Khaleel Mohammad, MD1, Marcoandrea Giorgi, MD1, Jawad Ali, MD1, Rouzbeh Moustaedi, MD2, Aaron Carr, MD1, Mohamed Ali, MD1. 1UC Davis Medical Center, 2The Permanente Medical Group
Introduction: Obesity has been commonly cited to be a major risk factor for the occurrence and progression of non-alcoholic fatty liver disease (NAFLD). In particular, bariatric surgery patients are hypothesized to be at highest risk for NAFLD and its consequences. In this study, we sought to characterize the extent of NAFLD, the prevalence of progression to NASH and fibrosis, and identify patient characteristics that correlate with fatty liver disease in this high-risk population.
Methods: Core liver biopsy was obtained on 529 consecutive patients undergoing bariatric surgery and assessed for the degree of steatosis, portal inflammation, and hepatic fibrosis. Demographic, anthropometric, laboratory, and co-morbidity data were collected and analyzed to identify relationships between the clinical condition of the patient and NAFLD.
Results: The study included 529 patients with an average body mass index (BMI) and age of 45.3±7.5 kg/m2and 45.3±11.2 years, respectively. Metabolic syndrome was present in 71.8% of patients. Hepatic steatosis, NASH and fibrosis were present in 69.6%, 44.2% and 18.1% of patients, respectively. There was a significant direct correlation between degree of steatosis and preoperative BMI (p<0.05), serum triglycerides (p<0.0001), and hemoglobin A1C (HbA1C) (p<0.0001), while HDL showed an inverse correlation with the degree of hepatic steatosis (p<0.001). Patients with metabolic syndrome had more steatosis (p <0.0001) and steatohepatitis (p<0.005) than patients without metabolic syndrome.
Conclusions: Factors such as elevated BMI, triglycerides, HbA1C and presence of metabolic syndrome correlated with the degree of hepatic steatosis. Although the majority of patients in this study exhibited hepatic steatosis, 30.4% of patients did not have steatosis despite having the high risk traditionally ascribed to advanced obesity. These findings suggest that the mere presence of obesity may not be enough to promote the progression of NAFLD to NASH and fibrosis and indicate that metabolic dysregulation may play a more vital role.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95869
Program Number: P101
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster