title: Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis.
abstract: BACKGROUND
  Both weight loss and gastrointestinal surgery for obesity can cause liver disease, making their role in the treatment of obesity-related liver disease controversial.
  
  
  METHODS
  Six hundred eighty-nine severely obese women (n=551) and men (n=138), BMI=47+/-9 kg.m(-2) (mean+/-SD), without known liver disease, underwent biliopancreatic diversion (BPD) with liver biopsy. Fourteen patients (2%) had cryptogenic cirrhosis, 11 of whom underwent multiple repeat biopsies. After 38+/-18 kg weight loss, 104 of the 689 patients underwent routine second biopsies during reoperations 41+/-25 months after BPD. All biopsy specimens were graded for steatosis, fibrosis, and inflammation by a blinded hepatopathologist.
  
  
  RESULTS
  All 689 patients lost weight accompanied by improvements in the metabolic syndrome. Among the 104 patients who underwent reoperation, severe fibrosis (grade 3-5) decreased in 28 whereas mild fibrosis (grade 1-2) appeared in 42. Increased fibrosis was related to low-normal serum albumin, uncontrolled diarrhea, low intake of alcohol, and menopausal status. Fibrosis and inflammation decreased over time (P<.01). The 11 patients with cirrhosis exhibited decreased fibrosis from a mean grade 5 to grade 3, as well as reduced inflammation, Mallory bodies, and glycogenated nuclei. Seven patients had disappearance and 2 regression of nodules and fibrous bridging.
  
  
  CONCLUSIONS
  The metabolic syndrome of obesity is a determinant of liver fibrosis and cirrhosis, treatable by substantial weight loss after malabsorptive surgery.
authors.affiliation: Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Kral
authors.forename: Swan N
authors.initials: SN
authors.lastname: Thung
authors.forename: Simon
authors.initials: S
authors.lastname: Biron
authors.forename: Frederic-Simon
authors.initials: FS
authors.lastname: Hould
authors.forename: Stefane
authors.initials: S
authors.lastname: Lebel
authors.forename: Simon
authors.initials: S
authors.lastname: Marceau
authors.forename: Serge
authors.initials: S
authors.lastname: Simard
authors.forename: Picard
authors.initials: P
authors.lastname: Marceau
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion; D001706:Biopsy; D016022:Case-Control Studies; D005234:Fatty Liver / Q000150:complications / Q000473:pathology; D005260:Female; D006505:Hepatitis / Q000150:complications / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology; D012086:Reoperation; D016037:Single-Blind Method; D016896:Treatment Outcome; D015431:Weight Loss