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Obesity Surgery
Published in: Obesity Surgery 10/2016

Open Access 01-10-2016 | Original Contributions

Prevalence of Liver Fibrosis and its Association with Non-invasive Fibrosis and Metabolic Markers in Morbidly Obese Patients with Vitamin D Deficiency

Authors: Maria Luger, Renate Kruschitz, Christian Kienbacher, Stefan Traussnigg, Felix B. Langer, Karin Schindler, Tanja Würger, Friedrich Wrba, Michael Trauner, Gerhard Prager, Bernhard Ludvik

Published in: Obesity Surgery | Issue 10/2016

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Abstract

Background

Morbidly obese patients are at risk for non-alcoholic fatty liver disease (NAFLD) and vitamin D deficiency (VDD). Non-alcoholic steatohepatitis (NASH) is the progressive variant of NAFLD and can advance to fibrosis, cirrhosis, and liver cancer. We aimed to examine prevalence of liver fibrosis and its non-invasive predictors in bariatric patients with VDD (<75 nmol/l).

Methods

Baseline liver biopsy of a randomized controlled trial was performed in 46 patients with omega loop gastric bypass. Clinical, laboratory, and histological data were examined and tested with univariate and multivariable analysis.

Results

In total, 80 % were females, aged 42 (SD 13) years with BMI 44 (4) kg/m2. Twenty-six percent had diabetes mellitus (DM) and 44 % metabolic syndrome (MeS). Seventy-two percent had NASH, 11 % simple steatosis, and 17 % normal liver. In total, 30 % demonstrated significant fibrosis (F ≥ 2) with 9 % of advanced (F3) and 4 % cirrhosis (F4). Increased stages of fibrosis were primarily associated with higher levels of HOMA2-insulin resistance (IR), procollagen type I propeptide (P1NP), lower osteocalcin, albumin-corrected calcium, parathyroid hormone, vitamin D, male sex, and higher age. Other independent risk factors for advanced fibrosis were MeS (OR = 9.3 [0.99–87.5], p = 0.052) and DM (OR = 12.8 [1.2–137.4], p = 0.035). The fibrosis FIB-4 index <10.62 and NAFLD fibrosis score <−26.93 had a negative predictive value of 100 and 96 %, respectively.

