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Obesity Surgery
Published in: Obesity Surgery 11/2015

01-11-2015 | Original Contributions

Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery

Authors: Palanivelu Praveenraj, Rachel M. Gomes, Saravana Kumar, Purushothaman Karthikeyan, Annapoorni Shankar, Ramakrishnan Parthasarathi, Palanisamy Senthilnathan, Subbiah Rajapandian, Chinnusamy Palanivelu

Published in: Obesity Surgery | Issue 11/2015

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Abstract

Background

Numerous studies worldwide have identified a high prevalence of non-alcoholic fatty liver disease (NAFLD) among morbidly obese subjects. Several predictors have been found to be associated with NAFLD and its histological high-risk components. Similar data from India is lacking. We aimed to determine the prevalence and the predictors of NAFLD and its histological high-risk components in a cohort of Indians with morbid obesity undergoing bariatric surgery. Safety of a routine intraoperative liver biopsy was also assessed.

Methods

There were 134 morbidly obese patients who underwent bariatric surgery with concomitant liver biopsy. These were assessed for NAFLD and its histological high-risk components. Clinical, biochemical, and histological features were evaluated, and predictors of NAFLD, non-alcoholic steatohepatitis (NASH), fibrosis, and advanced fibrosis were identified.

Results

Mean BMI was 44.66 ± 9.81. Eighty-eight (65.7 %) showed NAFLD. Forty-five (33.6 %) showed NASH and 42 (31.3 %) showed fibrosis both not mutually exclusive. Nineteen (14.1 %) showed advanced fibrosis. Higher alanine aminotransferase (ALT) independently predicted NAFLD and was significantly associated with NASH and fibrosis. Type 2 diabetes mellitus (T2DM) and the metabolic syndrome were significantly associated with fibrosis. Systemic hypertension (HT) independently predicted NASH and fibrosis. There were no intraoperative or postoperative complications related to the liver biopsy.

Conclusions

NAFLD has a high prevalence among morbidly obese patients. Elevated ALT, HT, T2DM, and the metabolic syndrome are predictors for NAFLD and its high-risk histological components. Routine intraoperative liver biopsy is safe in morbidly obese undergoing bariatric surgery for diagnosing NAFLD.
Literature
1.
2.
3.
4.
Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6(3):161–3.PubMed
5.
Singh SP, Nayak S, Swain M, et al. Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop Gastroenterol Off J Dig Dis Found. 2004;25(2):76–9.
6.
Mohan V, Farooq S, Deepa M, et al. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract. 2009;84(1):84–91.CrossRefPubMed
7.
Siraj P, Kohli N, Srivastava VK, et al. Relationship of nonalcoholic fatty liver disease with anthropometric measurement among patients attending a tertiary care hospital of Northern India. Indian J Community Health. 2013;25(3):208–12.
8.
Team R, LaBrecque DR, Abbas Z, et al. World Gastroenterology Organisation global guidelines: nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J Clin Gastroenterol. 2014;48(6):467–73.
9.
Nayak NC, Vasdev N, Saigal S, et al. End-stage nonalcoholic fatty liver disease: evaluation of pathomorphologic features and relationship to cryptogenic cirrhosis from study of explant livers in a living donor liver transplant program. Hum Pathol. 2010;41(3):425–30.CrossRefPubMed
10.
Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121(1):91–100.CrossRefPubMed
11.
Beymer C, Kowdley KV, Larson A, et al. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg Chic III 1960. 2003;138(11):1240–4.
12.
Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg. 2002;12(1):49–51.CrossRefPubMed
13.
Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol WJG. 2014;20(2):475–85.CrossRefPubMed
14.
Dolce CJ, Russo M, Keller JE, et al. Does liver appearance predict histopathologic findings: prospective analysis of routine liver biopsies during bariatric surgery. Surg Obes Relat Dis. 2009;5(3):323–8.CrossRefPubMed
15.
Duseja A. Nonalcoholic fatty liver disease in India—a lot done, yet more required! Indian J Gastroenterol. 2010;29(6):217–25.CrossRefPubMed
16.
Harrison SA, Oliver D, Arnold HL, et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57(10):1441–7.CrossRefPubMed
17.
Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15(3):310–5.CrossRefPubMed
18.
Abrams GA, Kunde SS, Lazenby AJ, et al. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatol Baltim Md. 2004;40(2):475–83.CrossRef
19.
Palekar NA, Naus R, Larson SP, et al. Clinical model for distinguishing nonalcoholic steatohepatitis from simple steatosis in patients with nonalcoholic fatty liver disease. Liver Int Off J Int Assoc Study Liver. 2006;26(2):151–6.CrossRef
20.
Frantzides CT, Carlson MA, Moore RE, et al. Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2004;8(7):849–55.CrossRef
21.
Duseja A, Das A, Das R, et al. The clinicopathological profile of Indian patients with nonalcoholic fatty liver disease (NAFLD) is different from that in the West. Dig Dis Sci. 2007;52(9):2368–74.CrossRefPubMed
22.
Amarapurkar DN, Patel ND. Prevalence of metabolic syndrome in non-diabetic and non-cirrhotic patients with non-alcoholic steatohepatitis. Trop Gastroenterol Off J Dig Dis Found. 2004;25(3):125–9.
23.
24.
Dixon JB, Bhathal PS, Jonsson JR, et al. Pro-fibrotic polymorphisms predictive of advanced liver fibrosis in the severely obese. J Hepatol. 2003;39(6):967–71.CrossRefPubMed
25.
Georgescu EF. Angiotensin receptor blockers in the treatment of NASH/NAFLD: could they be a first-class option? Adv Ther. 2008;25(11):1141–74.CrossRefPubMed
26.
Yokohama S, Tokusashi Y, Nakamura K, et al. Inhibitory effect of angiotensin II receptor antagonist on hepatic stellate cell activation in non-alcoholic steatohepatitis. World J Gastroenterol WJG. 2006;12(2):322–6.PubMed
27.
28.
Musso G, Cassader M, Olivetti C, et al. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev. 2013;14(5):417–31.CrossRefPubMed
29.
30.
Chang Y, Ryu S, Sung E, et al. Higher concentrations of alanine aminotransferase within the reference interval predict nonalcoholic fatty liver disease. Clin Chem. 2007;53(4):686–92.CrossRefPubMed
31.
Prati D, Taioli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137(1):1–10.CrossRefPubMed
32.
Amarapurkar DN, Patel ND. Clinical spectrum and natural history of non-alcoholic steatohepatitis with normal alanine aminotransferase values. Trop Gastroenterol Off J Dig Dis Found. 2004;25(3):130–4.
33.
34.
Shalhub S, Parsee A, Gallagher SF, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54–9.CrossRefPubMed
35.
Clark JM, Alkhuraishi ARA, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13(7):1180–6.CrossRefPubMed
36.
Dixon JB, Bhathal PS, Hughes NR, et al. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology. 2004;39(6):1647–54.CrossRefPubMed
37.
Stratopoulos C, Papakonstantinou A, Terzis I, et al. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg. 2005;15(8):1154–60.CrossRefPubMed
38.
Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135(1):48–58.CrossRefPubMed
Metadata
Title
Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery
Authors
Palanivelu Praveenraj
Rachel M. Gomes
Saravana Kumar
Purushothaman Karthikeyan
Annapoorni Shankar
Ramakrishnan Parthasarathi
Palanisamy Senthilnathan
Subbiah Rajapandian
Chinnusamy Palanivelu
Publication date
01-11-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1655-1

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