medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2008, Number 4

<< Back Next >>

Ann Hepatol 2008; 7 (4)

Nonalcoholic fatty liver disease in severely obese individuals: The influence of bariatric surgery

Andrade AR, Cotrim HP, Alves E, Soares D, Rocha R, Almeida A, Almeida CG, Freitas LA

Language: English
References: 26
Page: 364-368
PDF size: 122.20 Kb.


Text Extraction

Background: Obesity is the most frequent risk factor associated with NAFLD, and bariatric surgery (BAS) is traditionally indicated for the treatment of severely obese individuals. Here, we discuss the behavior and prognosis of this liver disease following post-surgical weight loss. Aim: To evaluate the influence of the BAS on the clinical and biochemical parameters of NAFLD in severely obese patients. Methodology: An intervention study included obese individuals (BMI≥ 35kg/m2), who had been submitted to liver biopsy during BAS and had NAFLD. HAIR (hypertension, ALT and insulin resistance and BAAT (BMI, ALT, age and triglycerides) scores and FLI (Fatty Liver Index) were used to compare the patients at the time of surgery, and 12-30 months following weight loss. Results: From October 2004 to September 2007, 122 patients were diagnosed with NAFLD, 40 of whom agreed to participate in the study. The mean age was 37.7 ± 12.5 years, 60% were women and 80% had steatohepatitis (NASH) with fibrosis upon analysis of the liver biopsy performed during BAS. Mean weight loss was 46.0 ± 2.0 kg. After 21 ± 5.8 months of follow-up, a significant improvement was found in all the variables analyzed (79.3% according to the HAIR scores, 95.2% as measured by the BAAT score and 72.5% by the FLI. Conclusion: The results suggest that treatment of obesity by bariatric surgery may influence the prognosis of NAFLD. In addition to weight loss, we observed improvement in the clinical and biochemical parameters related to NAFLD, such as anthropometrics index, hypertension, aminotransferases, triglycerides and insulin resistance.


REFERENCES

  1. Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29: 664-669. [PMID: 10051466].

  2. Ratziu V, Bonyhay L, Di Martino V, Charlotte F, Cavallaro L, Sayegh-Tainturier MH, Giral P, et al. Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis. Hepatology 2002; 35: 1485-1493. [PMID: 12029634].

  3. Adams LA, Angulo P, Lindor KD. Nonalcoholic fatty liver disease. CMAJ 2005; 172: 899-905. [PMID: 15795412].

  4. Bloomgarden ZT. American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome: 25-26 August 2002, Washington, DC. Diabetes Care 2003; 26: 1297-1303. [PMID: 12663612].

  5. Ong JP, Elariny H, Collantes R, Younoszai A, Chandhoke V, Reines HD, Goodman Z, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg 2005; 15: 310-315. [PMID: 15826462].

  6. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, Natale S, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37: 917-923. [PMID: 12668987].

  7. Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg 2003; 138: 1240-1244. [PMID: 14609874].

  8. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419. [PMID: 3899825].

  9. Guidorizzi de Siqueira AC, Cotrim HP, Rocha R, et al. Non-alcoholic fatty liver disease and insulin resistance: importance of risk factors and histological spectrum. Eur J Gastroenterol Hepatol 2005; 17: 837-41.10.

  10. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497. [PMID: 11368702].

  11. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 2001; 121: 91-100. [PMID: 11438497] 12.

  12. Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, Khalil L, et al. Liver fibrosis in overweight patients. Gastroenterology 2000; 128: 1117-1123. [PMID: 10833486].

  13. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, Tiribelli C. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006; 6: 33. [PMID: 1636651].

  14. Kral JG, Thung SN, Biron S, Hould FS, Lebel S, Marceau S, Simard S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery 2004; 135: 48-58. [PMID: 14694300].

  15. Dixon JB, Bhathal PS, Hughes NR, O’Brien PE. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss. Hepatology 2004; 39: 1647-1654. [PMID: 15185306].

  16. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004; 14(9): 115-64.

  17. Furuya CK Jr, de Oliveira CP, de Mello ES, Faintuch J, Raskovski A, Matsuda M, Vezozzo DC, et al. Effects of BAS on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol 2007; 22: 510-514. [PMID: 17376042].

  18. Barker KB, Palekar NA, Bowers SP, Goldberg JE, Pulcini JP, Harrison SA. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol 2006; 101: 368-373. [PMID: 16454845].

  19. García-Monzón C, Martín-Pérez E, Iacono OL, Fernández-Bermejo M, Majano PL, Apolinario A, Larrañaga E, et al. Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol 2000; 33: 716-724. [PMID: 11097478].

  20. Jaskiewicz K, Raczynska S, Rzepko R, Sledzinski Z. Nonalcoholic fatty liver disease treated by gastroplasty. Dig Dis Sci 2006; 51: 21-26. [PMID: 16416204].

  21. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. BAS: A systematic review and meta-analysis. JAMA 2004; 292: 1724-1737. [PMID: 15479938].

  22. Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, Karim R, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35: 373-379. [PMID: 11826411].23.

  23. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30: 1356-1362. [PMID: 10573511].

  24. Kim SH, Abbasi F, Reaven GM. Impact of degree of obesity on surrogate estimates of insulin resistance. Diabetes Care 2004; 27: 1998-2002. [PMID: 1527743].

  25. Poynard T, Morra R, Halfon P, Castera L, Ratziu V, Imbert Bismut F, Naveau S, et al. Meta-analyses of Fibro Test diagnostic value in chronic liver disease. BMC Gastroenterol 2007; 7: 40 [PMID: 17937811].

  26. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, Enders F et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007; 45: 846-854. [PMID: 17393509]




2020     |     www.medigraphic.com