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The effects of bariatric surgeries on nonalcoholic fatty liver disease

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Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and is associated with obesity. Bariatric surgery has been shown to be the most effective method for weight reduction. However, no conclusive data exists on the effects of weight reduction surgery on NAFLD. This study aimed to characterize liver histology, metabolic status, and liver function changes in patients who underwent bariatric surgery, before and after the weight-reduction procedure. This is a phase 1 report of a prospective cohort study of patients who underwent bariatric surgery. Biopsies were obtained at baseline (intraoperatively) and 3 months postoperatively. Clinical characteristics, biochemical profile, and histopathological data [steatosis, NAFLD activity score (NAS), hepatocyte ballooning, lobular inflammation, and degree of fibrosis] were obtained at each time point. Twenty-seven patients were included (9 men and 18 women), and the median age was 35 ± 8 years old. At baseline, 3 patients had dyslipidemia, 4 had diabetes, and 5 patients had hypertension, which did not change at follow-up. The average body mass index decreased from 44.6 ± 7.8 to 34.2 ± 6.3 kg/m2 at follow-up (P < 0.001). On histopathology, 12 of the 18 patients with preoperative steatosis (median score 2) had reduced steatosis scores postoperatively (P = 0.025); fibrosis (median score 1) was also reduced in 17 patients (P = 0.012), and NAS was decreased from 4 (3–5) to 2 (1–3) (P = 0.004). The changes in lobular inflammation and hepatocyte ballooning were not statistically significant on follow-up. The phase 1 results of this study described the histopathological changes following weight reduction surgery and suggested that hepatic steatosis, fibrosis, and NAFLD activity score were reduced 3 months after surgery. This clinical trial is financially supported by the National Plan for Science, Technology and Innovation Program grant number (11-MED1910-02).

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References

  1. Dixon JB (2007) Surgical treatment for obesity and its impact on non-alcoholicsteatohepatitis. Clin Liver Dis 11:141–154

    Article  PubMed  Google Scholar 

  2. Kamada Y, Takehara T, Hayashi N (2008) Adipocytokines and liver disease. J Gastroenterol 43:811–822

    Article  CAS  PubMed  Google Scholar 

  3. Gholam PM, Kotler DP, Flancbaum LJ (2002) Liver pathology in morbidlyobese patients undergoing Roux-en-Y gastric bypass surgery. ObesSurg 12:49–51

    Google Scholar 

  4. Oliveira CP, Faintuch J, Rascovski A, Furuya CK Jr, Bastos Mdo S, Matsuda M et al (2005) Lipid peroxidation in bariatric candidates with nonalcoholic fatty liver disease (NAFLD): Preliminary findings. ObesSurg 15:502–505

    Google Scholar 

  5. Frantzides CT, Carlson MA, Moore RE, Zografakis JG, Madan AK, Puumala S et al (2004) Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery. J Gastrointest Surg 8:849–855

    Article  PubMed  Google Scholar 

  6. Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR (2003) Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg 138:1240–1244

    Article  PubMed  Google Scholar 

  7. Dixon JB, Bhathal PS, O’Brien PE (2001) Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 121:91–100

    Article  CAS  PubMed  Google Scholar 

  8. Ekstedt M, Franzen LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G et al (2006) Long-term follow-up of patients with NAFLD andelevated liver enzymes. Hepatology 44:865–873

    Article  CAS  PubMed  Google Scholar 

  9. Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M et al (2011) Prevalence of nonalcoholic fatty liver disease and nonalcoholicsteatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 140:124–131

    Article  PubMed  Google Scholar 

  10. Sanyal AJNASH (2011) A global health problem. Hepatol Res 41:670–674

    PubMed  Google Scholar 

  11. Physical status: The use and interpretation of anthropometry. Reportof a WHO Expert Committee. World Health Organ Tech Rep Ser1995;854:1–452

  12. State-specific prevalence of obesity among adults–United States, 2005.Morb Mortal Wkly Rep 2006;55:985–8

  13. Hossain P, Kawar B, El Nahas M (2007) Obesity and diabetes in the developing world: a growing challenge. N Engl J Med 356:213–215

