Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 10/2020

01-10-2020 | Obesity | Original Contributions

Elastic Fibers Density: a New Parameter of Improvement of NAFLD in Bariatric Surgery Patients

Authors: Carine Leite, Rodrigo Tzovenos Starosta, Eduardo Neubarth Trindade, Eduardo de Melo Monteiro, Pedro Funari Pereira, Manoel Roberto Maciel Trindade, Mário Reis Álvares-da-Silva, Carlos Thadeu Schmidt Cerski

Published in: Obesity Surgery | Issue 10/2020

Login to get access

Abstract

Purpose

Obesity is a major risk factor for nonalcoholic fatty liver disease (NAFLD), affecting 25% of the worldwide population. Weight loss through bariatric surgery can improve much of the liver steatosis, inflammation, and fibrosis. However, it is not known whether there is reversal of the elastic fiber deposition process, triggered by hepatic damage and related to worse prognosis.

Materials and Methods

Individuals submitted to bariatric surgery at our institution, from March 2016 to June 2017, with intraoperative liver biopsy confirming NAFLD were approached. Those who consented were submitted to a second liver biopsy 1 year later and were included. Specimens were sliced and stained with hematoxylin-eosin and Sirius red for histological assessment according to Brunt’s criteria and with orcein for digital analysis morphometrics using ImageJ®. Quantification of elastic fibers was accomplished by corrected integrated density.

Results

Thirty-seven patients were included. Body mass index, metabolic markers, NAFLD activity score, and fibrosis improved 1 year after the procedure. The elastic fiber density showed a significant decrease: 239.3 × 103 absorbance micrometer2 (141.08–645.32) to 74.62 × 103 absorbance micrometer2 (57.42–145.17), p = 0.007.

