Resolution of fatty liver disease after growth hormone replacement in a pediatric survivor of thyroid cancer / Resolución de enfermedad hepática grasa posterior al reemplazo con hormona de crecimiento en un paciente pediátrico sobreviviente a cáncer de tiroides

Abstract Background A rare case of primary papillary thyroid cancer (PTC) and growth hormone (GH) deficiency in a pediatric patient is described. In addition, the patient developed fatty liver disease attributed to GH deficiency. Case report A 10-year-old male with a history of PTC with extension to the cervical nodes detected at 5 years of age was referred to the endocrinology consultation due to a low growth rate. On examination, GH deficiency was detected (height −3.51 standard deviations and low insulin-like growth factor-1 levels). This hormonal deficiency was not associated with thyroid cancer or treatment. Furthermore, elevated transaminases (~300 IU/ml), lipids, and fally liver disease by ultrasound were detected. These data suggested fatty liver disease, which was attributed to GH deficiency. Regardless of the risk of recurrence, somatotropin was administered due to liver dysfunction and very short stature of the patient. A considerable improvement in growth, transaminases, and lipid profile was observed. At present, at 14 years of age, resolution of hepatic steatosis and a considerable increase in his growth rate without recurrence of thyroid cancer 9 years after its diagnosis and 4 years after the initiation of GH treatment are confirmed. Conclusions GH therapy could be a good therapeutic option for pediatric cancer survivors to address impaired growth and fatty liver disease. However, additional medical evidence based on clinical trials is necessary to determine the benefits.

Resumen Introducción Se presenta el caso de un paciente pediátrico con una asociación de cáncer papilar de tiroides (CPT) y deficiencia de hormona de crecimiento (HC) que no ha sido descrita previamente. Además, presenta enfermedad hepática grasa atribuida a la deficiencia hormonal. Caso clínico Paciente de sexo masculino con antecedente de CPT con extensión a los ganglios cervicales diagnosticado a los 5 años de edad. Es referido a los 10 años por talla baja, sin datos de recurrencia del CPT. En el abordaje diagnóstico se detecta deficiencia de HC basándose en una estatura 3.51 desviaciones estándar por debajo de la media y niveles bajos de factor de crecimiento insulínico tipo 1. Adicionalmente, se detectó elevación de transaminasas (~300 IU/ml), dislipidemia y esteatosis hepática en el ultrasonido. Después de los estudios de extensión, la enfermedad hepática grasa se atribuyó a la deficiencia de HC. A pesar del riesgo de recurrencia del cáncer de tiroides, se decidió dar tratamiento con HC debido a la afectación hepática y de crecimiento. El paciente presentó una evolución satisfactoria y actualmente, a la edad de 14 años, la esteatosis hepática está resuelta, presenta una mejoría considerable en su estatura y no ha tenido recurrencia del cáncer de tiroides 9 años después del diagnóstico y 4 años después del inicio del tratamiento con HC. Conclusiones El tratamiento con HC puede ser una adecuada opción terapéutica para sobrevivientes de cáncer en la edad pediátrica con afectación en el crecimiento y esteatosis hepática. Sin embargo, se requieren estudios con mayor evidencia científica y seguimiento a largo plazo para apoyar esta afirmación.

Treatment with Ilex paraguariensis (yerba mate) aqueous solution prevents hepatic redox imbalance, elevated triglycerides, and microsteatosis in overweight adult rats that were precociously weaned