    Article  CAS  PubMed  Google Scholar 

  14. Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB et al (2005) Obesity in Saudi Arabia. Saudi Med J 26:824–829

    PubMed  Google Scholar 

  15. Angulo P, Lindor KD (2002) Non-alcoholic fatty liver disease. J GastroenterolHepatol 17(Suppl):S186–S190

    Google Scholar 

  16. Mattar SG, Velcu LM, Rabinovitz M, Demetris AJ, Krasinskas AM, Barinas-Mitchell E et al (2005) Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg 242:610–617

    PubMed  PubMed Central  Google Scholar 

  17. Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW (1990) The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 11:74–80

    Article  PubMed  Google Scholar 

  18. Ludwig J, Viggiano TR, McGill DB, Oh BJ (1980) Nonalcoholic steatohepatitis: mayo Clinic experiences with a hitherto unnamed disease. Mayo ClinProc 55:434–438

    CAS  Google Scholar 

  19. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41:1313–1321

    Article  PubMed  Google Scholar 

  20. Kirovski G, Schacherer D, Wobser H, Huber H, Niessen C, Beer C et al (2010) Prevalence of ultrasound-diagnosed non-alcoholic fatty liver disease ina hospital cohort and its association with anthropometric, biochemicaland sonographic characteristics. Int J Clin Exp Med 3:202–210

    PubMed  PubMed Central  Google Scholar 

  21. Paschos P, Paletas K (2009) Non alcoholic fatty liver disease and metabolicsyndrome. Hippokratia 13:9–19

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Al-hamoudi W, El-Sabbah M, Ali S, Altuwaijri M, Bedewi M, Adam M et al (2012) Epidemiological, clinical, and biochemical characteristics of Saudi patients with nonalcoholic fatty liver disease: a hospital-based study. Ann Saudi Med 32:288–292

    PubMed  Google Scholar 

  23. Ruhl CE, Everhart JE (2003) Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the UnitedStates. Gastroenterology 124:71–79

    Article  CAS  PubMed  Google Scholar 

  24. Spaulding L, Trainer T, Janiec D (2003) Prevalence of non-alcoholicsteatohepatitis in morbidly obese subjects undergoing gastric bypass. Obes Surg 13:347–349

    Article  PubMed  Google Scholar 

  25. Moretto M, Kupski C, Mottin CC, Repetto G, Garcia Toneto M, Rizzolli J et al (2003) Hepatic steatosis in patients undergoing bariatric surgery andits relationship to body mass index and co-morbidities. Obes Surg 13:622–624

    Article  PubMed  Google Scholar 

  26. Silverman EM, Sapala JA, Appelman HD (1995) Regression of hepatic steatosisin morbidly obese persons after gastric bypass. Am J Clin Pathol 104:23–31

    Article  CAS  PubMed  Google Scholar 

  27. Dixon JB, Bhathal PS, Hughes NR, O’Brien PE (2004) Nonalcoholic fatty liverdisease: improvement in liver histological analysis with weight loss. Hepatology 39:1647–1654

    Article  PubMed  Google Scholar 

  28. Padwal RS (2005) Characteristics of patients undergoing bariatric surgery inCanada. Obes Res 13:2052–2054

    Article  PubMed  Google Scholar 

  29. Trus TL, Pope GD, Finlayson SR (2005) National trends in utilization andoutcomes of bariatric surgery. Surg Endosc 19:616–620

    Article  CAS  PubMed  Google Scholar 

  30. Dixon JB, Anderson M, Cameron-Smith D, O’Brien PE (2004) Sustained weightloss in obese subjects has benefits that are independent of attainedweight. Obes Res 12:1895–1902

    Article  PubMed  Google Scholar 

  31. MacDonald KGJ, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL et al (1997) The gastric bypass operation reduces the progression andmortality of non-insulin-dependent diabetes mellitus. J GastrointestSurg 1:213–220

