Obesity Surgery

, Volume 25, Issue 6, pp 982–985 | Cite as

Effect of Roux-en-y Gastric Bypass on Nonalcoholic Fatty Liver Disease Evaluated Through NAFLD Fibrosis Score: a Prospective Study

  • Everton CazzoEmail author
  • Laísa Simakawa Jimenez
  • José Carlos Pareja
  • Elinton Adami Chaim
Original Contributions



Nonalcoholic fatty liver disease (NAFLD) is common among subjects who undergo bariatric surgery and its postsurgical improvement has been reported. This study aimed to determine the evolution of liver disease evaluated through NAFLD fibrosis score 12 months after surgery.


It is a prospective cohort study which evaluated patients immediately before and 12 months following Roux-en-Y gastric bypass (RYGB).


Mean score decreased from 1.142 to 0.066; surgery led to a resolution rate of advanced fibrosis of 55 %. Resolution was statistically associated with female gender, percentage of excess weight loss, postsurgical body mass index, postsurgical platelet count, and diabetes resolution.


As previously reported by studies in which postsurgical biopsies were performed, RYGB leads to a great resolution rate of liver fibrosis. Since postsurgical biopsy is not widely available and has a significant risk, calculation of NAFLD fibrosis score is a simple tool to evaluate this evolution through a noninvasive approach.


Fatty liver Gastric bypass Bariatric surgery Obesity Liver function tests 


Conflict of Interest

Everton Cazzo, Laisa Simakawa Jimenez, José Carlos Pareja, and Elinton Adami Chaim declared that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Abrams GA, Kunde SS, Lazenby AJ, et al. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatology. 2004;40(2):475–83.CrossRefPubMedGoogle Scholar
  2. 2.
    Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis. 2004;24(1):3–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142(4):711–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic and clinical implications. Hepatology. 2010;51(2):679–89.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    McCullough AJ. Pathophysiology of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40 suppl 1:S17–29.PubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Pais R, Charlotte F, Fedchuk L, et al. A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol. 2013;59(3):550–6.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference statement. Am J Clin Nutr 1992;55(2 Suppl):615S–619SGoogle Scholar
  14. 14.
    Wu J, You J, Yerian L, et al. Prevalence of liver steatosis and fibrosis and the diagnostic accuracy of ultrasound in bariatric surgery patients. Obes Surg. 2012;22(2):240–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Cazzo E, de Felice GF, Pareja JC, et al. Nonalcoholic fatty liver disease in morbidly obese subjects: correlation among histopathologic findings, biochemical features, and ultrasound evaluation. Obes Surg. 2014;24(4):666–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Liu X, Lazenby AJ, Clements RH, et al. Resolution of nonalcoholic steatohepatitis after gastric bypass surgery. Obes Surg. 2007;17(4):486–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101(2):368–73.CrossRefPubMedGoogle Scholar
  18. 18.
    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(7):1016–21.CrossRefPubMedGoogle Scholar
  19. 19.
    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.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Moretto M, Kupski C, da Silva VD, et al. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22(7):1044–9.CrossRefPubMedGoogle Scholar
  21. 21.
    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(12):1396–402.CrossRefPubMedGoogle Scholar
  22. 22.
    Le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243(1):108–14.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    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(2):532–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Shalhub S, Parsee A, Gallagher SF, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Simo KA, McKillop IH, McMillan MT, et al. Does a calculated “NAFLD fibrosis score” reliably negate the need for liver biopsy in patients undergoing bariatric surgery? Obes Surg. 2014;24(1):15–21.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Everton Cazzo
    • 1
    Email author
  • Laísa Simakawa Jimenez
    • 1
  • José Carlos Pareja
    • 1
  • Elinton Adami Chaim
    • 1
  1. 1.Department of Surgery; Faculty of Medical SciencesState University of Campinas (UNICAMP)CampinasBrazil

Personalised recommendations