Journal of Gastrointestinal Surgery

, Volume 8, Issue 7, pp 849–855

Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery

  • Constantine T. Frantzides
  • Mark A. Carlson
  • Ronald E. Moore
  • John G. Zografakis
  • Atul K. Madan
  • Susan Puumala
  • Ali Keshavarzian
Article

Abstract

The risk factors for nonalcoholic fatty liver disease in patients undergoing bariatric surgery are under study. We wanted to determine the correlation between nonalcoholic fatty liver disease and patient factors such as obesity and liver function tests. A retrospective analysis was performed on 177 nonalcoholic morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass with liver biopsy, to identify risk factors for nonalcoholic fatty liver disease. The histologic grade of liver disease was compared with preoperative body mass index, age, and liver function tests. Simple steatosis and steatohepatitis were present in 90% and 42% of patients, respectively. Elevated transaminaselevels were an independent risk for liver disease. Body mass index and liver disease were not correlated with univariate analysis. Regression analysis performed on age, body mass index, and liver disease demonstrated that the risk for liver disease increased with body mass index in the younger (<35 years old) age group and decreased with body mass index in the older (<45 years old) age group. There was a high incidence of steatosis and steatohepatitis in these nonalcoholic bariatric patients, and elevated transaminase level was indicative of disease. Body mass index was a positive risk factor for liver disease in younger patients but a negative risk factor in the older patients.

Key words

Nonalcoholic fatty liver disease morbid obesity laparoscopic bariatric surgery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: Summary of an AASLD Single Topic Conference. Hepatology 2003;37:1202–1219.PubMedCrossRefGoogle Scholar
  2. 2.
    Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980;55:434–438.PubMedGoogle Scholar
  3. 3.
    Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: An autopsy study with analysis of risk factors. Hepatology 1990;12:1106–1110.PubMedCrossRefGoogle Scholar
  4. 4.
    Ratziu V, Giral P, Charlotte F, et al. Liver fibrosis in overweight patients. Gastroenterology 2000;118:1117–1123.PubMedCrossRefGoogle Scholar
  5. 5.
    Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity. Gastroenterology 1999;116:1413–1419.PubMedCrossRefGoogle Scholar
  6. 6.
    Powell EE, Cooksley WG, Hanson R, et al. The natural history of nonalcoholic steatohepatitis: A follow-up study of forty-two patients for up to 21 years. Hepatology 1990;11:74–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: A follow-up study. Hepatology 1995;22:1714–1719.PubMedCrossRefGoogle Scholar
  8. 8.
    Propst A, Propst T, Zangerl G, et al. Prognosis and life expectancy in chronic liver disease. Dig Dis Sci 1995;40:1805–1815.PubMedCrossRefGoogle Scholar
  9. 9.
    Day CP, James OF. Steatohepatitis: A tale of two "hits"? Gastroenterology 1998;114:842–845.PubMedCrossRefGoogle Scholar
  10. 10.
    Harrison SA, Kadakia S, Lang KA, Schenker S. Nonalcoholic steatohepatitis: What we know in the new millennium. Am J Gastroenterol 2002;97:2714–2724.PubMedGoogle Scholar
  11. 11.
    Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917–923.PubMedCrossRefGoogle Scholar
  12. 12.
    Brolin RE, Bradley LJ, Taliwal RV. Unsuspected cirrhosis discovered during elective obesity operations. Arch Surg 1998; 133:84–88.PubMedCrossRefGoogle Scholar
  13. 13.
    Clark JM, Diehl AM. Nonalcoholic fatty liver disease: An underrecognized cause of cryptogenic cirrhosis. JAMA 2003; 289:3000–3004.PubMedCrossRefGoogle Scholar
  14. 14.
    Schirmer B, Watts SH. Laparoscopic bariatric surgery. Surg Endosc 2003;17:1875–1878.PubMedCrossRefGoogle Scholar
  15. 15.
    National Heart, Lung, and Blood Institute. Clinical guidelines on the identi.cation, evaluation, and treatment of overweight and obesity in adults. 1998. Available at: http://www.nhlbi.nih. gov/guidelines/obesity/ob_home.htm. Accessed 2004.Google Scholar
  16. 16.
    Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: A review of 3464 cases. Arch Surg 2003;138:957–961.PubMedCrossRefGoogle Scholar
  17. 17.
    Moretto M, Kupski C, Mottin CC, et al. Hepatic steatosis in patients undergoing bariatric surgery and its relationship to body mass index and co-morbidities. Obes Surg 2003;13:622–624.PubMedCrossRefGoogle Scholar
  18. 18.
    Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 2002;12:49–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Beymer C, Kowdley KV, Larson A, et al. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg 2003;138:1240–1244.PubMedCrossRefGoogle Scholar
  20. 20.
    Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: Effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord 1998;22:222–226.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2004

Authors and Affiliations

  • Constantine T. Frantzides
    • 1
  • Mark A. Carlson
    • 2
  • Ronald E. Moore
    • 3
  • John G. Zografakis
    • 1
  • Atul K. Madan
    • 4
  • Susan Puumala
    • 5
  • Ali Keshavarzian
    • 6
  1. 1.Department of SurgeryEvanston Northwestern HealthcareChicago
  2. 2.Department of SurgeryUniversity of Nebraska Medical Center and the Omaha VA Medical CenterOmaha
  3. 3.Department of SurgeryPlantation HospitalFort Lauderdale
  4. 4.Department of SurgeryUniversity of Tennessee-MemphisMemphis
  5. 5.Department of Preventive and Societal MedicineUniversity of Nebraska Medical CenterOmaha
  6. 6.Section of Gastroenterology and NutritionRush UniversityChicago
  7. 7.Minimally Invasive Surgery, Department of SurgeryEvanston Northwestern HealthcareEvanston

Personalised recommendations