Early weaning (EW) leads to overweight, visceral obesity, hyperleptinemia, and insulin resistance in adulthood. Treatment with Ilex paraguariensis (yerba mate) improves obesity and insulin resistance in these animals. Here, we evaluated the effects of chronic treatment with yerba mate on the redox balance and liver morphology of overweight early-weaned rats. To induce EW, we wrapped the dams with bandages to interrupt milk access during the last 3 days of lactation. Control pups (C) had free access to maternal milk for the full 21 days of lactation. On postnatal day (PN) 150, EW offspring were subdivided into the EW+YM group, which received the aqueous extract of yerba mate (1 g/kg bw by gavage once a day for 30 days) and the EW group, which received water by gavage for the same period. All rats were euthanized on PN180. The EW group showed higher bound carbonyl (a marker of total protein oxidation), higher TBARS levels (a marker of lipid peroxidation), and lower superoxide dismutase (SOD) activity in liver tissue than the C group, as well as higher triglyceride content and microsteatosis. In plasma, the EW offspring showed higher TBARS levels. One month of yerba mate treatment normalized these parameters. Thus, we have shown evidence that yerba mate improved antioxidant defenses and mitigated liver dysfunction in overweight adult rats that were weaned prematurely.

Esteatosis hepatica aguda en el tercer trimestre de embarazo gemelar: reporte de caso / Acute hepatic esteatosis during third trimester twin pregnancy: case report

Introducción: La esteatosis hepática aguda del embarazo (EHAE) es una patología metabólica grave e infrecuente caracterizada por esteatosis hepática microvesicular que conduce a insuficiencia hepática aguda. Aparece generalmente en el tercer trimestre de gestación y se reconoce el embarazo gemelar como un factor de riesgo para su desarrollo. Presentación del caso: Paciente femenina de 25 años sin antecedentes médicos, 2 embarazos, 1 parto y 0 abortos, cursando embarazo gemelar de 31 semanas de gestación, consultó por presentar cuadro de dolor abdominal, vómitos e ictericia. Se sospechó hepatitis aguda y se decidió hospitalizar. Al ingreso una ecografía obstétrica precisó latidos fetales ausentes decidiéndose interrupción del embarazo de urgencia. La paciente evolucionó con síndrome confusional y epistaxis masiva requiriendo transfusión. Exámenes de ingreso evidenciaron insuficiencia renal, insuficiencia hepática y trombocitopenia. Ingresó a Unidad de Paciente Crítico con diagnóstico de síndrome de HELLP requiriendo soporte con ventilación mecánica. Persistió con mala evolución clínica por lo que se solicitó tomografía de abdomen y pelvis mostrando signos de pancreatitis aguda y hematoma subcapsular hepático. Exámenes de control objetivaron hiperbilirrubinemia, transaminasas elevadas, hipoalbuminemia, hipocolesterolemia y tiempo de protrombina elevado. Se planteó diagnóstico de esteatosis hepática aguda del embarazo. Ingresó a lista de espera para trasplante hepático. Posteriormente evolucionó con mejoría espontánea de la función hepática y se logró extubar tras dos semanas de hospitalización. Discusión: El desarrollo de esteatosis hepática aguda del embarazo es infrecuente y potencialmente grave debiéndose interrumpir el embarazo precozmente y manejarse en unidades de paciente crítico debido a su alta mortalidad.

Introduction: Acute hepatic esteatosis of pregnancy (AHEP) is a serious and uncommon metabolic pathology characterized by microvesicular liver steatosis leading to acute liver failure. It usually appears in the third trimester of gestation and twin pregnancy is recognized as a risk factor for its development. Case Report: A 25-year-old female patient with no medical history, 2 pregnancies, 1 childbirth and 0 abortions, having a twin pregnancy of 31 weeks' gestation, consulted for abdominal pain, vomiting and jaundice. Acute hepatitis was suspected and it was decided to hospitalize. On admission, an obstetric ultrasonography screened for absent fetal beats, deciding to interrupt the pregnancy. The patient evolved with confusional syndrome and massive epistaxis requiring transfusion. She presented renal failure, hepatic failure, and thrombocytopenia. He entered a Critical Patient Unit with diagnosis of HELLP syndrome requiring support with mechanical ventilation. It persisted with poor clinical evolution, requiring tomography of the abdomen and pelvis showing signs of acute pancreatitis and subcapsular hepatic hematoma. Control examinations aimed at hyperbilirubinemia, elevated transaminases, hypoalbuminemia, hypocholesterolemia and elevated prothrombin time. A diagnosis of acute fatty liver of pregnancy was made. He entered the waiting list for liver transplantation. Subsequently it evolved with spontaneous improvement of the liver function and was able to extubate after two weeks of hospitalization. Discussion: The development of acute fatty liver of pregnancy is infrequent and potentially serious due to early termination of pregnancy and management in critical patient units due to its high mortality.

