Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the US, and obesity is the most common cause of NAFLD. Obesity and NAFLD are associated with hyperlipidemia, type 2 diabetes, and hypertension, all components of the metabolic syndrome. The purpose of this study was to examine the incidence of NAFLD among morbidly obese patients undergoing bariatric surgery and to determine if advanced liver disease can be predicted by demographics, comorbidities, and/or preoperative biochemical profiles. 135 nonconsecutive patients (109 female, average age 46) with mean body mass index (BMI) 50 (SD 7.6) who underwent liver biopsies during bariatric surgery were studied. Patient data including age, BMI, comorbidities, and preoperative liver function tests were analyzed against liver biopsy pathology. 86% of patients had abnormal liver biopsy results. 60% of patients had steatosis, and 27% had advanced liver disease (7% steatohepatitis, 16% fibrosis, and 4% cirrhosis). Patients were grouped according to liver biopsy pathology. Group A included patients with normal results and steatosis only. Group B included those patients with advanced liver disease:steatohepatitis, fibrosis, and cirrhosis. Of 37 patients in group B, 27% had abnormal preoperative liver function tests (LFTs) compared to 10% of patients in group A (p = 0.022). Patients in group B were more likely to have preoperative hyperlipidemia (p = 0.020) and were also found to have a significantly higher BMI (p = 0.042). Diabetes mellitus, male gender, and age were not predictive of advanced liver disease on liver biopsy, with p = 0.056, p = 0.074, p = 0.26, respectively. Liver disease is common in the morbidly obese. More than one quarter of morbidly obese patients undergoing bariatric surgery have advanced liver disease. Patients with increased preoperative LFTs, hyperlipidemia, and increased BMI are more likely to have non-alcoholic steatohepatitis, fibrosis, or cirrhosis on liver biopsy during weight loss surgery. Diabetes, male gender, and age did not predict advanced liver disease.
Similar content being viewed by others
References
Abrams GA, Kunde SS, Lazenby AJ, et al. (2004) Portal fibrosis and hepatic steatosis in morbidly obese subjects: A spectrum of nonalcoholic fatty liver disease. Hepatology 40: 475–83
Angelico F, Del Ben M, Conti R, et al. (2003) Non-alcoholic fatty liver syndrome: a hepatic consequence of common metabolic diseases. J Gastroenterol Hepatol 18: 588–94
Angulo P, Keach JC, Batts KP, et al. (1999) Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 30: 1356–62
Beymer C, Kowdley KV, Larson A, et al. (2003) revalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg 138: 1240–4
Brunt EM (2004) Nonalcoholic steatohepatitis. Semin Liver Dis 24: 3–20
Charlton M, Kasparova P, Weston S, et al. (2001) Frequency of nonalcoholic steatohepatitis as a cause of advanced liver disease. Liver Transpl 7: 608–14
Clain DJ, Lefkowitch JH (1987) Fatty liver disease in morbid obesity. Gastroenterol Clin North Am 16: 239–52
Dixon JB, Bhathal PS, O’Brien PE (2001) Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology, 121: 91–100
Duchini A, Brunson ME (2001) Roux-en-Y gastric bypass for recurrent nonalcoholic steatohepatitis in liver transplant recipients with morbid obesity. Transplantation, 72: 156–9
Duseja A, Nanda M, Das A, et al. (2004) Prevalence of obesity, diabetes mellitus and hyperlipidaemia in patients with cryptogenic liver cirrhosis. Trop Gastroenterol 25:15–7
Falck-Ytter Y, Younossi ZM, Marchesini G, et al. (2001) Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 21: 17–26
Galambos JT, Wills CE (1978) Relationship between 505 paired liver tests and biopsies in 242 obese patients. Gastroenterology 74: 1191–5
Gholam PM, Kotler DP, Flancbaum LJ (2002) Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 12: 49–51
Marceau P, Biron S, Hould FS, et al. (1999) Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab 84: 1513–7
McCullough AJ (2004) The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 8: 521–33, viii
Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 37: 1202–19
Ong JP, Elariny H, Collantes R, et al. (2005) Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg 15:310–5
Ratziu V, Giral P, Charlotte F, et al. (2000) Liver fibrosis in overweight patients. Gastroenterology 118:1117–23
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kroh, M., Liu, R. & Chand, B. Laparoscopic bariatric surgery: what else are we uncovering? Liver pathology and preoperative indicators of advanced liver disease in morbidly obese patients. Surg Endosc 21, 1957–1960 (2007). https://doi.org/10.1007/s00464-007-9351-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9351-4