How bariatric surgery affects liver volume and fat density in NAFLD patients

Luo, Ran B.; Suzuki, Toshiaki; Hooker, Jonathan; Covarrubias, Yesenia; Schlein, Alexandra; Liu, Shanglei; Schwimmer, Jeffrey B.; Reeder, Scott B.; Funk, Luke M.; Greenberg, Jacob A.; Campos, Guilherme M.; Sandler, Bryan J.; Horgan, Santiago; Sirlin, Claude B.; Jacobsen, Garth R.

doi:10.1007/s00464-017-5846-9

Cited by 51 publications

(41 citation statements)

References 19 publications

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“…Both studies measured liver volume by magnetic resonance imaging and showed significant reductions in liver volume 6 months after bariatric surgery. 46,53…”

Section: Study Characteristicsmentioning

confidence: 99%

Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis

Lee

Doumouras

et al. 2019

Clinical Gastroenterology and Hepatology

251

191

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e61. Learning Objective-Upon completion of this activity, successful learners will be able to demonstrate an increase in, or affirmation of, their clinical knowledge of nonalcoholic fatty liver disease and identify the role of bariatric surgery in nonalcoholic fatty liver disease treatment. BACKGROUND & AIMS: Bariatric surgery has been reported to lead to complete resolution of nonalcoholic fatty liver disease (NAFLD) following the sustained weight loss induced in obese patients. We performed a systematic review and meta-analysis to evaluate the effects of bariatric surgery on NAFLD in obese patients. METHODS: We searched MEDLINE, EMBASE, CENTRAL, and Web of Science databases through May 2018 for studies that compared liver biopsy results before and after bariatric surgery in obese patients. Primary outcomes were biopsy-confirmed resolution of NAFLD and NAFLD activity score. Secondary outcomes were worsening of NAFLD after surgery and liver volume. The Grading of Recommendations, Assessment, Development, and Evidence approach was conducted to assess overall quality of evidence. RESULTS: We analyzed data from 32 cohort studies comprising 3093 biopsy specimens. Bariatric surgery resulted in a biopsy-confirmed resolution of steatosis in 66% of patients (95% CI, 56%-75%), inflammation in 50% (95% CI, 35%-64%), ballooning degeneration in 76% (95% CI, 64%-86%), and fibrosis in 40% (95% CI, 29%-51%). Patients' mean NAFLD activity score was reduced significantly after bariatric surgery (mean difference, 2.39; 95% CI, 1.58-3.20; P < .001). However, bariatric surgery resulted in new or worsening features of NAFLD, such as fibrosis, in 12% of patients (95% CI, 5%-20%). The overall Grading of Recommendations, Assessment, Development, and Evidence quality of evidence was very low. CONCLUSIONS: Through this systematic review and meta-analysis, we found that bariatric surgery leads to complete resolution of NAFLD in obese patients. However, some patients develop new or worsened features of NAFLD. Randomized controlled trials are needed to further examine the therapeutic benefits of bariatric surgery for patients with NAFLD.

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“…Both studies measured liver volume by magnetic resonance imaging and showed significant reductions in liver volume 6 months after bariatric surgery. 46,53…”

Section: Study Characteristicsmentioning

confidence: 99%

Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis

Lee

Doumouras

et al. 2019

Clinical Gastroenterology and Hepatology

251

191

View full text Add to dashboard Cite

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“…A Cochrane review also showed a significant improvement for patients with NAFLD following bariatric surgery, demonstrating that surgical intervention for obesity reduces its associated comorbidities . LSG, one of the most effective and reliable procedures, also demonstrated NAFLD improvement in patients …”

Section: Discussionmentioning

confidence: 95%

Improvement of non‐alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients

Endo

Ohta

Tada

et al. 2019

Annals of Gastroent Surgery

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Purpose The purpose of this study was to evaluate changes in non‐alcoholic fatty liver disease (NAFLD) after laparoscopic sleeve gastrectomy (LSG) using computed tomography (CT) images. Methods We analyzed data from 57 patients who underwent LSG and had CTs performed before and after surgery. The patients included 34 women and 23 men (with an average age of 43 years); their mean preoperative weight and body mass index were 120 kg and 46 kg/m2, respectively. Obesity‐related health disorders included type 2 diabetes mellitus (T2DM) in 33 patients, hypertension in 33 and dyslipidemia in 32. We diagnosed NAFLD in cases with liver to spleen ratios (L/S ratio) <0.9 on non‐contrast CT images. We evaluated changes in body weights, BMIs, comorbidities, metabolic parameters, L/S ratios, and liver volumes after surgery. Results The mean interval between CT scans before and after surgery was 26 months. The total weight loss and % excess weight loss were 35 kg and 72%, respectively. The remission rates for T2DM, hypertension, and dyslipidemia were 85%, 76% and 84%, respectively. After LSG, the L/S ratio increased in all the patients, while all except for one had L/S ratio >0.9. We diagnosed 33 out of 57 patients (58%) as having NAFLD before the operation. After the operation, the L/S ratios and liver volumes were not statistically different between the patients with previous NAFLD and those without it. Conclusion Laparoscopic sleeve gastrectomy is an effective treatment for obesity‐related health disorders including NAFLD in Japanese obese patients.