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.

Actualización en el diagnóstico y manejo del daño hepático agudo grave en el embarazo / Causes and management of severe acute liver damage during pregnancy

Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial.

Enfermedad de hígado graso no alcohólico: Un problema silente en la salud Costarricense / Non alcoholic fatty liver disease: A silent problem in Costa Rican health

La enfermedad de hígado graso no alcohólico es una condición que engloba el espectro de esteatosis hepática no alcohólica simple y esteatohepatitis no alcohólica. Esta entidad afecta de un 20 a 30% de la población adulta general en sociedades occidentales. Asimismo suele estar asociada a obesidad, síndrome metabólico, diabetes, entre otras patologías cada vez más frecuentes a nivel mundial. Recientemente se reporta una prevalencia alarmante de 72% en pacientes diabéticos tipo 2 en Costa Rica, los cuales representan un aproximado 10,5% de los costarricenses. Su alta prevalencia, clínica silente, asociación importante a riesgo cardiovascular y de complicaciones hepáticas serias, convierten esta entidad en un tema de suma relevancia para la salud pública...

Non-alcoholic fatty liver disease is a condition that encompasses the spectrum of simple hepatic steatosis and non-alcoholic steatohepatitis. This condition affects 20 to 30% of the general adult population in Western societies. Is often associated with obesity, metabolic syndrome, and diabetes among other frequent diseases nowadays. Recently it has been reported an alarming prevalence of 72% diabetic type 2 patients in Costa Rica, which are approximately 10,5% of the population in the country. Its high prevalence, silent clinical manifestations, important cardiovascular risk and serious liver complications association, turn this entity on a topic of great relevance to public health...

Hypercholesterolemic diet induces hepatic steatosis and alterations in mRNA expression of NADPH oxidase in rat livers / Dieta hipercolesterolemiante induz esteatose hepática e alterações na expressão de mRNA da NADPH oxidase em fígados de ratos

Objective : This study aimed to determine whether a hypercholesterolemic diet induces hepatic steatosis, alterations in mRNA expression of NADPH oxidase subunits, and antioxidant defenses.Materials and methods : Fischer rats were divided into two groups of eight animals according to the treatment, control (C) and hypercholesterolemic diet (H). Those in group C were fed a standard diet (AIN-93M), and those of the group H were fed a hypercholesterolemic diet (25% soybean oil and 1% cholesterol).Results : The hypercholesterolemic diet did not affect body weight, but resulted in the accumulation of lipids in the liver, increased serum activities of aminotransferases and cholesterol levels. Biomarker of lipid peroxidation (TBARS) and mRNA expression of NADPH oxidase subunits p22phox and p47phox were increased in the liver of animals in group H. Besides, the activity and expression of antioxidant enzymes were altered.Conclusion : The results show increased mRNA expression of NADPH oxidase subunits and changes in antioxidant enzyme activities in diet-induced hepatic steatosis. Arq Bras Endocrinol Metab. 2014;58(3):251-9.

