Obesity Surgery

, Volume 18, Issue 7, pp 847–853 | Cite as

Fatty Liver Disease: Predictors of Nonalcoholic Steatohepatitis and Gallbladder Disease in Morbid Obesity

  • Phui-Ly Liew
  • Wei-Jei Lee
  • Weu Wang
  • Yi-Chih Lee
  • Wei-Yu Chen
  • Chia-Lang Fang
  • Ming-Te Huang
Research Article

Abstract

Background

Nonalcoholic steatohepatitis (NASH) and gallbladder disease (GD) are members of metabolic syndrome in morbidly obesity. Insulin resistance is a risk factor for NASH and GD. The aim of the present study was to investigate the relationship between insulin resistance (HOMA-IR), liver fibrosis, NASH and GD in morbidly obese patients who presented with fatty liver during preoperative abdominal ultrasonography examination.

Methods

We studied 152 morbid obese patients with fatty liver disease including 54 with NASH, 11 with GD and two with concurrent NASH and GD that were undergoing laparoscopic bariatric surgery. Clinical data (gender, age, body mass index [BMI], and associated diseases), laboratory evaluation, and histopathology were obtained from the patient databases. We analyzed the relationship between clinical characteristics, histological parameters, HOMA-IR, and fibrosis stage associated with NASH and GD in morbid obese patients.

Results

Among the 152 patients with fatty liver disease, 93 were females and 59 were males. The mean age was 30.3 ± 8.9 years and the mean BMI was 44.9 ± 5.4 kg/m2. Fifty-four patients (54/152, 35.5%) were diagnosed as NASH and 11 patients (11/152, 7.2%) received concomitant laparoscopic cholecystectomy because of gallbladder disease (GD). Morbidly obese patients with fatty liver disease and GD were significantly older (P = 0.020), had higher serum levels of cholesterol (P = 0.020) and low-density lipoprotein (LDL)-cholesterol (P = 0.044), and had lower serum levels of total bilirubin (P = 0.044), C-peptide (P = 0.023), and insulin (P = 0.039) than the NASH group. Histopathology factors of hepatic steatosis (P = 0.012), ballooning degeneration (P = 0.001), lobular inflammation (P = 0.019), fibrosis (P = 0.026), and glycogenated nuclei (P = 0.028) were significantly different between NASH and GD groups. However, further multivariate analysis failed to demonstrate any independent clinicopathological factor. The prevalence of chronic hepatitis B and NASH was the same (18%) in all 11 GD patients. Besides, when we compared NASH patients (n = 54) with concurrent NASH-GD patients (n = 2), we found that waist (P = 0.016), waist/hip (P = 0.039), and HOMA-IR (P = 0.040) were independent associated factors. We further assessed the HOMA-IR distribution and the relationship between fibrosis stage in patients with NASH and GD. In the NASH group, HOMA-IR distribution progressively decreased when the severity of fibrosis was plotted as a function of insulin resistance.

Conclusion

The prevalence of NASH in gallbladder disease was 18% in morbid obese population. We concluded that age, serum cholesterol, and low-density lipoprotein cholesterol levels were risk factors associated with gallbladder disease and fatty liver disease. Insulin resistance was more common in concurrent NASH and gallbladder disease. The mechanism between insulin resistance, fibrosis stage, NASH, and gallbladder disease is unknown.

Keywords

Morbid obesity Fatty liver disease Nonalcoholic steatohepatitis Gallbladder disease HOMA-IR Liver fibrosis Histopathology 

