Prevalence of Non-alcoholic Fatty Liver Disease and Steatohepatitis Risk Factors in Patients Undergoing Bariatric Surgery

Background Non-alcoholic fatty liver disease (NAFLD) associated with obesity comprises pathological changes ranging from steatosis to steatohepatitis; these can evolve to cirrhosis and hepatocellular carcinoma. Objectives The objectives of this study are to assess the prevalence of and predictive ma...

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Bibliographic Details
Published in:	Obesity surgery Vol. 25; no. 12; pp. 2335 - 2343
Main Authors:	Morita, Shinhiti, Neto, Dalísio De Santi, Morita, Flávio Hiroshi Ananias, Morita, Nina Kimie, Lobo, Suzana Margareth Ajeje
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-12-2015 Springer Nature B.V
Subjects:	Adult Alanine Transaminase - blood Bariatric Surgery - statistics & numerical data Cohort Studies Cross-Sectional Studies Fatty Liver - complications Fatty Liver - epidemiology Fatty Liver - surgery Female Gastrointestinal surgery Humans Liver Cirrhosis - complications Liver Cirrhosis - epidemiology Liver Cirrhosis - surgery Liver diseases Male Medicine Medicine & Public Health Middle Aged Non-alcoholic Fatty Liver Disease - complications Non-alcoholic Fatty Liver Disease - epidemiology Non-alcoholic Fatty Liver Disease - surgery Obesity Obesity, Morbid - complications Obesity, Morbid - epidemiology Obesity, Morbid - surgery Original Contributions Prevalence Risk Factors Surgery Morbid obesity Non-alcoholic fatty liver disease Steatohepatitis Steatosis
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Summary:	Background Non-alcoholic fatty liver disease (NAFLD) associated with obesity comprises pathological changes ranging from steatosis to steatohepatitis; these can evolve to cirrhosis and hepatocellular carcinoma. Objectives The objectives of this study are to assess the prevalence of and predictive markers for steatohepatitis in obese patients undergoing bariatric surgery. Methods A prospective study of 184 morbidly obese patients undergoing bariatric surgery formed the study cohort. Patients taking potentially hepatotoxic medications and those with viral diseases and a history of excessive alcohol consumption were excluded. Liver biopsies were performed during surgery with a “Trucut” needle. Patients were classified into the following groups according to the histopathological findings: normal, steatosis, mild steatohepatitis, and moderate-severe steatohepatitis. Factors associated with steatohepatitis were evaluated using logistic regression. p values <0.05 were considered significant. Results The prevalence of NAFLD was 84 % (steatosis, 22.0 %; mild steatohepatitis, 30.8 %; moderate-severe steatohepatitis, 32.0 %). Independent predictive factors for steatohepatitis were age (odds ratio (OR), 1.05; 95 % confidence interval (CI), 1.01–1.09; p = 0.011), waist circumference (OR, 1.03; 95 % CI, 1.00–1.06; p = 0.021), serum alanine aminotransferase (ALT) levels (OR, 1.04; 95 % CI, 1.01–1.08; p = 0.005), and serum triglyceride levels (OR, 1.01; 95 % CI, 1.00–1.01; p = 0.042). Score values for each predictor were derived from regression coefficients and odds ratio, and a total (risk) score was obtained from the sum of the points to evaluate the probability of having steatohepatitis. Conclusion Age, waist circumference, serum ALT levels, and serum triglyceride levels are efficient and non-invasive predictive markers for the diagnosis and management of steatohepatitis in morbidly obese patients.
ISSN:	0960-8923 1708-0428
DOI:	10.1007/s11695-015-1696-5