Objetivo Determinar se uma dieta hipercolesterolemiante induz esteatose hepática, alterações na expressão de mRNA da NADPH oxidase e nas defesas antioxidantes.Materiais e métodos : Ratas Fischer foram divididas em dois grupos de oito animais de acordo com o tratamento recebido, controle (C) e hipercolesterolêmico (H). Aquelas do grupo C foram alimentadas com dieta padrão (AIN-93M) e as do grupo H foram alimentadas com dieta hipercolesterolemiante (25% de óleo de soja e 1% de colesterol). As dietas foram oferecidas por oito semanas.Resultados : O grupo H apresentou acúmulo de lipídios no fígado, aumento das atividades de ALT e AST e da concentração de colesterol no soro comparado ao grupo C. O marcador da peroxidação lipídica (TBARS) e os níveis de mRNA das subunidades p47phox da NADPH-oxidase e p22phox foram aumentados no fígado de animais do grupo H, além de alteração da atividade e expressão de enzimas antioxidantes.Conclusão : Os resultados mostram um aumento na expressão de subunidades da NADPH oxidase e alterações na atividade das enzimas antioxidantes na esteatose hepática induzida por dieta hipercolesterolemiante. Arq Bras Endocrinol Metab. 2014;58(3):251-9.

Sistema endocanabinoide y desarrollo de esteatosis hepática / A role for the endocannabinoid system in hepatic steatosis

The endocannabinoid system (SEC) is an important modulator of several metabolic functions. This system is composed by cannabinoid receptors type 1 and 2 (RCB1 and RCB2), their endogenous ligands, known as endocannabinoids, and the enzymes involved in their synthesis and degradation. A deregulated SEC originates metabolic alterations in several tissues, resulting in the typical manifestations of the metabolic syndrome. Liver steatosis of different origins constitutes a physiopathological condition where an altered hepatic SEC is observed. In this condition, there is an increased expression of RCB1 and/or higher endocannabinoid levels in different hepatic cells, which may exert an autocrine/paracrine hyperstimulation of RCB1/RCB2. Activation of RCB1 stimulate the expression of several hepatocyte lipogenic factors, thus leading to increased de novo fatty acids synthesis and consequently to an abnormal accumulation of triglycerides. The effect of RCB2 activity on hepatic function is still controversial because, on one side its stimulation has an interesting protective effect on alcoholic liver disease while, on the other, it may enhance the development of hepatic steatosis in experimental models of diet-induced obesity. In this review we discuss the proposed mechanisms by which SEC is involved in the etiology of hepatic steatosis, as well as the therapeutic possibilities involving peripheral RCB1/RCB2 antagonism/agonism, for the treatment of this condition.

Chemotherapy induced liver abnormalities: an imaging perspective

Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.

Nonalcoholic fatty liver disease in severe obese patients, subjected to bariatric surgery / Doenca hepatica gordurosa nao alcoolica em pacientes com obesidade morbida, submetidos a cirurgia bariatrica

Context Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe) deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis. Objective The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis. Methods A total of 250 liver biopsies were conducted in the transoperation of the surgeries. Results Steatosis was present in 226 (90.4%) of the samples, 76 (30.4%) being classified as mild; 71 (28.4%) as moderate and 79 (31.6%) as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4%) cases, where 120 (48.4%) were mild; 50 (20%) were moderate, and 6 (2.4%) cases were intense. Fibrosis was referred to in 108 (43.2%) biopsies, 95 of which (38%) were mild; 2 (0.8%) were moderate; 7 (2.8%) were intense, and cirrhosis was diagnosed in 4 (1.6%) cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001) and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001). Only 13 (5.2%) samples showed Fe deposits. Conclusion There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease. .