Abbreviations

BMI

Body mass index

NASH

Nonalcoholic steatohepatitis

NAS

NAFLD activity score

GD

Gallbladder disease

CHB

Chronic hepatitis B

GGT

γ-glutamyltransferase

HOMA-IR

Homeostatic model assessment method-insulin resistance

ALT

Alanine transaminase

AST

Aspartate transaminase

LDL-C

Low-density lipoprotein cholesterol

HDL-C

High-density lipoprotein cholesterol

References

  1. 1.
    Ludwig J, Viggiona TR, McGill DB, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hither-to unnamed disease. Mayo Clin Proc. 1980;55:434–8.PubMedGoogle Scholar
  2. 2.
    Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in severely obese. Gastroenterology. 2001;121:91–100.PubMedCrossRefGoogle Scholar
  3. 3.
    Angulo P, Keach JC, Butts KP, et al. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15:310–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Moretto M, Kupski C, Mottin CC, et al. Hepatic steatosis in patients undergoing bariatric surgery and its relationship to body mass index and co-morbidities. Obes Surg. 2003;13:622–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Wolf AM, Busch A, Kuhlmann HW, et al. Histological changes in liver of morbidly obese patients: correlation with metabolic parameters. Obes Surg. 2005;15:228–37.PubMedCrossRefGoogle Scholar
  7. 7.
    Harnois F, Msika S, Sabate J-M, et al. Prevalence and predictive factors of non-alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery. Obes Surg. 2006;16:183–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Aidonopouios AP, Papavramidis ST, Zaraboukas TG, et al. Gallbladder findings after cholecystectomy in morbidly obese patients. Obes Surg. 1994;4:8–12.CrossRefGoogle Scholar
  9. 9.
    Fobi M, Lee H, Igwe D, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg. 2002;12:350–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Dittrick GW, Thompson JS, Campos D, et al. Gallbladder pathology in morbid obesity. Obes Surg. 2005;15:238–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Liew P-L, Lee Y-C, Lin Y-C, et al. Comparison of artificial neural networks with logistic regression in prediction of gallbladder disease among obese patients. Dig Liver Dis. 2007;39:356–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Seinige UL, Sataloff DH, Lieber CP, et al. Gallbladder disease in the morbidly obese patient. Obes Surg. 1991;1:51–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Pagliarulo M, Fornari F, Fraqueli M, et al. Gallstone disease and related risk factors in a large cohort of diabetes patients. Dig Liver Dis. 2004;36:130–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Fraquelli M, Pagliarulo M, Colucci A, et al. Gallbladder motility in obesity, diabetes mellitus and coeliac disease. Dig Liver Dis. 2003;35:S12–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Sanyal AJ, Campbell-Sargent C, Mirshahi F, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology. 2001;120:1183–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Nervi F, Miquel JF, Alvarez M, et al. Gallbladder disease is associated with insulin resistance in a high risk hispanic population. J Hepatol. 2006;45:299–306.PubMedCrossRefGoogle Scholar
  18. 18.
    Lu S-N, Chang W-Y, Wang L-Y, et al. Risk factors for gallstones among Chinese in Taiwan. J Clin Gastroenterol. 1990;12:542–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Loria P, Lonardo A, Lombardini S, et al. Gallstone disease in non-alcoholic fatty liver: prevalence and associated factors. J Gastroenterol Hepatol. 2005;20:1176–84.PubMedCrossRefGoogle Scholar
  20. 20.
    Sheen I-S, Liaw Y-F. The prevalence and incidence of cholecystolithiasis in patients with chronic liver diseases: a prospective study. Hepatology. 1989;9:538–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Liew P-L, Lee W-J, Lee Y-C, et al. Hepatic histopathology of morbid obesity: concurrence of other forms of chronic liver disease. Obes Surg. 2006;16:1584–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Haffner SM, Miettinen H, Stern MP. The homeostasis model in the San Antonio Heart Study. Diabetes Care. 1997;20:1087–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Brunt EM, Janney CG, Bisceglie AMD, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging histologic lesions. Am J Gastroenterol. 1999;94:2467–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Kleiner DE, Brunt EM, Natta MV, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Silverman JF, O’ Brien KF, Long S, et al. Liver pathology in morbidly obese patients with and without diabetes. Am J Gastroenterol. 1990;85:1349–55.PubMedGoogle Scholar
  26. 26.
    Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg. 2002;12:49–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Dixon JB, Bhathal PS, Hughes NR, et al. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology. 2004;39:1647–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Liew P-L, Weu Wang, Yi-Chih L, et al. Gallbladder disease among obese patients in Taiwan. Obes Surg. 2007;17:383–90.PubMedCrossRefGoogle Scholar
  29. 29.
    Ruhl CE, Everhart JE. Association of diabetes, serum insulin, and C-peptide with gallbladder disease. Hepatology. 2000;31:299–303.PubMedCrossRefGoogle Scholar
  30. 30.
    Papadia FS, Marinari GM, Camerini G, et al. Liver damage in severely obese patients: a clinical-biochemical-morphologic study on 1,000 liver biopsies. Obes Surg. 2004;14:952–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Buchner AM, Sonnenberg A. Factors influencing the prevalence of gallstones in liver disease: the beneficial and harmful influences of alcohol. Am J Gastroenterol. 2002;97:905–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Chu C-M, Lin D-Y, Liaw Y-F. Does increased body mass index with hepatic steatosis contribute to seroclearance of hepatitis B virus (HBV) surface antigen in chronic HBV infection? Int J Obes. 2007;31:1–5.CrossRefGoogle Scholar
  33. 33.
    Conte D, Fraquelli M, Fornari F, et al. Close relation between cirrhosis and gallstones. Arch Intern Med. 1999;159:49–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Phui-Ly Liew
    • 1
  • Wei-Jei Lee
    • 2
  • Weu Wang
    • 3
  • Yi-Chih Lee
    • 4
  • Wei-Yu Chen
    • 5
  • Chia-Lang Fang
    • 5
  • Ming-Te Huang
    • 3
  1. 1.Department of PathologyTaipei Medical University HospitalTaipei CityTaiwan
  2. 2.Department of SurgeryMin-Sheng General HospitalTaoyuan HsienTaiwan
  3. 3.Department of SurgeryTaipei Medical University HospitalTaipei CityTaiwan
  4. 4.Department of International BusinessChing Yun UniversityZhongli CityTaiwan
  5. 5.Department of Pathology, Municipal Wan Fang HospitalTaipei Medical UniversityTaipei CityTaiwan

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