Obesity is a major risk factor for nonalcoholic fatty liver disease (NAFLD), affecting 25% of the worldwide population. Weight loss through bariatric surgery can improve much of the liver steatosis, inflammation, and fibrosis. However, it is not known whether there is reversal of the elastic fiber deposition process, triggered by hepatic damage and related to worse prognosis.
Materials and Methods
Individuals submitted to bariatric surgery at our institution, from March 2016 to June 2017, with intraoperative liver biopsy confirming NAFLD were approached. Those who consented were submitted to a second liver biopsy 1 year later and were included. Specimens were sliced and stained with hematoxylin-eosin and Sirius red for histological assessment according to Brunt’s criteria and with orcein for digital analysis morphometrics using ImageJ®. Quantification of elastic fibers was accomplished by corrected integrated density.
Thirty-seven patients were included. Body mass index, metabolic markers, NAFLD activity score, and fibrosis improved 1 year after the procedure. The elastic fiber density showed a significant decrease: 239.3 × 103 absorbance micrometer2 (141.08–645.32) to 74.62 × 103 absorbance micrometer2 (57.42–145.17), p = 0.007.
Liver elastic fiber density decreases with the reversal of NAFLD through weight loss.
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Younossi ZM, Henry L, Bush H, et al. Clinical and economic burden of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Clin Liver Dis. 2018;22(1):1–10.
Younossi ZM, Stepanova M, Negro F, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore). 2012;91(6):319–27.
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.
Lee Y, Doumouras AG, Yu J, et al. Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(6):1040–60.e11.
Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53.
Kanta J. Elastin in the liver. Front Physiol. 2016;7:491.
Nakayama H, Itoh H, Kunita S, et al. Presence of perivenular elastic fibers in nonalcoholic steatohepatitis fibrosis stage III. Histol Histopathol. 2008;23(4):407–9.
Porto LC, Chevallier M, Guerret S, et al. Elastin in alcoholic liver disease. An immunohistochemical and immunoelectron microscopic study. Pathol Res Pract. 1990;186(5):668–79.
Kielty CM, Sherratt MJ, Shuttleworth CA. Elastic fibres. J Cell Sci. 2002;115(Pt 14):2817–28.
Houghton AM, Quintero PA, Perkins DL, et al. Elastin fragments drive disease progression in a murine model of emphysema. J Clin Invest. 2006;116(3):753–9.
Chen W, Yan X, Xu A, et al. Dynamics of elastin in liver fibrosis: accumulates late during progression and degrades slowly in regression. J Cell Physiol. 2019;234:22613–22.
Kendall TJ, Dolman GE, Duff CM, et al. Hepatic elastin content is predictive of adverse outcome in advanced fibrotic liver disease. Histopathology. 2018;73(1):90–100.
Hauck M, Seres I, Kiss I, et al. Effects of synthesized elastin peptides on human leukocytes. Biochem Mol Biol Int. 1995;37(1):45–55.
Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis. 2012;32(1):3–13.
Trang T, Petersen JR, Snyder N. Non-invasive markers of hepatic fibrosis in patients co-infected with HCV and HIV: comparison of the APRI and FIB-4 index. Clin Chim Acta. 2008;397(1–2):51–4.
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(6):1313–21.
Schneider CA, Rasband WS, Eliceiri KW. NIH image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9(7):671–5.
Hartig SM. Basic image analysis and manipulation in ImageJ. Curr Protoc Mol Biol. 2013;Chapter 14:Unit14.5.
Leite C, Starosta RT, Trindade EN, et al. Corrected integrated density: a novel method for liver elastic fibers quantification in chronic hepatitis C. Surg Exp Pathol. 2020;3(1):4
Goodman ZD, Becker RL, Pockros PJ, et al. Progression of fibrosis in advanced chronic hepatitis C: evaluation by morphometric image analysis. Hepatology. 2007;45(4):886–94.
Lomonaco R, Ortiz-Lopez C, Orsak B, et al. Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease. Hepatology. 2012;55(5):1389–97.
Pellicoro A, Aucott RL, Ramachandran P, et al. Elastin accumulation is regulated at the level of degradation by macrophage metalloelastase (MMP-12) during experimental liver fibrosis. Hepatology. 2012;55(6):1965–75.
Masugi Y, Abe T, Tsujikawa H, et al. Quantitative assessment of liver fibrosis reveals a nonlinear association with fibrosis stage in nonalcoholic fatty liver disease. Hepatol Commun. 2018;2(1):58–68.
Leng SX, Xue QL, Huang Y, et al. Baseline total and specific differential white blood cell counts and 5-year all-cause mortality in community-dwelling older women. Exp Gerontol. 2005;40(12):982–7.
Elkind MS, Cheng J, Boden-Albala B, et al. Elevated white blood cell count and carotid plaque thickness: the northern Manhattan stroke study. Stroke. 2001;32(4):842–9.
Furuncuoğlu Y, Tulgar S, Dogan AN, et al. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci. 2016;20(7):1300–6.
Veronelli A, Laneri M, Ranieri R, et al. White blood cells in obesity and diabetes: effects of weight loss and normalization of glucose metabolism. Diabetes Care. 2004;27(10):2501–2.
Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14(3):160–9.
Burza MA, Romeo S, Kotronen A, et al. Long-term effect of bariatric surgery on liver enzymes in the Swedish Obese Subjects (SOS) study. PLoS One. 2013;8(3):e60495.
von Schönfels W, Beckmann JH, Ahrens M, et al. Histologic improvement of NAFLD in patients with obesity after bariatric surgery based on standardized NAS (NAFLD activity score). Surg Obes Relat Dis. 2018;14(10):1607–16.
Gancheva S, Ouni M, Jelenik T, et al. Dynamic changes of muscle insulin sensitivity after metabolic surgery. Nat Commun. 2019;10(1):4179.
Meek CL, Lewis HB, Reimann F, et al. The effect of bariatric surgery on gastrointestinal and pancreatic peptide hormones. Peptides. 2016;77:28–37.
Fried M. Bariatric and metabolic surgery. Minerva Endocrinol. 2013;38(3):237–44.
Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.
Conflict of Interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
Human and Animal Rights/Ethical Approval
The study was approved by the HCPA Ethical Committee numbers 1.887.117 and 3.227.637. 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.
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Leite, C., Starosta, R.T., Trindade, E.N. et al. Elastic Fibers Density: a New Parameter of Improvement of NAFLD in Bariatric Surgery Patients. OBES SURG 30, 3839–3846 (2020). https://doi.org/10.1007/s11695-020-04722-x
- Nonalcoholic fatty liver disease
- Elastic fibers