Conclusion

Liver elastic fiber density decreases with the reversal of NAFLD through weight loss.
Literature
1.
Younossi ZM, Henry L, Bush H, et al. Clinical and economic burden of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Clin Liver Dis. 2018;22(1):1–10.PubMedCrossRef
2.
Younossi ZM, Stepanova M, Negro F, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore). 2012;91(6):319–27.CrossRef
3.
Pais R, Charlotte F, Fedchuk L, et al. A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol. 2013;59(3):550–6.PubMedCrossRef
4.
Lee Y, Doumouras AG, Yu J, et al. Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(6):1040–60.e11.PubMedCrossRef
5.
Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53.PubMedPubMedCentralCrossRef
6.
7.
Nakayama H, Itoh H, Kunita S, et al. Presence of perivenular elastic fibers in nonalcoholic steatohepatitis fibrosis stage III. Histol Histopathol. 2008;23(4):407–9.PubMed
8.
Porto LC, Chevallier M, Guerret S, et al. Elastin in alcoholic liver disease. An immunohistochemical and immunoelectron microscopic study. Pathol Res Pract. 1990;186(5):668–79.PubMedCrossRef
9.
10.
Houghton AM, Quintero PA, Perkins DL, et al. Elastin fragments drive disease progression in a murine model of emphysema. J Clin Invest. 2006;116(3):753–9.PubMedPubMedCentralCrossRef
11.
Chen W, Yan X, Xu A, et al. Dynamics of elastin in liver fibrosis: accumulates late during progression and degrades slowly in regression. J Cell Physiol. 2019;234:22613–22.PubMedCrossRef
12.
Kendall TJ, Dolman GE, Duff CM, et al. Hepatic elastin content is predictive of adverse outcome in advanced fibrotic liver disease. Histopathology. 2018;73(1):90–100.PubMedPubMedCentralCrossRef
13.
Hauck M, Seres I, Kiss I, et al. Effects of synthesized elastin peptides on human leukocytes. Biochem Mol Biol Int. 1995;37(1):45–55.PubMed
14.
Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis. 2012;32(1):3–13.PubMedCrossRef
15.
Trang T, Petersen JR, Snyder N. Non-invasive markers of hepatic fibrosis in patients co-infected with HCV and HIV: comparison of the APRI and FIB-4 index. Clin Chim Acta. 2008;397(1–2):51–4.PubMedCrossRef
16.
Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.PubMedCrossRef
17.
18.
Hartig SM. Basic image analysis and manipulation in ImageJ. Curr Protoc Mol Biol. 2013;Chapter 14:Unit14.5.
19.
Leite C, Starosta RT, Trindade EN, et al. Corrected integrated density: a novel method for liver elastic fibers quantification in chronic hepatitis C. Surg Exp Pathol. 2020;3(1):4
20.
Goodman ZD, Becker RL, Pockros PJ, et al. Progression of fibrosis in advanced chronic hepatitis C: evaluation by morphometric image analysis. Hepatology. 2007;45(4):886–94.PubMedCrossRef
21.
Lomonaco R, Ortiz-Lopez C, Orsak B, et al. Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease. Hepatology. 2012;55(5):1389–97.PubMedCrossRef
22.
Pellicoro A, Aucott RL, Ramachandran P, et al. Elastin accumulation is regulated at the level of degradation by macrophage metalloelastase (MMP-12) during experimental liver fibrosis. Hepatology. 2012;55(6):1965–75.PubMedCrossRef
23.
Masugi Y, Abe T, Tsujikawa H, et al. Quantitative assessment of liver fibrosis reveals a nonlinear association with fibrosis stage in nonalcoholic fatty liver disease. Hepatol Commun. 2018;2(1):58–68.PubMedCrossRef
24.
Leng SX, Xue QL, Huang Y, et al. Baseline total and specific differential white blood cell counts and 5-year all-cause mortality in community-dwelling older women. Exp Gerontol. 2005;40(12):982–7.PubMedCrossRef
25.
Elkind MS, Cheng J, Boden-Albala B, et al. Elevated white blood cell count and carotid plaque thickness: the northern Manhattan stroke study. Stroke. 2001;32(4):842–9.PubMedCrossRef
26.
Furuncuoğlu Y, Tulgar S, Dogan AN, et al. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci. 2016;20(7):1300–6.PubMed
27.
Veronelli A, Laneri M, Ranieri R, et al. White blood cells in obesity and diabetes: effects of weight loss and normalization of glucose metabolism. Diabetes Care. 2004;27(10):2501–2.PubMedCrossRef
28.
Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14(3):160–9.PubMedCrossRef
29.
Burza MA, Romeo S, Kotronen A, et al. Long-term effect of bariatric surgery on liver enzymes in the Swedish Obese Subjects (SOS) study. PLoS One. 2013;8(3):e60495.PubMedPubMedCentralCrossRef
30.
von Schönfels W, Beckmann JH, Ahrens M, et al. Histologic improvement of NAFLD in patients with obesity after bariatric surgery based on standardized NAS (NAFLD activity score). Surg Obes Relat Dis. 2018;14(10):1607–16.CrossRef
31.
32.
Meek CL, Lewis HB, Reimann F, et al. The effect of bariatric surgery on gastrointestinal and pancreatic peptide hormones. Peptides. 2016;77:28–37.PubMedCrossRef
33.
Fried M. Bariatric and metabolic surgery. Minerva Endocrinol. 2013;38(3):237–44.PubMed
34.
Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.PubMedPubMedCentralCrossRef
Metadata
Title
Elastic Fibers Density: a New Parameter of Improvement of NAFLD in Bariatric Surgery Patients
Authors
Carine Leite
Rodrigo Tzovenos Starosta
Eduardo Neubarth Trindade
Eduardo de Melo Monteiro
Pedro Funari Pereira
Manoel Roberto Maciel Trindade
Mário Reis Álvares-da-Silva
Carlos Thadeu Schmidt Cerski
Publication date
01-10-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04722-x

Other articles of this Issue 10/2020

Obesity Surgery 10/2020 Go to the issue

Letter to the Editor

Are Patients Suffering from Severe Obesity Getting a Raw Deal During COVID-19 Pandemic?

Original Contributions

Three Hundred Four Robotically Assisted Biliopancreatic Diversion with Duodenal Switch Operations with Gradual Robotic Approach Implementation: Short-Term Outcomes, Complication Profile, and Lessons Learned

Brief Communication

Jejuno-Jejunal Intussusception after Roux-en-Y Gastric Bypass

Multimedia Article

Really Totally Robotic SADI-S in a Patient with Extreme Morbid Obesity and Non-Reducible Umbilical Hernia: Case Report

Original Contributions

Laparoscopic Sleeve Gastrectomy with T-Shaped Omentoplasty: Impact on the Early Postoperative Outcomes

Letter to the Editor

Laparoscopic Roux-en-Y Gastric Bypass After Nissen Fundoplication Preserving Wraps Integrity