Skip to main content

Advertisement

SpringerLink
Log in

Improvement in Non-alcoholic Fatty Liver Disease Score Correlates with Weight Loss in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: a Two-Centre Study from an Asian Cohort

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

Incidence of non-alcoholic fatty liver disease (NAFLD) is on the rise and is one of the most common causes of chronic liver disease worldwide. Obesity and metabolic syndrome are considered the most significant risk factors. Bariatric surgery is the only treatment modality in morbid obesity which allows long-term weight loss with improvement in associated co-morbid conditions. However, the effects of bariatric surgery on NAFLD are not well established. NAFLD fibrosis score (NFS) is a validated non-invasive scoring system used to assess advanced fibrosis. We used the NFS to analyse the impact of weight loss on NAFLD following sleeve gastrectomy.

Materials and Methods

174 patients who underwent bariatric surgery between 2010 and 2016 were retrospectively reviewed. Multivariate analysis was performed using pre-operative patient characteristics, biochemical markers and TANITA body analysis measurements to determine significant risk factors for NFS > 0.675. Additionally, the NFS was calculated at 6 months, 1 year and 2 years post-operatively to determine correlation with weight loss.

Results

Pre-operatively, 13.8% of our patients had significant fibrosis by NFS. Mean change in NFS was − 0.46 ± 1.02, − 0.55 ± 0.98 and − 0.55 ± 1.12 at 6 months, 1 year and 2 years respectively. This was significantly correlated with percent of total weight loss with R coefficients of 0.253, 0.292 and 0.274 respectively (P < 0.05). 79.2% of patients with NFS > 0.675 achieved resolution by 2 years post-operatively.

Conclusion

Based on our study, we conclude that sleeve gastrectomy may be a viable treatment option for management of NAFLD in the obese.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Chart 1

Similar content being viewed by others

References

  1. Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95.

    Article  PubMed  Google Scholar 

  2. Bedogni G, Miglioli L, Masutti F, et al. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005;42:44–52.

    Article  PubMed  Google Scholar 

  3. Fan JG, Zhu J, Li XJ, et al. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol. 2005;43:508–14.

    Article  PubMed  Google Scholar 

  4. Nomura H, Kashiwagi S, Hayashi J, et al. Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med. 1988;27:142–9.

    Article  CAS  PubMed  Google Scholar 

  5. The World at Six Billion. UN Population Division.

  6. Chitturi S, Farrell GC, Hashimoto E, et al. Nonalcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. J Gastroenterol Hepatol. 2007;22(6):778–87.

    Article  PubMed  Google Scholar 

  7. Jafar TH, Hatcher J, Poulter N, et al. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med. 2009;151(9):593–601.

    Article  PubMed  Google Scholar 

  8. Lear SA, Toma M, Birmingham CL, et al. Modification of the relationship between simple anthropometric indices and risk factors by ethnic background. Metabolism. 2003;52(10):1295–301.

    Article  CAS  PubMed  Google Scholar 

  9. Hamaguchi M, Kojima T, Takeda N, et al. The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med. 2005;143(10):722–8.

    Article  CAS  PubMed  Google Scholar 

  10. Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis. 2004;24(1):3–20.

    Article  PubMed  Google Scholar 

  11. Cusi K. Role of obesity and lipotoxicity in the development of non-alcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142(4):711–25.

    Article  CAS  PubMed  Google Scholar 

  12. Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic and clinical implications. Hepatology. 2010;51(2):679–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. McCullough AJ. Pathophysiology of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40(suppl 1):S17–29.

    CAS  PubMed  Google Scholar 

  14. Duvnjak M, Lerotić I, Barsić N, et al. Pathogenesis and management issues for non-alcoholic fatty liver disease. World J Gastroenterol. 2007;13(34):4539–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Siebler J, Galle PR, Weber MM. The gut-liver-axis: endotoxemia, inflammation, insulin resistance and NASH. J Hepatol. 2008;48(6):1032–4.

    Article  CAS  PubMed  Google Scholar 

  16. Wong VW, Wong GL, Choi PC, et al. Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 2010;59(7):969–74.

    Article  PubMed  Google Scholar 

  17. Pais R, Pascale A, Fedchuck L, et al. Progression from isolated steatosis to steatohepatitis and fibrosis in nonalcoholic fatty liver disease. Clin Res Hepatol Gastroenterol. 2011;35(1):23–8.

    Article  CAS  PubMed  Google Scholar 

  18. Pais R, Charlotte F, Fedchuk L, et al. A systematic review of followup biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol. 2013;59(3):550–6.

    Article  CAS  PubMed  Google Scholar 

  19. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–54.

    Article  CAS  PubMed  Google Scholar 

  20. McPherson S, Stewart SF, Henderson E, et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59(9):1265–9.

    Article  PubMed  Google Scholar 

  21. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221–31.

    Article  CAS  PubMed  Google Scholar 

  22. Qureshi K, Clements RH, Abrams GA. The utility of the “NAFLD fibrosis score” in morbidly obese subjects with NAFLD. Obes Surg. 2008;18(3):264–70.

    Article  PubMed  Google Scholar 

  23. Pimentel SK, Strobel R, Gonçalves CG, et al. Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery. Arq Gastroenterol. 2010;47(2):170–3.

