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Noninvasive assessment of hepatic steatosis and fibrosis in patients with severe obesity

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Abstract

Purpose

In morbid obesity nonalcoholic fatty liver disease (NAFLD) is endemic. Aim of this study is to evaluate the diagnostic accuracy of the most common noninvasive methods for identify NAFLD and fibrosis in a cohort of morbid obese population.

Methods

Ninety morbid obese patients undergoing bariatric surgery (BS) and intraoperative liver biopsy were evaluated preoperatively with Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and serum biomarkers for steatosis and fibrosis and liver stiffness measurement (LSM) using acoustic radiation force impulse (ARFI) elastography. All nondiabetic patient (n = 77) underwent OGTT and calculation of Oral Glucose Insulin Sensitivity index (OGIS).

Results

In the entire cohort prevalence of NAFLD was 77%, NASH 24%, moderate/severe steatosis 50%, and significant fibrosis 14%. New cut-offs were evaluated for all steatosis score assessed in this population. In all patients with moderate/severe steatosis HOMA IR was significantly greater than 3.5. ALT, GGT, Triglycerides, HOMA IR, and ARFI increased with fibrosis grade (p 0.03, p 0.008, p 0.04, p 0.05, respectively) and AST to Platelet ratio (APRI) was the only noninvasive fibrosis score significantly increased in significant fibrosis (p 0.04). A combination of 1/OGIS and VAI was able to discriminate NASH from simple steatosis (NAFL) (p 0.02).

Conclusions

In morbid obese subjects, we calculated new cut-offs of the most common steatosis indexes and found that a score based on insulin resistance (1/OGIS) and abdominal obesity (VAI) could represent a way to identify morbid obese subjects at risk of NASH.

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Abbreviations

OGIS:

oral glucose insulin sensitivity index

NAFLD:

nonalcoholic fatty liver disease

NASH:

nonalcoholic steatohepatitis

NAFL:

nonalcoholic fatty liver

HOMA-IR:

homeostasis model assessment of insulin resistance

T2D:

type 2 diabetes mellitus

OGTT:

oral glucose tolerance test

LSG:

laparoscopic sleeve gastrectomy

HDL:

high-density lipoprotein cholesterol

ALT:

alanine aminotransferase

AST:

aspartate aminotransferase

γ-GT:

γ-glutamyl-transpeptidase

LSM:

liver stiffness measurement

ARFI:

acoustic radiation force impulse

HSI:

hepatic steatosis index

FLI:

fatty liver index

LAP:

lipid accumulation product

NAFLD-LFS:

NAFLD-liver fat score

Tyg Index:

triglycerides and glucose

VAI:

visceral adiposity index

FIB-4:

fibrosis 4 calculator (FIB4)

NFS:

NAFLD fibrosis score (NFS)

APRI index:

AST to platelet ratio index

BAAT:

BMI, ALT, AST, triglycerides

BS:

Bariatric surgery

NAS:

NAFLD activity score

AUC:

area under curve

AUROC:

area under the receiver operating characteristics curver

HR:

hazard ratio

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Acknowledgements

The authors wish to thank all the people who contributed to the study, to the interpretation of results and to the writing of the manuscript. All authors approved the final version of the article, including the authorship list.

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Authors and Affiliations

  1. Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Via Guido Reni 1, 04100, Latina, Italy

    Federica Coccia, Moira Testa, Gloria Guarisco, Frida Leonetti & Danila Capoccia

  2. Department of Experimental Medicine, Sapienza University of Rome, Latina, Italy

    Enea Bonci

  3. Pathology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Claudio Di Cristofano

  4. General Surgery Unit and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Gianfranco Silecchia

  5. Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Amalia Gastaldelli

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  1. Federica Coccia
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Correspondence to Frida Leonetti.

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Coccia, F., Testa, M., Guarisco, G. et al. Noninvasive assessment of hepatic steatosis and fibrosis in patients with severe obesity. Endocrine 67, 569–578 (2020). https://doi.org/10.1007/s12020-019-02155-w

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