28. Bariatric Surgery Significantly Improves Nonalcoholic Fatty Liver Disease (NAFLD) and the Metabolic Syndrome
Samer G. Mattar, MD, FACS*, Laura M. Velcu, MD*, Mordechai Rabinovitz, MD*, A J. Demetris, MD*, A Kransinskas, MD*, Emma Barinas-Mirchell, PhD*, George M. Eid, MD*, Ramesh Ramanathan, MD*, Philip R. Schauer, MD*
University of Pittsburgh, Pittsburgh, PA (Sponsored by: John Fung, MD)
The current epidemic of morbid obesity is associated with a concurrent rise in NAFLD and the metabolic syndrome. The effect of surgical weight loss on NAFLD is uncertain. The aim of this study was to assess the effect of surgically induced weight loss on NAFLD.
Demographic and outcome data was collected on patients who had serial needle liver biopsies in conjunction with weight loss surgery. Included in the analysis were laboratory markers of the metabolic syndrome (hypertension, diabetes mellitus, hyperlipidemia and fatty liver disease). Liver biopsies were scored for NASH grades (0-3) and stages (0-4).
There were 62 patients, 72% female, mean age of 47±9 and initial BMI of 56.5±10.8. Forty-four patients (71%) met criteria for the metabolic syndrome. The mean BMI at second liver biopsy (12±3.5 months postop) was 39.8±10.5, and 35 (80%) patients had resolution of metabolic syndrome. By histology, postoperative quantitative fat scores markedly decreased as compared to the preoperative scores (2.38±075. vs. 0.48±0.65, p<0.001). Similarly, there was a significant decrease in the inflammatory grading (1.18±0.69. vs. 0.58±0.54, p<0.001) and in the fibrosis staging (1.29±1.04 vs. 0.87±1.01, p<0.014). The graph shows a significant reduction in the number of patients with moderate and severe disease.
Surgically induced weight loss results in significant improvement of NAFLD and of the metabolic syndrome.