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“…Weight loss is known to reduce liver fat, which can be measured with proton density fat fraction (PDFF), a noninvasive quantitative biomarker designed to measure liver fat using confounder‐corrected chemical‐shift‐encoded magnetic resonance imaging (CSE‐MRI). Reductions in hepatic PDFF reflect reductions in liver fat shown by histology and improvements in insulin sensitivity.…”

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confidence: 99%

“…[6][7][8][9] In the pancreas, excess fat accumulation has been associated with beta cell dysfunction, insulin resistance, DM-2, pancreatitis, and pancreatic cancer. 2,[10][11][12] Weight loss is known to reduce liver fat, 13,14 which can be measured with proton density fat fraction (PDFF), a noninvasive quantitative biomarker designed to measure liver fat using confounder-corrected chemical-shift-encoded magnetic resonance imaging (CSE-MRI). Reductions in hepatic PDFF reflect reductions in liver fat shown by histology and improvements in insulin sensitivity.…”

mentioning

confidence: 99%

Pilot study on longitudinal change in pancreatic proton density fat fraction during a weight‐loss surgery program in adults with obesity

Covarrubias

Fowler

Mamidipalli

et al. 2019

Magnetic Resonance Imaging

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Background Quantitative‐chemical‐shift‐encoded (CSE)‐MRI methods have been applied to the liver. The feasibility and potential utility CSE‐MRI in monitoring changes in pancreatic proton density fat fraction (PDFF) have not yet been demonstrated. Purpose To use quantitative CSE‐MRI to estimate pancreatic fat changes during a weight‐loss program in adults with severe obesity and nonalcoholic fatty liver disease (NAFLD). To explore the relationship of reduction in pancreatic PDFF with reductions in anthropometric indices. Study Type Prospective/longitudinal. Population Nine adults with severe obesity and NAFLD enrolled in a weight‐loss program. Field Strength/Sequence CSE‐MRI fat quantification techniques and multistation‐volumetric fat/water separation techniques were performed at 3 T. Assessment PDFF values were recorded from parametric maps colocalized across timepoints. Statistical Tests Rates of change of log‐transformed variables across time were determined (linear‐regression), and their significance assessed compared with no change (Wilcoxon test). Rates of change were correlated pairwise (Spearman's correlation). Results Mean pancreatic PDFF decreased by 5.7% (range 0.7–17.7%) from 14.3 to 8.6%, hepatic PDFF by 11.4% (2.6–22.0%) from 14.8 to 3.4%, weight by 30.9 kg (17.3–64.2 kg) from 119.0 to 88.1 kg, body mass index by 11.0 kg/m2 (6.3–19.1 kg/m2) from 44.1 to 32.9 kg/m2, waist circumference (WC) by 25.2 cm (4.0–41.0 cm) from 133.1 to 107.9 cm, HC by 23.5 cm (4.5–47.0 cm) from 135.8 to 112.3 cm, visceral adipose tissue (VAT) by 2.9 L (1.7–5.7 L) from 7.1 to 4.2 L, subcutaneous adipose tissue (SCAT) by 4.0 L (2.9–7.4 L) from 15.0 to 11.0 L. Log‐transformed rate of change for pancreatic PDFF was moderately correlated with log‐transformed rates for hepatic PDFF, VAT, SCAT, and WC (ρ = 0.5, 0.47, 0.45, and 0.48, respectively), although not statistically significant. Data Conclusion Changes in pancreatic PDFF can be estimated by quantitative CSE‐MRI in adults undergoing a weight‐loss surgery program. Pancreatic and hepatic PDFF and anthropometric indices decreased significantly. Level of Evidence: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;50:1092–1102.

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How bariatric surgery affects liver volume and fat density in NAFLD patients

Cited by 51 publications

References 19 publications

Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis

Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis

Improvement of non‐alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients

Pilot study on longitudinal change in pancreatic proton density fat fraction during a weight‐loss surgery program in adults with obesity

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