Obesity Surgery

, Volume 22, Issue 7, pp 1016–1021

Improvement of Nonalcoholic Fatty Liver Disease After Bariatric Surgery in Morbidly Obese Chinese Patients

  • Chi-Ming Tai
  • Chih-Kun Huang
  • Jau-Chung Hwang
  • Hung Chiang
  • Chi-Yang Chang
  • Ching-Tai Lee
  • Ming-Lung Yu
  • Jaw-Town Lin
Clinical Research

Abstract

Background

Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), which appears to improve after weight loss induced by bariatric surgery in Western countries. The present study aims to determine the alterations of clinical measurements and liver histology of NAFLD after bariatric surgery in morbidly obese Chinese patients.

Methods

Between November 2006 and December 2007, 21 morbidly obese patients receiving intra-operative liver biopsy and follow-up liver biopsy 1 year after laparoscopic Roux-en-Y gastric bypass were enrolled. NAFLD activity score (NAS) and fibrosis stage were histologically evaluated.

Results

The mean body mass index fell from 43.8 ± 7.5 to 28.3 ± 4.6 kg/m2 (P < 0.01). Biochemical improvement was found in serum levels of alanine aminotransferase (P < 0.01) and γ-glutamyltransferase (P < 0.01), but not aspartate aminotransferase (P = 0.66). Histological improvement was noted in NAS (P < 0.01) and individual components, including steatosis (P < 0.01), ballooning degeneration (P < 0.01), and lobular inflammation (P = 0.02). Pre-operatively, 4 (19.0%), 11 (52.4%), and 6 (28.6%) patients were found to have NAS ≧5, 3 or 4, and ≦2, respectively. All patients had NAS ≦2 after surgery. Fibrosis stage also showed significant improvement (P < 0.01).

Conclusions

Bariatric surgery can achieve a dramatic improvement of NAFLD both biochemically and histologically in morbidly obese Chinese patients.

Keywords

Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Obesity Bariatric surgery Liver biopsy 

Abbreviations

NAFLD

Nonalcoholic fatty liver disease

NASH

Nonalcoholic steatohepatitis

RYGB

Roux-en-Y gastric bypass

NAS

NAFLD activity score

BMI

Body mass index

LRYGB

Laparoscopic Roux-en-Y gastric bypass

WC

Waist circumference

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

GGT

γ-Glutamyltransferase

HDL

High-density lipoprotein

LDL

Low-density lipoprotein

HOMA

Homeostatic model assessment

SD

Standard deviation

References

  1. 1.
    Harrison SA, Kadakia S, Lang KA, et al. Nonalcoholic steatohepatitis: what we know in the new millennium. Am J Gastroenterol. 2002;97:2714–24.PubMedGoogle Scholar
  2. 2.
    Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastroenterology. 2002;122:1649–57.PubMedCrossRefGoogle Scholar
  4. 4.
    Clark JM, Alkhuraishi AR, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13:1180–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Pillai AA, Rinella ME. Non-alcoholic fatty liver disease: is bariatric surgery the answer? Clin Liver Dis. 2009;13:689–710.PubMedCrossRefGoogle Scholar
  6. 6.
    Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37:917–23.PubMedCrossRefGoogle Scholar
  7. 7.
    Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med. 1999;107:450–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242:610–7.PubMedGoogle Scholar
  10. 10.
    Mottin CC, Moretto M, Padoin AV, et al. Histological behavior of hepatic steatosis in morbidly obese patients after weight loss induced by bariatric surgery. Obes Surg. 2005;15:788–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Csendes A, Smok G, Burgos AM. Histological findings in the liver before and after gastric bypass. Obes Surg. 2006;16:607–11.PubMedCrossRefGoogle Scholar
  12. 12.
    de Almeida SR, Rocha PR, Sanches MD, et al. Roux-en-Y gastric bypass improves the nonalcoholic steatohepatitis (NASH) of morbid obesity. Obes Surg. 2006;16:270–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101:368–73.PubMedCrossRefGoogle Scholar
  14. 14.
    Liu X, Lazenby AJ, Clements RH, et al. Resolution of nonalcoholic steatohepatits after gastric bypass surgery. Obes Surg. 2007;17:486–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Furuya Jr CK, de Oliveira CP, de Mello ES, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol. 2007;22:510–4.PubMedCrossRefGoogle Scholar
  16. 16.
    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
  17. 17.
    Liew PL, Lee WJ, Wang W, et al. Fatty liver disease: predictors of nonalcoholic steatohepatitis and gallbladder disease in morbid obesity. Obes Surg. 2008;18:847–53.PubMedCrossRefGoogle Scholar
  18. 18.
    Huang CK, Lee YC, Hung CM, et al. Laparoscopic Roux-en-Y gastric bypass for morbidly obese Chinese patients: learning curve, advocacy and complications. Obes Surg. 2008;18:776–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487–95.PubMedCrossRefGoogle Scholar
  21. 21.
    Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Mummadi RR, Kasturi KS, Chennareddygari S, et al. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6:1396–402.PubMedCrossRefGoogle Scholar
  23. 23.
    Padoin AV, Mottin CC, Moretto M, et al. A comparison of wedge and needle hepatic biopsy in open bariatric surgery. Obes Surg. 2006;16:178–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137:532–40.PubMedCrossRefGoogle Scholar
  25. 25.
    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;(1):CD007340.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Chi-Ming Tai
    • 1
    • 2
  • Chih-Kun Huang
    • 3
  • Jau-Chung Hwang
    • 4
  • Hung Chiang
    • 5
  • Chi-Yang Chang
    • 1
  • Ching-Tai Lee
    • 1
  • Ming-Lung Yu
    • 6
  • Jaw-Town Lin
    • 1
    • 7
  1. 1.Department of Internal Medicine, E-Da HospitalI-Shou UniversityKaohsiungTaiwan
  2. 2.Institute of Clinical Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.Department of Surgery, E-Da HospitalI-Shou UniversityKaohsiungTaiwan
  4. 4.Department of Pathology, E-Da HospitalI-Shou UniversityKaohsiungTaiwan
  5. 5.Department of Anatomic PathologyTaipei Institute of PathologyTaipeiTaiwan
  6. 6.Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  7. 7.Department of Internal Medicine, National Taiwan University HospitalNational Taiwan UniversityTaipeiTaiwan

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