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Non-alcoholic Fatty Liver Disease in Morbidly Obese Individuals Undergoing Bariatric Surgery: Prevalence and Effect of the Pre-Bariatric Very Low Calorie Diet

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Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) affects 75 to 100% of the patients undergoing bariatric surgery (BSx), with non-alcoholic steatohepatitis (NASH) being present in 24 to 98% of the patients. We do not know whether these rates were before or after a very low calorie diet (VLCD) often prescribed before laparoscopic BSx and what is the prevalence of NAFLD post-VLCD.

Purpose

The purpose of this study is to determine the prevalence of simple steatosis (SS) and NASH in obese individuals undergoing BSx post-VLCD and assess biochemical markers pre- and post-VLCD in a subgroup of patients.

Methods

One hundred and thirty-nine patients undergoing BSx at a single Canadian bariatric program had biochemical and clinical variables collected pre-VLCD. In 21 patients, biochemical measurements were repeated post-VLCD. During BSx, a wedged liver biopsy was performed in all patients and histology was reported as normal liver (NL), SS, or NASH.

Results

NAFLD was diagnosed in 76.3% of the BSx patients with 61.9% having SS and 14.4% having NASH; 23.7% had NL. Those with NASH had significantly higher (p < 0.05) pre-VLCD ALT, AST, insulin resistance, and proportion of individuals with diabetes compared to those with NL. Overall, VLCD resulted in significant decreases in BMI, ALP, fasting glucose and insulin, HbA1c, total cholesterol, HDL and LDL cholesterol, and significant increases in AST and ALT. Changes were similar between groups.

Conclusions

Post-VLCD, the prevalence of NAFLD and NASH was lower compared to published reports, with almost 25% of the patients having a NL. With VLCD, metabolic and clinical changes were similar between the three groups suggesting that pre-VLCD factors may affect liver histology.

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Acknowledgements

The authors are appreciative and acknowledge the important contributions made by the research assistants, clinical staff, surgical staff, bariatric clinic nurses, operating room nurses, and study participants at the University Health Network.

Funding

This study was funded by the Canadian Institutes for Health Research, Operating Grant MOP-126139.

Author information

Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Katherine J. P. Schwenger & Allan Okrainec

  2. Toronto General Hospital, University Health Network, 585 University Avenue, 9-973, Toronto, ON, M5G 2C4, Canada

    Katherine J. P. Schwenger, Sandra E. Fischer & Johane P. Allard

  3. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Sandra E. Fischer

  4. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    Timothy D. Jackson & Allan Okrainec

  5. Division of General Surgery|, University Health Network, Toronto, ON, Canada

    Timothy D. Jackson & Allan Okrainec

  6. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Johane P. Allard

  7. Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada

    Johane P. Allard

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  1. Katherine J. P. Schwenger
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Correspondence to Johane P. Allard.

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Conflict of Interest

Authors 1–3 and 5 have no conflict of interest to declare. Author 4 has relevant financial activities outside of the submitted work. He is provided an honorarium for speaking and teaching from Ethicon and Medtronic.

Ethical Approval

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Schwenger, K.J.P., Fischer, S.E., Jackson, T.D. et al. Non-alcoholic Fatty Liver Disease in Morbidly Obese Individuals Undergoing Bariatric Surgery: Prevalence and Effect of the Pre-Bariatric Very Low Calorie Diet. OBES SURG 28, 1109–1116 (2018). https://doi.org/10.1007/s11695-017-2980-3

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