Contexto A doença hepática gordurosa não alcoólica engloba um espectro de alterações histopatológicas que abrangem desde a esteatose simples até a esteato-hepatite não alcoólica. Trabalhos sugerem que depósitos de ferro (Fe) no fígado estão envolvidos na fisiopatologia da esteato-hepatite não alcoólica. Objetivo Determinar a prevalência de esteatose simples e de esteato-hepatite não alcoólica nos pacientes com obesidade mórbida, submetidos à cirurgia bariátrica e estabelecer uma correlação dos achados anatomopatológicos com a presença de fibrose hepática. Método Foram analisadas 250 biópsias hepáticas realizadas no transoperatório das cirurgias. Resultados A esteatose esteve presente em 226 (90,4%) das amostras, sendo 76 (30,4%) classificadas como leves; 71 (28,4%), como moderadas e, 79 (31,6%) como intensas. A esteato-hepatite não alcoólica esteato-hepatite não alcoólica foi diagnosticada em 176 (70,4%) dos casos, nos quais 120 (48,4%) eram de grau leve; 50 (20%) moderado e, 6 (2,4%) intenso. A fibrose foi referida em 108 (43,2%) biópsias, das quais 95 (38%) eram leves; 2 (0,8%), moderadas; 7 (2,8%) intensas e, em 4 (1,6%) casos, foi diagnosticado cirrose. Observou-se uma correlação entre o grau de esteatose e o nível de atividade inflamatória (rs = 0,460; P<0,001) e entre o grau dessa atividade com o de fibrose (rs = 0,583; P<0,001). Apenas 13 (5,2%) amostras apresentaram depósitos de Fe. Conclusão Existe uma prevalência elevada de esteato-hepatite não alcoólica nesses pacientes e uma correlação positiva dos graus de esteato-hepatite não alcoólica com a intensidade da fibrose. A baixa prevalência de depósitos de Fe encontrada torna questionável que a presença deste ...

The spectrum of non alcoholic fatty liver disease in morbidly obese patients: prevalence and associate risk factors

PURPOSE: To determine the prevalence of non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery and to identify risk factors associated with the disease spectrum. METHODS: Liver biopsy was performed in 60 patients who underwent bariatric surgery, after other causes of liver disease were excluded. Clinical, biochemical and histological features were evaluated. RESULTS: NAFLD was detected in fifty-seven patients (95%) of the sample and forty patients (66.7%) of the total sample met the criteria for NASH. Perisinusoidal fibrosis was only found in three (7.5%) patients with NASH. The γGT was an independent predictive factor associated with the degree of hepatic steatosis. The variables such as dyslipidemia and ALT were independently associated with the presence of Mallory's corpuscles with the following values, respectively, OR 0, 05, 95% CI 0.002 to 0.75, P = 0.031 and OR 10, 99, 95% CI 1.44 to 83.93, P = 0.021. CONCLUSIONS: Non alcoholic fatty liver disease seems to be an obese-related condition with approximately half of asymptomatic morbidly obese patients having histological NASH. The γGT was an independent predictor of the degree of steatosis.

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 ...

Effect of concurrent training on risk factors and hepatic steatosis in obese adolescents / Efecto del entrenamiento concurrente sobre factores de riesgo y esteatosis hepatica en adolescentes obesos / Efeito do treinamento concorrente sobre fatores de risco e esteatose hepatica em adolescentes obesos

OBJECTIVE To analyze the effects of a 20-week concurrent training on the variables of body composition, lipid profile, and fatty liver diagnosis in obese adolescents. METHODS An open clinical trial was carried out with 34 obese adolescents aged between 12 and 15 years. Total body fat, trunk fat mass, total cholesterol and its fractions (HDL, LDL and VLDL), and triglycerides were analyzed; an upper abdominal ultrasound was performed in order to diagnose fatty liver. The participants underwent concurrent training (association of weight training with aerobic training) three times per week, lasting one hour for 20 weeks. Statistical analysis included paired Studentâ€(tm)s t-test and frequency analysis in order to verify the relative and absolute reductions of fatty liver diagnosis, being significant p<0.05. RESULTS The studied adolescents showed statistically significant improvement in body composition, with a decrease of total body fat percentage, total fat mass, trunk fat, and an a increase in the lean body mass. They also presented reduced size of liver lobes, decrease in total cholesterol and in LDL-cholesterol, with a lower prevalence of fatty liver. CONCLUSIONS The concurrent training was effective for promoting significant improvements in body fat composition and lipid profile variables, besides reducing fatty liver prevalence rate. .

