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Introduction: Obesity correlates with nonalcoholic fatty liver disease (NAFLD) and occurs in 90 to 100% of severely obese individuals (body mass index [BMI] > 35 kg/m2). Coffee consumption (CC) has been associated with reduced progression of fibrosis in both hepatitis C infection and NAFLD; however, this topic is still under discussion when this liver disease affects severely obese individuals., Objective: To assess the association between CC, insulin resistance (IR) and histological NAFLD morbid obese patients., Material and Methods: Cross-sectional study, including obese individuals undergoing bariatric surgery, liver biopsy and histological diagnosis between September 2013 and August 2014. The patients were classified into 3 groups according to their weekly CC: 0- 239.9 mL; 240-2099.9 mL and ≥ 2100 mL., Results: A total of 112 obese individuals were included (BMI = 41.9 ± 4.3 kg/m2), with a mean age of 34.7 ± 7.4 years; 68.6% were women. CC was reported by 72.3% of patients. There were no statistical significant differences between groups regarding the presence of IR (84.8% vs. 74.2% vs. 75.9%; p = 0.536). Progressively higher percentages of individuals with normal liver histology were observed (14.7% vs. 21.9% vs. 24.3%). NASH (65.7% vs. 70.3% vs. 57.5%) were observed among those who consumed greater coffee volumes (p = 0.812). In conclusion, obese individuals with elevated CC exhibited lower frequencies of NASH, although with no statistical significance in this sample.

Objectives: The effect of light-to-moderate alcohol consumption (LMAC) in nonalcoholic fatty liver disease (NAFLD) remains a controversial subject. The aim of this study was to evaluate the relationship between LMAC and the severity of NAFLD in morbidly obese patients., Methods: We studied 132 patients undergoing liver biopsy during bariatric surgery. The patients were divided into three groups: G1: alcohol intake greater than 20 g/day and less than 40 g/day; G2: alcohol intake less than 20 g/day; G3: no alcohol intake. Insulin resistance was defined by the Homeostasis Model Assessment (>3). NAFLD was classified according to the Matteoni types: type I: steatosis alone; type II: steatosis with inflammation; types III-IV: steatosis with ballooning and/or fibrosis., Results: The mean age was 37.3+/-11 years. Sixty-three percent were females and body mass index was 43.9+/-5.6 kg/m. G1, G2, and G3 included 19, 56, and 57 patients, respectively. Histological diagnoses classified by levels of alcohol were: G1: 10.5% normal liver, 89.5% type III or IV; G2: 10.7% normal liver, 1.8% type I or II, and 87.5% grade III or IV; G3: 10.5% normal liver, 3.5% type I or II, and 86% type III or IV (one had cirrhosis). The presence of IR was similar in moderate and no alcohol consumption (81.3 and 78.7%) but significantly less in the light consumption group (54%, P<0.05)., Conclusion: The results suggest that LMAC may have a protection effect against IR in severely obese patients. However, it had no impact on the severity of activity and stage of liver disease.

Aim: To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis., Methods: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard., Results: The study included 105 patients. The mean age was 37.2+/-10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis on US was associated to advanced grades of steatosis on histology (P=0.016)., Conclusion: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

Background: Obesity has been shown to be an important risk factor for several gastrointestinal diseases. However, the indication for preoperative upper gastrointestinal endoscopy (UGE) for all patients before bariatric surgery is controversial. The aim of the present study was to evaluate the spectrum of gastrointestinal diseases detected during preoperative UGE in patients undergoing bariatric surgery and the relevance of this procedure., Methods: A series of severely obese patients, who had undergone UGE before Roux-en-Y gastric bypass from October 2004 to May 2005 were consecutively enrolled in this study. The demographic and clinical data and endoscopic diagnoses were evaluated. Gastric biopsies were performed in elective patients according to the endoscopic findings., Results: The study included 162 patients, 69.8% of whom were women. The mean age was 36.7 +/- 10.8 years. Abnormal findings were observed in 77.2% of patients. Esophagitis was present in 38.9%, gastritis in 51.2% (erosive gastritis in 49.3% and nonerosive gastritis in 50.7%), gastric ulcers in 1.9%, hiatal hernia, in 8.6%, gastric polyp in .6%, and duodenitis in 6.8% of patients. No patient had esophageal or gastric varices. Helicobacter pylori infection was investigated in 96 patients and was detected in 37.5%. Gastric biopsies were performed in 36 patients, with chronic inflammation found in 72.2%, inflammatory activity in 30.6%, and intestinal metaplasia in 11.1%. Glandular atrophy was not found in any patient., Conclusion: The results of our study have shown that the spectrum of gastrointestinal diseases observed in severely obese patients who underwent bariatric surgery is broad. Although this issue remains highly controversial, these findings suggest that systematic preoperative UGE and H. pylori testing should be performed in all patients scheduled to undergo bariatric surgery.

Unlabelled: Obesity is an important risk factor of Nonalcoholic Fatty Liver Disease (NAFLD) and it has been considered a predictor of severity of this condition. However, in severe obese patients the spectrum of NAFLD is in discussion., Aim: To describe the clinical and histological characteristics of NAFLD in obese patients submitted to bariatric surgery., Methodology: The study included 141 severe obese (BMI > or = 35kg/m2) who underwent bariatric surgery from October 2004 to May 2005 had clinical and histological diagnosis of NAFLD., Exclusion Criteria: alcoholic intake more than 140 g/week, positive markers for other liver diseases. All patients were submitted to hepatic biopsy, as first procedure during the surgery., Results: The mean age of the patients was of 37.3 +/- 11.1 years and 76.4% were female. BMI was greater than 40 kg/m2 in 77.7% of the cases. The frequency of metabolic syndrome was 51.9% (104). Elevated aminotransferases and hepatic steatosis on ultrasound were present in 29.5% (105) and 59.0% (105) respectively. Normal liver biopsy or unspecfic findings were found in 11.3% of the cases and NAFLD in 88.7%: isolated steatosis in 2.8%, steatohepatitis (NASH) in 85.1% (NASH and fibrosis in 76.6%) and cirrhosis in 0.7%., Conclusions: NAFLD in severe obese patients, in general, was asymptomatic and presented normal enzymes, liver function and ultrasound. However, it has a large histological spectrum and cases of steatohepatitis with fibrosis were more frequent. These results suggest that liver biopsy may be considered during the bariatric surgery to better diagnosis and prognosis of severe obese patients.

Background: Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery., Methods: In a cross-sectional study developed in Bahia, northeastern Brazil. 108 patients (78 women and 30 men) from the Obesity Treatment and Surgery Center--"Núcleo de Tratamento e Cirurgia da Obesidade" underwent standard polysomnography. Patients with an apnea-hypopnea index (AHI) > or = 5 events/hour were considered apneic., Results: Mean +/- SD for age and BMI were 37.1 +/- 10.2 years and 45.2 +/- 5.4 kg/m2, respectively. The calculated AHI ranged widely from 2.5 to 128.9 events/hour. Sleep apnea was detected in 93.6% of the sample, wherein 35.2% had mild, 30.6% moderate and 27.8% severe apnea. Oxyhemoglobin desaturation was directly related to the AHI and was more severe in men., Conclusion: There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request polysomnography, thus enabling therapeutic management and prognostication.