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The Use of Noninvasive Scores in Predicting NAFLD Progression After Bariatric Surgery

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Abstract

Background

Bariatric surgery has been postulated to impact liver function resulting in favorable effects on nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the long-term impact of bariatric surgery on noninvasive scores predicting the progression of liver fibrosis in a bariatric population.

Methods

We retrospectively reviewed the records of patients without pre-existing liver disease who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at our center between 2010 and 2018. Four predictive scores for liver fibrosis (AST/ALT, APRI, Fib-4, and BARD) were calculated preoperatively, 6 months post-operatively, and annually up to 5 years. Correlations were analyzed with Pearson R. Subgroup and sensitivity analyses were performed to identify populations at increased risk.

Results

A total of 2769 patients were included. The mean age was 40 years, and the majority was females (88.5%) and of Hispanic ethnicity (59.2%). There was a steady post-operative increase in the percentage of patients at increased risk of progression of liver fibrosis. The Fib-4 score showed the largest increase in the population at risk for liver fibrosis (11.3% preoperatively to 28.9% at 5 years). Patients with diabetes and those who underwent a sleeve gastrectomy continued to display a higher risk for liver fibrosis than did patients without diabetes and those who underwent RYGB, respectively.

Conclusion

There was an overall trend to increased liver fibrosis scores over the 5-year post-operative follow-up, but this increase remained lower than that reported in previous literature. Bariatric surgery offers NAFLD risk reduction in a high-risk population.

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Authors and Affiliations

  1. Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA

    Leaque Ahmed, Amrita Persaud, Kashif Saeed, Khuram Khan, Saqib Saeed, Sara Alothman, Bianca Passos-Fox, Hector DePaz & Paritosh Suman

  2. Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA

    Leaque Ahmed, Selim Gebran, Amrita Persaud, Kashif Saeed, Khuram Khan, Sara Alothman, Bianca Passos-Fox, Hector DePaz & Paritosh Suman

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  1. Leaque Ahmed
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Correspondence to Selim Gebran.

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Key Points

• Bariatric surgery is the most effective and durable weight loss treatment and is known to impact liver function positively.

• There was an overall trend of an increase in liver fibrosis scores over the 5-year post-operative follow-up.

• The increase in liver fibrosis scores over time remained lower than that reported in previous NAFLD literature.

• Patients at risk for liver fibrosis were those with preoperative DM, those undergoing SG, and those with EWL less than 40%.

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Ahmed, L., Gebran, S., Persaud, A. et al. The Use of Noninvasive Scores in Predicting NAFLD Progression After Bariatric Surgery. OBES SURG 33, 4026–4033 (2023). https://doi.org/10.1007/s11695-023-06912-9

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  • DOI: https://doi.org/10.1007/s11695-023-06912-9

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