OBJETIVO Analizar los efectos de 20 semanas de entrenamiento concurrente sobre las variables de composición corporal, perfil lipídico y diagnóstico de la esteatosis hepática en adolescentes obesos. MÉTODOS Se realizó un ensayo clínico abierto con 34 adolescentes obesos con edades entre los 12 y los 15 años (13,7±1,17). Se analizaron grasa corporal total y de tronco, colesterol total y sus fracciones (HDL, LDL y VLDL) y triglicéridos, siendo realizado examen de ultrasonografía abdominal superior para diagnosticar esteatosis hepática. Los participantes fueron sometidos al entrenamiento concurrente (asociación de entrenamiento con pesos y ejercicio aeróbico) tres veces por semana, con duración de una hora clase durante 20 semanas. Para el tratamiento estadístico, se realizaron análisis descriptivo, prueba t de Student pareada y análisis de frecuencia, a fin de verificar las reducciones relativa y absoluta del diagnóstico de la esteatosis hepática, adoptando p<0,05. RESULTADOS Los adolescentes estudiados presentaron mejoras significativas de la composición corporal, con reducción del porcentaje de grasa total, de la masa gorda total, de la grasa de tronco y del aumento de masa magra, además de reducción del tamaño de los lóbulos del hígado, de los índices de prevalencia de la esteatosis hepática, del colesterol total y del LDL-colesterol. CONCLUSIONES El entrenamiento concurrente fue efectivo por promover mejorías significativas de variables de la composición corporal y del perfil lipídico, además de reducir la prevalencia de la esteatosis hepática. .

OBJETIVO Analisar os efeitos de 20 semanas de treinamento concorrente sobre as variáveis de composição corporal, perfil lipídico e diagnóstico da esteatose hepática em adolescentes obesos. MÉTODOS Realizou-se um ensaio clínico aberto com 34 adolescentes obesos com idades entre 12 e 15 anos. Foram analisados gordura corporal total e de tronco, colesterol total e suas frações (HDL, LDL e VLDL) e triglicérides, sendo realizado exame de ultrassonografia de abdome superior para diagnosticar esteatose hepática. Os participantes foram submetidos ao treinamento concorrente (associação de treino com pesos e exercício aeróbio) três vezes por semana, com duração de uma hora-aula durante 20 semanas. Para o tratamento estatístico, foram realizados o teste t de Student pareado e a análise de frequência, a fim de verificar as reduções relativa e absoluta do diagnóstico da esteatose hepática, adotando-se p<0,05. RESULTADOS Os adolescentes estudados apresentaram melhoras significativas da composição corporal, com diminuição do percentual de gordura total, da massa gorda total, da gordura de tronco e do aumento da massa magra, além de redução do tamanho dos lóbulos do fígado, dos índices de prevalência da esteatose hepática, do colesterol total e LDL-colesterol. CONCLUSÕES O treinamento concorrente foi efetivo por promover melhorias significativas de variáveis da composição corporal e do perfil lipídico, além de reduzir a prevalência da esteatose hepática. .

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.

clinical characteristics and etiological study of nonalcoholic fatty liver disease in Chinese women with PCOS

