Non-invasive methods for diagnosis of non-alcoholic fatty liver disease in children and adolescents: literature review / Métodos não invasivos para diagnóstico da doença hepática gordurosa não alcoólica em crianças e adolescentes: revisão da literatura

With the significant increase in the prevalence of nonalcoholic fatty liver disease (NAFLD) in children and adolescents and knowing its association with other clinical conditions and its implications in adult life, noninvasive diagnostic methods may represent new paths for prevention, early diagnosis and follow-up of the evolution of the disease. Objective: To describe noninvasive methods for diagnosing NAFLD in children and adolescents. Methods: integrative review. The articles were searched in the PubMed, Lilacs, Medline, Embase and Google Scholar databases, from August to December 2021. The descriptors "non-alcoholic fatty liver disease", "non-invasive methods", "biomarkers", "child" and "adolescent" were used. Results: Several biomarkers have been associated with the diagnosis of NAFLD, and among the most recognized are the lipid and glucose profile, liver enzymes, anti-inflammatory profile and assessment of body fat reserves. Antioxidant profile, uric acid, genome, lipidomics and proteomics evaluations are also predictors of steatosis; however, it remains to be determined whether these markers should be used together or in isolation for better results. Conclusions: Noninvasive markers for the diagnosis of NAFLD in children and adolescents are promising and, when used in association with clinical data, can be useful in guiding and managing this population for the prevention and control of NAFLD. 

Most patients with severe obesity has liver fibrosis even without Metabolic Syndrome/ A maioria dos pacientes com obesidade grave apresenta fibrose Hepática mesmo sem Síndrome Metabólica

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a condition commonly associated with metabolic syndrome (MS). This association is frequently found in people with severe obesity, yet some who are diagnosed with NAFLD do not fulfill the criteria for MS. We aimed to compare the clinical and histological characteristics of NAFLD in patients with obesity with and without MS.METHODOLOGY: Cross-sectional study with patients with severe obesity (BMI ≥35kg/m2) diagnosed with NAFLD on liver biopsy during bariatric surgery between Sep/2014 and May/2015.  Patients with a history of chronic alcohol consumption and other liver diseases were excluded. MS diagnosis was based on the International Diabetes Federation criteria. Statistical analyses were performed using Chi-square and t tests. P<0.05 were considered significant. RESULTS: The simple included 170 patients with severe obesity with histological diagnosis of NAFLD. The mean BMI (body mass index) was 43.2±5.3 kg/m2; 60% were female and the mean age was 37.1±10.7 years. Dyslipidemia (81.7%) and arterial hypertension (48.2%) were the most frequent NAFLD risk factor associated with obesity in these patients. A total of 75 of them (44.1%) did not meet the criteria for MS. They were younger than those with MS [33.8 (9.9) vs 39.7 (10.8) years; p<0.001], and 68.0% (51) of them had nonalcoholic steatohepatitis (NASH) and fibrosis.  CONCLUSION: The results reinforce the relevance to evaluate NAFLD in people with severe obesity, even those without MS. Despite not presenting MS, these patients with severe obesity already had NASH with fibrosis and can potentially evolve to cirrhosis

