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How bariatric surgery affects liver volume and fat density in NAFLD patients

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Abstract

Introduction

Nonalcoholic fatty liver disease (NAFLD) is an epidemic in the obese population. Bariatric surgery is known to reverse multiple metabolic complications of obesity such as diabetes, dyslipidemia, and NAFLD, but the timing of liver changes has not been well described.

Materials and Methods

This was an IRB-approved, two-institutional prospective study. Bariatric patients received MRIs at baseline and after a pre-operative liquid diet. Liver biopsies were performed during surgery and if NAFLD positive, the patients received MRIs at 1, 3, and 6 months. Liver volumes and proton-density fat fraction (PDFF) were calculated from offline MRI images. Primary outcomes were changes in weight, body mass index (BMI), percent excess weight loss (EWL%), liver volume, and PDFF. Resolution of steatosis, as defined as PDFF < 6.4% based on previously published cutoffs, was assessed. Secondarily, outcomes were compared between patients who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB).

Results

From October 2010 to June 2015, 124 patients were recruited. 49 patients (39.5%) completed all five scans. EWL% at 6 months was 55.6 ± 19.0%. BMI decreased from 45.3 ± 5.9 to 34.4 ± 5.1 kg/m2 and mean liver volume decreased from 2464.6 ± 619.4 to 1874.3 ± 387.8 cm3 with a volume change of 21.4 ± 11.4%. PDFF decreased from 16.6 ± 7.8 to 4.4 ± 3.4%. At 6 months, 83.7% patients had resolution of steatosis. Liver volume plateaued at 1 month, but PDFF and BMI continued to decrease. There were no statistically significant differences in liver volume or PDFF reduction from baseline to 6 months between the LSG versus LRYGB subgroups.

Conclusion

Patients with NAFLD undergoing bariatric surgery can expect significant decreases in liver volume and hepatic steatosis at 6 months, with 83.7% of patients achieving resolution of steatosis. Liver volume reduction plateaus 1-month post-bariatric surgery, but PDFF continues to decrease. LSG and LRYGB did not differ in efficacy for inducing regression of hepatosteatosis.

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Funding

National Institute of Health (NIH) Grants: R01DK088925, R01DK083380, R01DK100651, K24DK102595.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, 9500 Gilman Drive MC 0740, San Diego, CA, 92093, USA

    Ran B. Luo, Toshiaki Suzuki, Shanglei Liu, Bryan J. Sandler, Santiago Horgan & Garth R. Jacobsen

  2. Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, CA, USA

    Jonathan C. Hooker, Yesenia Covarrubias, Alexandra Schlein & Claude B. Sirlin

  3. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, San Diego, CA, USA

    Jeffrey B. Schwimmer

  4. Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Wisconsin, MI, USA

    Scott B. Reeder

  5. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Luke M. Funk & Jacob A. Greenberg

  6. Division of Bariatric and GI Surgery, Virginia Commonwealth University, Richmond, VA, USA

    Guilherme M. Campos

  7. Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, CA, USA

    Jeffrey B. Schwimmer

Authors
  1. Ran B. Luo
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  2. Toshiaki Suzuki
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  3. Jonathan C. Hooker
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  4. Yesenia Covarrubias
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  5. Alexandra Schlein
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  6. Shanglei Liu
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  7. Jeffrey B. Schwimmer
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  8. Scott B. Reeder
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  9. Luke M. Funk
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  10. Jacob A. Greenberg
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  11. Guilherme M. Campos
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  12. Bryan J. Sandler
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  13. Santiago Horgan
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  14. Claude B. Sirlin
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  15. Garth R. Jacobsen
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Corresponding author

Correspondence to Ran B. Luo.

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Disclosures

Dr. Reeder reports other from Cellectar Biosciences, other from Elucent Medical, other from Calimetrix, LCC, personal fees from Parexel International, outside the submitted work. Dr. Sandler reports personal fees from W.L Gore, personal fees from Bard/Davol, personal fees from ValenTx, Inc. outside the submitted work. Dr. Horgan reports personal fees from Johnson and Johnson/Ethicon, personal fees from W.L. Gore, personal fees from Torax/Ethicon, personal fees from ValenTx, Inc outside the submitted work. Dr. Sirlin reports grants from National Institute of Health, during the conduct of the study; grants from Bayer, grants from Guerbet, grants from Siemens, grants from General Electric, grants from Supersonic, grants from Arterys, personal fees from Alexion, personal fees from AstraZeneca, personal fees from Bioclinica, personal fees from BMS, personal fees from Bracco, personal fees from Celgene, personal fees from Fibrogen, personal fees from Galmed, personal fees from Genentech, personal fees from Genzyme, personal fees from Gilead, personal fees from Icon, personal fees from Intercept, personal fees from Isis, personal fees from Janssen, personal fees from NuSirt, personal fees from Perspectum, personal fees from Pfizer, personal fees from Profil, personal fees from Sanofi, personal fees from Shire, personal fees from Synageva, personal fees from Tobira, personal fees from Takeda, personal fees from Virtual Scopics, outside the submitted work. Dr. Jacobsen reports personal fees from W.L.Gore, personal fees from Davol/Bard, personal fees from Viasite, personal fees from Ethicon, outside the submitted work. Drs. Luo, Suzuki, Liu, Schwimmer, Funk, Greenberg and Campos, Mr. Hooker, Ms. Schlein, and Ms. Covarrubias have no conflicts of interest or financial ties to disclose.

Additional information

Ran B. Luo and Toshiaki Suzuki are co-first authors.

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Luo, R.B., Suzuki, T., Hooker, J.C. et al. How bariatric surgery affects liver volume and fat density in NAFLD patients. Surg Endosc 32, 1675–1682 (2018). https://doi.org/10.1007/s00464-017-5846-9

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  • DOI: https://doi.org/10.1007/s00464-017-5846-9

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