Polycystic ovary syndrome [PCOS] is highly associated with non-alcoholic fatty liver disease [NAFLD]. There are extensive ethnic differences in the clinical manifestations, pathological changes, and ovarian changes in women with PCOS. To investigate the prevalence and clinical characteristics of NAFLD in Chinese women with PCOS. Non-pregnant women with PCOS [N= 602] and matched controls without PCOS [N=588] were recruited. Basal endocrine, oral glucose tolerance test, insulin release level, lipid level, blood pressure, and body mass index [BMI] were measured. Liver biochemical and B-hepatitis and C-hepatitis indices were determined. NAFLD was significantly more prevalent in women with PCOS than controls [32.9% vs.18.5%] and included 113 [57.1%] mild, 75 [37.8%] moderate and 10 [5.1%] severe cases. Luteinizing hormone was significantly lower in PCOS women with NAFLD than without NAFLD. In the PCOS group, NAFLD prevalence and severity increased with BMI. The liver index was significantly higher [p<0.001], and the quantitative insulin sensitivity check index and high density lipoprotein cholesterol were significantly lower [p<0.001] in the PCOS group than controls. Insulin resistance, abdominal obesity, diabetes mellitus, abnormal glucose tolerance, liver dysfunction, dyslipidemia, hypertension, and metabolic syndrome were significantly more prevalent in the NAFLD group than controls. Chinese women with PCOS have a high prevalence of mostly mild and moderate NAFLD, not significantly associated with hyperandrogenism that increased significantly with BMI. Insulin resistance and metabolic abnormalities are important factors associated with NAFLD. Chinese women with BMI >/= 24 kg/m[2] P2P should be screened for NAFLD

The Intestinal Microbiota and Human Disease / 대한소화기학회지

Advances in sequencing technology and the development of metagenomics have opened up new ways to investigate the microorganisms inhabiting the human gut. The intestinal microbiota confer protection against pathogens, contribute to the maturation of the immune system, and regulate host metabolism. The composition of gut microbiota in early life is influenced by mode of birth, diet, and antibiotics. Decreased biodiversity and alterations in the composition of the intestinal microbiota have been observed in many diseases including obesity, neonatal necrotizing enterocolitis, inflammatory bowel disease, and recurrent Clostridium difficile infection. Therapeutic options for the diseases linked to imbalance in the microbiota include modifying the gut microbiota through diet, probiotics, and fecal transplants.

Regeneración hepática en enfermedad de hígado graso no-alcohólica / Liver regeneration in nonalcoholic fatty liver disease

La esteatosis hepática es el acúmulo de grasa en los hepatocitos, que puede ser la consecuencia del proceso de regeneración hepática o de procesos patológicos como la enfermedad del hígado graso alcohólica y no-alcohólica. A pesar de su importancia, en ambos casos el mecanismo exacto en que la esteatosis influye en la regeneración hepática es escasamente comprendido. Estudios previos han demostrado que los pacientes que presentan hígado graso expresan una regeneración hepática dispar, posiblemente debido a la acumulación de especies reactivas de oxígeno generada por procesos inflamatorios ocasionados por activación de las células de Kupffer. En este artículo se revisan distintos factores que afectan la regeneración hepática, tratando de comprender el mecanismo involucrado en la regeneración dispar en hígados con esteatosis ocasionada por una enfermedad de hígado graso no-alcohólica.

Steatosis is the accumulation of fat in hepatocytes, which may be the result of liver regeneration or pathological processes such as alcoholic and nonalcoholic fatty liver disease. Despite its importance, in both cases the exact mechanism that prevails in fatty liver regeneration is poorly understood. Previous studies have shown that patients with fatty liver express dispar regeneration, possibly due to the accumulation of reactive oxygen species generated by inflammatory processes caused by activation of Kupffer cells. In this article we review several factors that affect liver regeneration, trying to understand the underlying mechanism of dispar regeneration in fatty liver as a consequence of nonalcoholic fatty liver disease.

Relação entre o estado nutricional de vitamina a e a regressão da esteatose hepática após gastroplastia em Y- de- Roux para tratamento da obesidade classe III / Relationship of the nutritional status of vitamin a and the regression of hepatic steatosis after Roux-en-Y gastric bypass surgery for treatment of class III obesity