Conclusions

Liver fibrosis is frequent in morbidly obese patients with concurrent DM and/or MeS. Increased serum levels of IR, P1NP, lower osteocalcin, and VDD are clinically relevant predictors of fibrosis. Consequently, we suggest that patients with preoperative presence of these markers are at increased risk for liver fibrosis and should be monitored closely.
Literature
1.
2.
3.
Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology. 2010;51(2):679–89.CrossRefPubMedPubMedCentral
4.
de Marco R, Locatelli F, Zoppini G, Verlato G, Bonora E, Muggeo M. Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study. Diabetes Care. 1999;22(5):756–61.CrossRefPubMed
5.
Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45(4):600–6.CrossRefPubMed
6.
Putz-Bankuti C, Pilz S, Stojakovic T, Scharnagl H, Pieber TR, Trauner M, et al. Association of 25-hydroxyvitamin D levels with liver dysfunction and mortality in chronic liver disease. Liver Int. 2012;32(5):845–51.CrossRefPubMed
7.
Eliades M, Spyrou E, Agrawal N, Lazo M, Brancati FL, Potter JJ, et al. Meta-analysis: vitamin D and non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2013;38:246–54.CrossRefPubMed
8.
9.
Grunhage F, Hochrath K, Krawczyk M, Hoblinger A, Obermayer-Pietsch B, Geisel J, et al. Common genetic variation in vitamin D metabolism is associated with liver stiffness. Hepatology. 2012;56(5):1883–91.CrossRefPubMed
10.
Vander Naalt SJ, Gurria JP, Holterman AL. Surgical treatment of nonalcoholic fatty liver disease in severely obese patients. Hepat Med. 2014;6:103–12.PubMedPubMedCentral
11.
Luger M, Kruschitz R, Marculescu R, Haslacher H, Hoppichler F, Kallay E, et al. The link between obesity and vitamin D in bariatric patients with omega-loop gastric bypass surgery—a vitamin D supplementation trial to compare the efficacy of postoperative cholecalciferol loading (LOAD): study protocol for a randomized controlled trial. Trials. 2015;16(1):328.CrossRefPubMedPubMedCentral
12.
Dale O, Salo M. The Helsinki Declaration, research guidelines and regulations: present and future editorial aspects. Acta Anaesthesiol Scand. 1996;40(7):771–2.CrossRefPubMed
13.
14.
Jain A, Bhayana S, Vlasschaert M, House A. A formula to predict corrected calcium in haemodialysis patients. Nephrol Dial Transplant. 2008;23(9):2884–8.CrossRefPubMed
15.
Veith R. What is the optimal vitamin D status for health? Prog Biophys Mol Biol. 2006;92(1):26–32.CrossRef
16.
Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994;330(13):877–84.CrossRefPubMed
17.
Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998;21(12):2191–2.CrossRefPubMed
18.
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. IDF. 2006.
19.
McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59(9):1265–9.CrossRefPubMed
20.
Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–54.CrossRefPubMed
21.
Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Nonalcoholic Steatohepatitis Clinical Research, N. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.CrossRefPubMed
22.
Bedossa P, Poitou C, Veyrie N, Bouillot JL, Basdevant A, Paradis V, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology. 2012;56(5):1751–9.CrossRefPubMed
23.
Luger M, Kruschitz R, Langer F, Prager G, Walker M, Marculescu R, et al. Effects of omega-loop gastric bypass on vitamin D and bone metabolism in morbidly obese bariatric patients. Obes Surg. 2015;25(6):1056–62.CrossRefPubMed
24.
Tsuneoka K, Tameda Y, Takase K, Nakano T. Osteodystrophy in patients with chronic hepatitis and liver cirrhosis. J Gastroenterol. 1996;31(5):669–78.CrossRefPubMed
25.
Beilfuss A, Sowa JP, Sydor S, Beste M, Bechmann LP, Schlattjan M, et al. Vitamin D counteracts fibrogenic TGF-beta signalling in human hepatic stellate cells both receptor-dependently and independently. Gut. 2015;64(5):791–9.CrossRefPubMed
26.
Targher G, Bertolini L, Scala L, Cigolini M, Zenari L, Falezza G, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 2007;17(7):517–24.CrossRefPubMed
27.
Zhu L, Kong M, Han YP, Bai L, Zhang X, Chen Y, et al. Spontaneous liver fibrosis induced by long term dietary vitamin D deficiency in adult mice is related to chronic inflammation and enhanced apoptosis. Can J Physiol Pharmacol. 2015;93(5):385–94.CrossRefPubMed
28.
Guanabens N, Pares A, Alvarez L, Martinez de Osaba MJ, Monegal A, Peris P, et al. Collagen-related markers of bone turnover reflect the severity of liver fibrosis in patients with primary biliary cirrhosis. J Bone Miner Res. 1998;13(4):731–8.CrossRefPubMed
29.
Veidal SS, Vassiliadis E, Bay-Jensen AC, Tougas G, Vainer B, Karsdal MA. Procollagen type I N-terminal propeptide (PINP) is a marker for fibrogenesis in bile duct ligation-induced fibrosis in rats. Fibrogenesis Tissue Repair. 2010;3(1):5.CrossRefPubMedPubMedCentral
30.
Miroliaee A, Nasiri-Toosi M, Khalilzadeh O, Esteghamati A, Abdollahi A, Mazloumi M. Disturbances of parathyroid hormone-vitamin D axis in non-cholestatic chronic liver disease: a cross-sectional study. Hepatol Int. 2010;4(3):634–40.CrossRefPubMedPubMedCentral
31.
Adorini L. Vitamin D receptor polymorphisms in primary biliary cirrhosis: a functional connection? J Hepatol. 2009;50(6):1071–3.CrossRefPubMed
32.
Kim D, Kim WR, Kim HJ, Therneau TM. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2013;57(4):1357–65.CrossRefPubMedPubMedCentral
33.
Petta S, Vanni E, Bugianesi E, Di Marco V, Camma C, Cabibi D, et al. The combination of liver stiffness measurement and NAFLD fibrosis score improves the noninvasive diagnostic accuracy for severe liver fibrosis in patients with nonalcoholic fatty liver disease. Liver Int. 2015;35(5):1566–73.CrossRefPubMed
34.
Hafeez S, Ahmed MH. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance? J Obes. 2013;2013:839275.CrossRefPubMedPubMedCentral
35.
Bhangui P, Laurent A, Amathieu R, Azoulay D. Assessment of risk for non-hepatic surgery in cirrhotic patients. J Hepatol. 2012;57(4):874–84.CrossRefPubMed
Metadata
Title
Prevalence of Liver Fibrosis and its Association with Non-invasive Fibrosis and Metabolic Markers in Morbidly Obese Patients with Vitamin D Deficiency
Authors
Maria Luger
Renate Kruschitz
Christian Kienbacher
Stefan Traussnigg
Felix B. Langer
Karin Schindler
Tanja Würger
Friedrich Wrba
Michael Trauner
Gerhard Prager
Bernhard Ludvik
Publication date
01-10-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2123-2

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