    Article  Google Scholar 

  32. Kashyap SR, Daud S, Kelly KR, Gastaldelli A, Win H, Brethauer S,et al. Acute effects of gastric bypass versus gastric restrictivesurgery on beta-cell function and insulinotropic hormones inseverely obese patients with type 2 diabetes. Int J Obes (Lond)2010;34:462–71

  33. Klein S, Mittendorfer B, Eagon JC, Patterson B, Grant L, Feirt N et al (2006) Gastric bypass surgery improves metabolic and hepatic abnormalities associated with nonalcoholic fatty liver disease. Gastroenterology 130:1564–1572

    Article  CAS  PubMed  Google Scholar 

  34. Moschen AR, Molnar C, Geiger S, Graziadei I, Ebenbichler CF, Weiss H et al (2010) Anti-inflammatory effects of excessive weight loss: potentsuppression of adipose interleukin 6 and tumour necrosis factor alphaexpression. Gut 59:1259–1264

    Article  CAS  PubMed  Google Scholar 

  35. Clark JM, Alkhuraishi AR, Solga SF, Alli P, Diehl AM, Magnuson TH (2005) Roux-en-Y gastric bypass improves liver histology in patients withnon-alcoholic fatty liver disease. Obes Res 13:1180–1186

    Article  PubMed  Google Scholar 

  36. Furuya CK Jr, de Oliveira CP, de Mello ES, Faintuch J, Raskovski A, Matsuda M et al (2007) Effects of bariatric surgery on nonalcoholic fatty liverdisease: preliminary findings after 2 years. J Gastroenterol Hepatol 22:510–514

    Article  CAS  PubMed  Google Scholar 

  37. Mathurin P, Hollebecque A, Arnalsteen L, Buob D, Leteurtre E, Caiazzo R et al (2009) Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology 137:532–540

    Article  CAS  PubMed  Google Scholar 

  38. Papadia F, Marinari GM, Camerini G, Adami GF, Murelli F, Carlini F et al (2003) Short-term liver function after biliopancreatic diversion. Obes Surg 13:752–755

    Article  PubMed  Google Scholar 

  39. Keshishian A, Zahriya K, Willes EB (2005) Duodenal switch has no detrimental effects on hepatic function and improves hepatic steatohepatitis after6 months. Obes Surg 15:1418–1423

    Article  PubMed  Google Scholar 

  40. Burza MA, Romeo S, Kotronen A, Svensson PA, Sjöholm K, Torgerson JS, Lindroos AK, Sjöström L, Carlsson LM, Peltonen M (2013) Long-term effect of bariatric surgery on liver enzymes in the Swedish Obese Subjects (SOS) study. PLoS ONE 8(3):e60495

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This clinical trial is financially supported by The National Plan for Science, Technology and Innovation Program Grant Number (11-MED1910-02).

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Tamadar Aldoheyan, Mazen Hassanain, Amnah Al-Mulhim, Atheer Al-Sabhan, Shaden Al-Amro & Fahad Bamehriz

  2. Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Tamadar Aldoheyan & Hisham Al-Khalidi

  3. Liver Disease Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Tamadar Aldoheyan & Mazen Hassanain

  4. Department of Oncology, McGill University, Montreal, Canada

    Mazen Hassanain

  5. Hubert Department of Global Health, Emory University, Atlanta, USA

    Mazen Hassanain

Authors
  1. Tamadar Aldoheyan
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  2. Mazen Hassanain
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  3. Amnah Al-Mulhim
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  4. Atheer Al-Sabhan
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  7. Hisham Al-Khalidi
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Correspondence to Mazen Hassanain.

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Authors T. Aldoheyan, M. Hassanian, A. Al-Mulhim, A. Al-Sabhan, S. Al-Amro, F. Bamehriz and H. Al Khalid have no conflicts of interest.

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Tamadar Aldoheyan and Mazen Hassanian have equally shared first co-authorship.

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Aldoheyan, T., Hassanain, M., Al-Mulhim, A. et al. The effects of bariatric surgeries on nonalcoholic fatty liver disease. Surg Endosc 31, 1142–1147 (2017). https://doi.org/10.1007/s00464-016-5082-8

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  • DOI: https://doi.org/10.1007/s00464-016-5082-8

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