RT info:eu-repo/semantics/doctoralThesis
T1 Estudio de la prevalencia y factores asociados a la Enfermedad por hígado graso no alcohólico en pacientes obesos mórbidos sometidos a Cirugía bariátrica
A1 Tafur Sánchez, Carla Noemí
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Obesidad
K1 Surgery
K1 Esteatohepatitis
K1 Esteatohepatitis
K1 obesity
K1 obesidad
K1 Bariatric surgery
K1 Cirugía bariatrica
K1 3205.03 Gastroenterología
AB INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent among obese patients, since it is associated with metabolic risk factors such as type 2 diabetes mellitus (DM-2), insulin resistance (IR), dyslipidemia and hypertension. The evolution of NAFLD will depend on the histological stage of the liver disease, so simple steatosis tends to remain stable while steatohepatitis is more likely to progress to fibrosis, cirrhosis and hepatocarcinoma. Recently, the term metabolic hepatic steatosis (MetHS) was proposed in 2020, a definition that exists to encompass and involve all those cardiometabolic factors that promote the development of NAFLD. The new definition places more emphasis on the role of metabolic dysfunction and no longer requires the exclusion of significant alcohol intake or other chronic liver disease for diagnosis. Liver biopsy is the gold standard for the diagnosis of NAFLD but it is an invasive test, not without risk and with high interobserver variability. In patients with grade III obesity refractory to hygienic-dietary measures, bariatric surgery is considered, and NAFLD is cured in 70-90% of them. The importance of this study lies in the fact of knowing the prevalence of NAFLD and its severity assessed by liver biopsy in morbidly obese patients in order to establish recommendations on NAFLD screening in this population according to the associated risk factors.OBJECTIVES: To describe cardiovascular risk factors, adipocytokines and histopathological lesions in liver biopsy obtained during bariatric surgery in morbidly obese patients prior to bariatric surgery, to analyze the association between cardiovascular risk factors and adipocytokines with histological findings, to study and validate the usefulness of noninvasive NAFLD indices in this population. MATERIAL AND METHODS: This is an observational, cross-sectional, descriptive study in morbidly obese patients undergoing bariatric surgery from 2005 to 2015. A liver biopsy was performed at the time of surgery and anthropometric, biochemical and histopathological variables were analyzed. RESULTS: Ninety-seven patients with grade III obesity (66% women; mean age, 43.39 ± 11.3 years; mean body mass index, 47.93 ± 7.45 kg/m(2)) were analyzed. 43% presented metabolic syndrome, 44.9% AHT and 17.2% DM-2.  The prevalence of NASH in this study population was 29.9%. Another 20 patients (20.6%) had simple steatosis without NASH. 13.4% had significant fibrosis (F≥2). Only 4 patients had normal liver histology. CONCLUSIONS: The majority of morbidly obese patients in our series had some type of liver histological lesion in association with NAFLD.The liver function parameters associated with the presence of NASH on liver biopsy are elevated ALT, HOMA-IR, LDL-cholesterol and triglyceride levels. Elevated adiponectin levels are a protective factor for fibrosis and IR is an independent risk factor for NASH. Central obesity as assessed by waist circumference is the only independent variable associated with fibrosis and significant fibrosis, demonstrating the importance of body fat distribution in relation to NAFLD. Non-invasive indices of fibrosis present better sensitivity and specificity than steatosis indices compared to biopsy, with the NAFLD fibrosis score (NFS) presenting the highest diagnostic accuracy.
YR 2021
FD 2021
LK https://uvadoc.uva.es/handle/10324/59942
UL https://uvadoc.uva.es/handle/10324/59942
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 20-jun-2024