    Article  PubMed  Google Scholar 

  24. Attar BM, Van Thiel DH. Current concepts and management approaches in nonalcoholic fatty liver disease. ScientificWorldJournal. 2013;2013:481893.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Marra F, Lotersztajin S. Pathophysiology of NASH: perspectives for a targeted treatment. Curr Pharm Des. 2013;19(29):5250–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Mi X-X, Wang L, Xun Y-H, et al. Assessment nonalcoholic fatty liver disease fibrosis score for staging and predicting outcome. Int J Clin Exp Med. 2016;9(8):16146–56.

    CAS  Google Scholar 

  27. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and managements of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23. https://doi.org/10.1002/hep.25762.

    Article  PubMed  Google Scholar 

  28. Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg. 2012;22:1016–21.

    Article  PubMed  Google Scholar 

  29. Kakizaki S, Takizawa D, Yamazaki Y, et al. Nonalcoholic fatty liver disease in Japanese patients with severe obesity who received laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in comparison to non-Japanese patients. J Gastroenterol. 2008;43(1):86–92.

    Article  PubMed  Google Scholar 

  30. Praveen RP, Gomes RM, Kumar S, et al. The effect of surgically induced weight loss on nonalcoholic fatty liver disease in morbidly obese Indians: NASHOST prospective observational trial. Surg Obes Relat Dis. 2015;11(6):1315–22.

    Article  Google Scholar 

  31. Froylich D, Corcelles R, Daigle C, et al. Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on nonalcoholic fatty liver disease: a comparative study. Surg Obes Relat Dis. 2016;12(1):127–31.

    Article  PubMed  Google Scholar 

  32. Vargas V, Allende H, Lecube A, et al. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol. 2012;4(12):382–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cazzo E, Jimenez LS, Pareja JC, et al. Effect of roux-en-y gastric bypass on Nonalcoholic Fatty Liver Disease evaluated through NAFLD fibrosis score: a prospective study. Obes Surg. 2015;25:982–5.

    Article  PubMed  Google Scholar 

  34. Karcz WK, Krawczykowski D, Kuesters S, et al. Influence of sleeve gastrectomy on NASH and type 2 diabetes mellitus. J Obes. 2011;2011:765473.

    Article  CAS  PubMed  Google Scholar 

  35. Myronovych A et al. Vertical sleeve gastrectomy reduces hepatic steatosis while increasing serum bile acids in a weight-loss-independent manner. Obesity. 2014;22:390–400.

    Article  CAS  PubMed  Google Scholar 

  36. Myronovych A, Salazar-Gonzalez R-M, Ryan KK, et al. The role of small heterodimer partner in nonalcoholic fatty liver disease improvement after sleeve gastrectomy in mice. Obesity. 2014;22:2301–11.

    Article  CAS  PubMed  Google Scholar 

  37. Du J, Tian J, Ding L, et al. Vertical sleeve gastrectomy reverses diet-induced gene-regulatory changes impacting lipid metabolism. Sci Rep. 2017;7:5274.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. European Association for Study of Liver. Asociacion Latinoamericana para el Estudio del Higado EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63:237–64. https://doi.org/10.1016/j.jhep.2015.04.006.

    Article  Google Scholar 

  39. McPherson S, Stewart SF, Henderson E, et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59:1265–9. https://doi.org/10.1136/gut.2010.216077.

    Article  PubMed  Google Scholar 

  40. Kim D, Kim WR, Kim HJ, et al. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2013;57:1357–65. https://doi.org/10.1002/hep.26156.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Treeprasertsuk S, Björnsson E, Enders F, et al. NAFLD fibrosis score: a prognostic predictor for mortality and liver complications among NAFLD patients. World J Gastroenterol. 2013;19:1219–29. https://doi.org/10.3748/wjg.v19.i8.1219.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wong VW, Wong GL, Chim AM, et al. Validation of the NAFLD fibrosis score in a Chinese population with low prevalence of advanced fibrosis. Am J Gastroenterol. 2008;103:1682–8. https://doi.org/10.1111/j.1572-0241.2008.01933.x.

    Article  PubMed  Google Scholar 

  43. Mummadi RR, Kasturi KS, Chennareddygari S, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta- analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.

    Article  PubMed  Google Scholar 

  44. Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, et al. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. 2010;20(1):CD007340.

    Google Scholar 

  45. Ministry of Health. National health survey 2010. Singapore: Epidemiology and Disease Control Division, Ministry of Health; 2011.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Zong Jie Koh, Hrishikesh Pandurang Salgaonkar, Guo Wei Kim, Davide Lomanto, Jimmy Bok Yan So & Asim Shabbir

  2. Department of Gastroenterology, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Wei Jie Jonathan Lee & Yock Young Dan

  3. Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore

    Chun Hai Tan & Anton Cheng

Authors
  1. Zong Jie Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hrishikesh Pandurang Salgaonkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Jie Jonathan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guo Wei Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chun Hai Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anton Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Davide Lomanto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jimmy Bok Yan So
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yock Young Dan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Asim Shabbir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zong Jie Koh.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Statements

This study has been approved by the institutional research ethics committee. No formal consent was required as this was a retrospective study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koh, Z.J., Salgaonkar, H.P., Lee, W.J.J. et al. Improvement in Non-alcoholic Fatty Liver Disease Score Correlates with Weight Loss in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: a Two-Centre Study from an Asian Cohort. OBES SURG 29, 862–868 (2019). https://doi.org/10.1007/s11695-018-3581-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3581-5

Keywords

Search

Navigation