4% (14/53) no grupo em uso de terapia de reposição hormonal e 39,9% (79/198) no grupo sem uso desta terapia. A gama-glutamil transpeptidase (P = 0,001), alanina transaminase (P<0,01), ferritina (P<0,001) e resistência à insulina (obtida pelo modelo de avaliação homeostática de resistência à insulina ≥ 3) (P<0,001) foram ...

AssociaþÒo entre índice glicÛmico e carga glicÛmica dietéticos e doenþa hepática gordurosa nÒo alcoólica em idosos / [Relationship between dietary glycemic index and glycemic load and nonalcoholic fatty liver disease in elderly].

OBJECTIVE: To investigate if there is an association between glycemic index (GI) and glycemic load (GL) of the diet and the presence of nonalcoholic fatty liver disease (NAFLD) in the elderly. METHODS: Retrospective study, composed of 229 patients seen at the Outpatient Clinic of Arterial Hyperten- sion in a public hospital, 103 carriers and 126 noncarriers of NAFLD. Food intake was analyzed to GI and GL. RESULTS: We found a high prevalence of inadequate dietary GI, with an average of 62.0 +/- 6.3 among patients with NAFLD and 62.5 +/- 6.5 among patients without NAFLD. The same occurred with the GL, 101.7 +/- 33.3 and 101.4 +/- 40.2, respectively, between carriers and noncarriers of the disease. There was no statistical difference between the values of GI and GL found in the diet of patients with and without NAFLD. CONCLUSION: In the evaluated group there was no association between GI and GL dietetic with NAFLD, but the findings put all of the patients at higher risk for the development of chronic diseases.

Frequency and risk factors associated with non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus / Frequência e fatores de risco associados à doença hepática gordurosa não alcoólica em pacientes com diabetes melito tipo 2

OBJECTIVE: To evaluate the frequency of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (DM2) and to describe its risk factors. SUBJECTS AND METHODS: Blood samples of 78 patients were collected for assessment of glycemic and lipid profile, liver enzymes, TNF-α and HOMA-IR. The diagnosis of NAFLD was established by ultrasound. RESULTS: NAFLD was observed in 42 percent of patients who had greater BMI (p < 0.001), and frequency of hypertension (p < 0.001). Metabolic syndrome was more frequent in those with NAFLD (p = 0.019). The levels of aspartate, alanine aminotransferase, γ-glutamyl transpeptidase, uric acid, TNF-α, insulin and HOMA-IR were significantly higher in patients with NAFLD than those without NAFLD. CONCLUSION: Almost half of patients with DM2 were found to have NAFLD, and they have more elevated BMI, as well as higher levels of aminotransferases, γ-GT, uric acid, TNF-α, insulin and HOMA-IR than subjects without NAFLD.

OBJETIVO: Avaliar a frequência de doença hepática gordurosa não alcoólica (DHGNA) em pacientes com diabetes mellitus tipo 2 (DM2) e descrever seus fatores de risco. SUJEITOS E MÉTODOS: Amostras de sangue foram coletadas de 78 pacientes para avaliação dos perfis glicídico e lipídico, enzimas hepáticas, TNF-α e HOMA-IR. O diagnóstico de DHGNA foi estabelecido por ultrassonografia. RESULTADOS: NAFLD foi observada em 42 por cento dos pacientes que apresentaram maior IMC (p < 0,001). Hipertensão arterial sistêmica (p < 0,001) e síndrome metabólica foram mais frequentes naqueles com DHGNA (p = 0,019). Os níveis de aspartato aminotransferase, alanina aminotransferase, γ-glutamil transpeptidase, ácido úrico, TNF-α, insulina e HOMA-IR foram significativamente maiores nos pacientes com do que naqueles sem DHGNA. CONCLUSÃO: Quase metade dos pacientes com DM2 apresentaram DHGNA, os quais tiveram IMC mais elevado, bem como maiores níveis de aminotransferases, γ-GT, ácido úrico, TNF-α, insulina e HOMA-IR do que os indivíduos sem DHGNA.

Esteatoepatite não alcoólica induzida por rápida perda de peso em uso de balão intragástrico: um relato de caso / Non-alcoholic steatohepatitis induced by fast weight loss during the use of intragastric balloon: a case report

A obesidade é uma doença crônica, atualmente considerada uma epidemia global. Está associada a várias co-morbidades clínicas, entre elas a doença esteatótica hepática não alcoólica (DEHNA), e sua complicação, a esteatoepatite não alcoólica (EHNA). Apresentamos um caso de uma paciente de 58 anos com obesidade refratária ao tratamento clínico, submetida à colocação do balão intragástrico (BIG), que evoluiu com um quadro de esteatoepatite não alcoólica, associada a rápida perda de peso.

Obesity is a chronic disease that has been considered an epidemic nowadays. It is associated to much co-morbidity, such as non-alcoholic fatty liver disease (NAFLD) and its complication, steatohepatitis. We report a case of a 58-year-old obese patient refractory to clinical treatment who was submitted to the use of intragastric balloon (BIB), developing steatohepatitis induced by fast weight loss.