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Impact of Weight-Loss Surgery and Diabetes Status on Serum ALT Levels

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Abstract

Background

Alanine aminotransferase (ALT) is used to detect non-alcoholic fatty liver disease and has been associated with increased risk of metabolic syndrome and type II diabetes mellitus (T2DM). Bariatric procedures result in significant weight loss and a rapid resolution of T2DM. We aimed to study the impact of bariatric interventions on ALT levels in patients with or without T2DM and compare this effect between different types of weight-loss procedures.

Methods

We reviewed 756 patients undergoing bariatric surgery. Demographics, co-morbidities, baseline and post-operative ALT and HbA1C levels, weight-loss data, and diabetes status were recorded. ALT levels were compared between different procedures and between diabetic and non-diabetic patients. Chi-square test, ANOVA, and t test were used to evaluate outcomes.

Results

Males and diabetics had significantly higher ALT at baseline. Both Roux-en-Y gastric bypass surgery (RYGB) and laparoscopic adjustable gastric banding (LAGB) resulted in significant reduction in ALT levels beginning at the third post-operative month (20 and 17 %, respectively, compared to baseline, p < 0.001). ALT remained at the new low level up to year 3 after surgery. The degree of reduction was similar for both procedures and was independent of the degree of weight loss. In diabetics, ALT reduction was associated with improvement in disease; but in T2DM patients who remained on insulin, ALT remained elevated.

Conclusions

RYGB and LAGB decrease ALT levels to the same degree and independent of weight loss. Our data confirm higher ALT in diabetics and demonstrate a rapid normalization after bariatric surgery with a simultaneous decrease in HbA1C. These results suggest that ALT may be used as a marker of metabolic improvement after bariatric surgery.

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Acknowledgment

AT is supported by a KL2 Medical Research Investigator Training grant awarded via Harvard Catalyst, the Harvard Clinical and Translational Science Center (NIH grant #1KL2RR025757-01 and financial contributions from Harvard University and its affiliated academic health care centers).

Conflict of Interest

We, the authors, verify that the submitted material has not been published and is not currently submitted for publication elsewhere. We agree to the inclusion of our names in the list of authors on the manuscript in the order shown on the title page. D. Xourafas, A. Ardestani, and S. W. Ashley have no conflicts of interest or financial ties to disclose. A. Tavakkoli has been a consultant for GlaxoSmithKlein and Novartis Pharmaceutical. He has an equity interest in Avaxia Biologics, Inc.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Dimitrios Xourafas, Ali Ardestani, Stanley W. Ashley & Ali Tavakkoli

Authors
  1. Dimitrios Xourafas
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  2. Ali Ardestani
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  3. Stanley W. Ashley
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  4. Ali Tavakkoli
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Corresponding author

Correspondence to Ali Tavakkoli.

Additional information

Different abstracts from this manuscript were presented at the Academic Surgical Congress, San Antonio, TX, February 2010, and at the American Society of Metabolic and Bariatric Surgeons Congress, Las Vegas, NV, June 2010.

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Xourafas, D., Ardestani, A., Ashley, S.W. et al. Impact of Weight-Loss Surgery and Diabetes Status on Serum ALT Levels. OBES SURG 22, 1540–1547 (2012). https://doi.org/10.1007/s11695-012-0677-1

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