Nonalcoholic Fatty Liver Disease in Severe Obese Patients, Subjected to Bariatric Surgery

Abstract

-Context -Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe) deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis. Objective -The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis. Methods -A total of 250 liver biopsies were conducted in the transoperation of the surgeries. were moderate, and 6 (2.4%) cases were intense. Fibrosis was referred to in 108 (43.2%) biopsies, 95 of which (38%) were mild; 2 (0.8%) were moderate; 7 (2.8%) were intense, and cirrhosis was diagnosed in 4 (1.6%) cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (r s = 0.460; P<0.001) and between the degree of this activity and the degree of fibrosis (r s = 0.583; P<0.001). Only 13 (5.2%) samples showed Fe deposits. Conclusion -There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease. HEADINGS -Fatty Liver. Liver cirrhosis. Morbid obesity. Bariatric surgery. Iron metabolism disorders.

Non-Alcoholic Steatohepatitis: Clinical and Translational Research

“…Overall, this study identified a positive correlation between higher hemoglobin levels and elevated ALT, which could indicate the presence of NAFLD (56). Losekann et al (57) found only low iron deposition in liver biopsies of NAFLD patients referred for bariatric surgery, suggesting that iron is unlikely to play a major role in the pathogenicity of NAFLD.…”

Effectiveness of a Low-Calorie Diet for Liver Volume Reduction Prior to Bariatric Surgery: a Systematic Review

“…All these factors may contribute to reduced intra-abdominal space, reduced freedom of surgical movement and limited exposure of the gastric cardia, making the surgery technically more challenging and potentially resulting in complications [4,5]. Up to 90% of candidates for bariatric surgery have nonalcoholic fatty liver disease (NAFLD) characterized by an enlarged and fatty liver [6]. An enlarged left liver lobe complicates the approach to the gastroesophageal junction and results in an increased risk of bleeding upon surgical manipulation since the NAFLD liver is more vulnerable [5].…”

Role of bariatric surgery in treatment of non-alcoholic fatty liver disease

“…10 However, Results from different studies show that the prevalence of NAFLD varies between 16.7% and 96% in morbidly obese patients subjected to bariatric surgery. [10][11][12][13][14][15][16][17][18][19][20][21][22] The wide range of NAFLD prevalence depends on the biochemical criteria and the method sensitivity used to detect NAFLD. 8,23 Furthermore, NASH, as a progressive manifestation of NAFLD, occurs in 7.3% to 98% of such patients.…”

“…8,23 Furthermore, NASH, as a progressive manifestation of NAFLD, occurs in 7.3% to 98% of such patients. 10,12,13,17,18,[20][21][22][24][25][26][27][28][29][30] The study which reported NASH in 98% of their patients, indicated that the mean super obese state (Mean BMI 52.8 kg ⁄m 2 ) in their population is the reason of high NASH prevalence. 30 Another study concluded that the differences in NASH prevalence can be explained by the histological criteria used to diagnose NASH.…”