Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy

Abstract

Considerable attention has been focused on nonalcoholic fatty liver disease (NAFLD) which occasionally develops after pancreatoduodenectomy (PD). The present study aimed to clarify the prevalence, sequential change in properties and risk factors for NAFLD development after PD. We enrolled 196 patients who underwent PD and a computed tomography (CT) scan 1 month, 6 months and 1 year after surgery. NAFLD was defined as a liver‐to‐spleen attenuation ratio on plain CT of <0.9. We compared various clinical factors between the NAFLD group and the control group. Individual prevalence of NAFLD at 1 month, 6 months and 1 year after surgery was 12%, 21% and 15%. Significantly different factors by univariate analysis were as follows: 1 month: age, sex, total protein (TP), total cholesterol (TC) and copper (Cu); 6 months: sex, disease, surgical method, portal vein resection (PVR), frequency of defecation, TC and Cu; 1 year: age, sex, disease, surgical method, PVR, frequency of defecation, TP and Cu. Risk factors by multivariate analysis were as follows: 1 month: not elderly age, female sex and a decrease in Cu; 6 months: female sex and a decrease in Cu; 1 year: a decrease in Cu. NAFLD after PD frequently developed in women with a decrease in serum Cu and was influenced by various factors related to poor digestion and absorption associated with pancreatic exocrine insufficiency.

Preventive Effect of High-Dose Digestive Enzyme Management on Development of Nonalcoholic Fatty Liver Disease after Pancreaticoduodenectomy: A Randomized Controlled Clinical Trial

“…Second, a recent study used the pancreatic digestive enzyme pancrelipase delayed-release supplement (Lipacreon, Mylan EPD GK) 1.2 g/day and reportedly significantly improved NAFLD after PD 4,21 ; however, other studies indicated that the prevalence of NAFLD was not significantly reduced, even in patients who received pancrelipase supplements. 6,22 Third, several patients in this study might have recovered from NAFLD even if they had not received pancreatic digestive enzyme; however, it was difficult to identify these patients. To demonstrate the effectiveness of high-dose pancreatic enzyme treatment with respect to improvement of NAFLD, another randomized controlled trial involving the application and lack of intervention for patients with NAFLD is necessary; the strength of our conclusions may have been limited by the study design.…”

“…In this study, patients who underwent PD were scheduled for CT scans at 1, 3, 6, and 12 months after surgery. Fujii and colleagues 22 reported that several patients recovered from NAFLD spontaneously, while others exhibited progressive deterioration. A more detailed examination may therefore reveal the incidence of NAFLD to be higher than previously reported.…”

Mechanisms of nonalcoholic fatty liver disease and implications for surgery

“…Pancreatoduodenectomy (PD) is the standard surgical treatment for periampullary and pancreatic head tumor lesions, including pancreatic and biliary malignant, premalignant, and benign neoplasms. Advances in surgical techniques, perioperative management, and adjuvant chemotherapy have reduced surgery-related morbidity and mortality [ 43 , 44 ]. With improved long-term survival rates, there has also been an increase in rates of long-term metabolic complications, including NAFLD.…”

Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer

“…The attenuation values were the average of the four measurements in each segment of the liver and spleen, as previously described [43]. Fatty liver was diagnosed as liver-to-spleen ratios <0.9 [44]. These analyses were performed using the diagnostic software ImageJ Version 1.50 (National Institutes of Health, Bethesda, MD, USA) [39].…”