Alteração de enzimas hepáticas em trabalhadores de refinaria de petróleo

OBJECTIVE: Occupational exposure typical of an oil refinery may alter liver function among the workers. Thus, the objective of the study was to identify risk factors for liver enzyme abnormalities among oil refinery workers. METHODS: The workers at an oil refinery in Northeastern Brazil underwent routine annual medical examination from 1982 to 1998. This case-control study investigated all the 150 cases of individuals with simultaneous gamma-glutamyltransferase and alanine aminotransferase abnormalities of at least 10% above reference levels. As controls, 150 workers without any liver enzyme or bilirubin abnormalities since starting to work there were selected. Odds ratios and the respective 95% confidence intervals were calculated from logistic regression models. RESULTS: In all the production sectors, the risk of liver enzyme abnormalities was significantly higher than in the administrative sector (OR=5.7; 95% CI: 1.7-18.4), even when the effects of alcohol, obesity and medical history of hepatitis were controlled for. During the period from 1992 to 1994, 88 out of the 89 cases occurred among workers from the various production sectors. CONCLUSIONS: Occupational exposure plays an important role in causing liver enzyme abnormalities among oil refinery workers. This is in addition to the specifically biological and/or behavioral risk factors such as obesity and alcohol consumption.OBJETIVO: A exposição ocupacional típica de uma refinaria de petróleo pode alterar a função hepática de seus trabalhadores. Assim, o objetivo do estudo foi identificar fatores de risco de alterações em enzimas hepáticas em trabalhadores de uma refinaria de petróleo. MÉTODOS: Os trabalhadores de uma refinaria de petróleo, localizada em São Francisco do Conde, Estado da Bahia, eram submetidos a exames periódicos anuais de 1982 a1998. O estudo caso-controle investigou todos os 150 casos de indivíduos com alteração simultânea de gama-glutamil transferase e de alanino amino transferase, de pelo menos 10% acima do valor de referência. Como controles, foram selecionados 150 indivíduos sem quaisquer alterações de enzimas hepáticas ou de bilirrubinas, desde a sua admissão. Foram calculadas as razões de chance e respectivos intervalos de confiança de 95% a partir de modelos de regressão logística. RESULTADOS: Em todos os setores de produção, o risco de alteração de enzimas hepáticas foi significantemente mais elevado do que no setor administrativo (RC=5,7; IC 95%: 1,7-18,4), estando controlados os efeitos do álcool, obesidade e antecedentes médicos de hepatite. No período 1992-1994 foram registrados 89 casos, 88 deles provieram dos diversos setores da produção. CONCLUSÕES: A exposição ocupacional desempenha papel importante na determinação de alterações de enzimas hepáticas em trabalhadores do refino de petróleo, além dos fatores de risco eminentemente biológicos e/ou comportamentais como obesidade e o consumo de álcool

Alteração de enzimas hepáticas em trabalhadores de refinaria de petróleo

OBJECTIVE: Occupational exposure typical of an oil refinery may alter liver function among the workers. Thus, the objective of the study was to identify risk factors for liver enzyme abnormalities among oil refinery workers. METHODS: The workers at an oil refinery in Northeastern Brazil underwent routine annual medical examination from 1982 to 1998. This case-control study investigated all the 150 cases of individuals with simultaneous gamma-glutamyltransferase and alanine aminotransferase abnormalities of at least 10% above reference levels. As controls, 150 workers without any liver enzyme or bilirubin abnormalities since starting to work there were selected. Odds ratios and the respective 95% confidence intervals were calculated from logistic regression models. RESULTS: In all the production sectors, the risk of liver enzyme abnormalities was significantly higher than in the administrative sector (OR=5.7; 95% CI: 1.7-18.4), even when the effects of alcohol, obesity and medical history of hepatitis were controlled for. During the period from 1992 to 1994, 88 out of the 89 cases occurred among workers from the various production sectors. CONCLUSIONS: Occupational exposure plays an important role in causing liver enzyme abnormalities among oil refinery workers. This is in addition to the specifically biological and/or behavioral risk factors such as obesity and alcohol consumption.OBJETIVO: A exposição ocupacional típica de uma refinaria de petróleo pode alterar a função hepática de seus trabalhadores. Assim, o objetivo do estudo foi identificar fatores de risco de alterações em enzimas hepáticas em trabalhadores de uma refinaria de petróleo. MÉTODOS: Os trabalhadores de uma refinaria de petróleo, localizada em São Francisco do Conde, Estado da Bahia, eram submetidos a exames periódicos anuais de 1982 a1998. O estudo caso-controle investigou todos os 150 casos de indivíduos com alteração simultânea de gama-glutamil transferase e de alanino amino transferase, de pelo menos 10% acima do valor de referência. Como controles, foram selecionados 150 indivíduos sem quaisquer alterações de enzimas hepáticas ou de bilirrubinas, desde a sua admissão. Foram calculadas as razões de chance e respectivos intervalos de confiança de 95% a partir de modelos de regressão logística. RESULTADOS: Em todos os setores de produção, o risco de alteração de enzimas hepáticas foi significantemente mais elevado do que no setor administrativo (RC=5,7; IC 95%: 1,7-18,4), estando controlados os efeitos do álcool, obesidade e antecedentes médicos de hepatite. No período 1992-1994 foram registrados 89 casos, 88 deles provieram dos diversos setores da produção. CONCLUSÕES: A exposição ocupacional desempenha papel importante na determinação de alterações de enzimas hepáticas em trabalhadores do refino de petróleo, além dos fatores de risco eminentemente biológicos e/ou comportamentais como obesidade e o consumo de álcool