RACIONAL: A vitamina A participa de várias funções primordiais no organismo humano e as suas concentrações séricas podem estar diminuídas nas doenças crônicas não transmissíveis. OBJETIVO: Avaliar a relação entre o estado nutricional da vitamina A, e a regressão da esteatose hepática em indivíduos submetidos à gastroplastia em Y-de-Roux para tratamento da obesidade classe III. MÉTODOS: Foram estudados 30 pacientes obesos classe III, de ambos os sexos, com esteatose hepática, submetidos à gastroplastia em Y-de-Roux. Seis meses após a operação, os pacientes foram submetidos à ultrassonografia abdominal e distribuídos em dois grupos: grupo 1 - pacientes com esteatose detectada na ultrassonografia e grupo 2 - pacientes sem esteatose detectada na ultrassonografia. No pré-operatório e seis meses após a operação foram realizadas análises antropométricas e exames bioquímicos: insulina basal, glicemia, Homeostasis Model Assessment Index (HOMA IR), colesterol, HDL, LDL, triglicerídeos, AST, ALT, Gama-GT, albumina, bilirrubina total, retinol, e beta caroteno. RESULTADOS: A média de perda de peso foi de 35,05 + 10,47 (p<0,01) e a diminuição no Índice de Massa Corporal (IMC) de 11,6 + 4,99 Kg/m² (p<0,01). Após seis meses, todos os exames bioquímicos apresentaram diminuição significativa das concentrações (p<0,05). O grupo 2 (sem esteatose) apresentou no pós-operatório, concentrações significativamente inferiores (p<0,05), nas variáveis: peso, IMC, AST, ALT, gama GT, HOMA IR, insulina basal. As concentrações séricas de albumina apresentaram valores médios aproximados, sem diferença significativa nos dois tempos avaliados. Observaram-se concentrações séricas mais elevadas de retinol e de β-caroteno e redução menor em relação as concentrações do pré-operatório nos pacientes sem esteatose, porém sem diferença estatística. CONCLUSÃO: Adequado estado nutricional de vitamina A pode contribuir na regressão da esteatose hepática em pacientes submetidos à Gastroplastia em Y-de-Roux para tratamento da obesidade classe III.

BACKGROUND: Vitamin A participates in several essentials functions in the human body and their serum concentrations may be decreased in non-transmissible diseases. AIM: To assess the relationship of the nutritional status of Vitamin A through the serum concentrations of retinol and beta carotene, with regression of hepatic steatosis in individuals who undergone Roux-en-Y gastric bypass surgery for treatment of class III obesity. METHODS: Were included 30 individuals, male and female, submitted to Roux-en-Y gastric bypass for treatment of class III obesity, who were diagnosed through an abdominal ultrasonography as presenting hepatic steatosis. From the result of an ultrasonography screened six months after the surgical procedure those subjects were divided into two groups: group 1 - patients with steatosis detected in the ultrasonography (16 subjects) and group 2 - patients without steatosis detected in the ultrasonography (14 subjects). Before and six months after the surgery, were carried out anthropometrical analyses and biochemical exams (basal insulin, glicemy, Homeostasis Model Assessment Index (HOMA IR), cholesterol, HDL, LDL, triglycerides, AST, ALT, Gamma-GT, albumin, total bilirubin, retinol, and beta carotene. RESULTS: The individuals presented an average weight loss of 35.05 + 10.47 (p<0.01) and a decrease in the Body Mass Index (BMI) of 11.6 + 4.99 Kg/m² (p<0.01). After six months, all the biochemical exams presented a significant decrease in their basal concentrations (p<0.05). In the post-operative period the group 2 (without steatosis) presented concentrations significantly lower (p<0.05) in the following variables: weight, BMI, AST, ALT, Gamma-GT, HOMA IR, basal insulin. The albumin serum concentrations presented close average values, with no significant difference in the two periods evaluated. In the assessment of retinol and beta carotene, higher serum concentrations and a small decrease in relation to the concentrations of the pre-operative period in the group without steatosis were observed, however, no statistical difference was found. CONCLUSION: An adequate nutritional status of vitamin A might contribute in the improvement of the hepatic esteatosis after Roux-en-Y gastric bypass for class III obesity treatment.