Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome.
OBJECTIVE
To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients.


BACKGROUND
Nonalcoholic fatty liver disease (NAFLD), a spectrum that extends to liver fibrosis and cirrhosis, is rising at an alarming rate. This increase is occurring in conjunction with the rise of severe obesity and is probably mediated in part by metabolic syndrome (MS). Surgical weight loss operations, probably by reversing MS, have been shown to result in improvement in liver histology.


METHODS
Patients who underwent laparoscopic surgical weight loss operations from March 1999 through August 2004, and who agreed to have an intraoperative liver biopsy followed by at least one postoperative liver biopsy, were included.


RESULTS
There were 70 patients who were eligible. All patients underwent laparoscopic operations, the majority being laparoscopic Roux-en-Y gastric bypass. The mean excess body weight loss at time of second biopsy was 59% +/- 22% and the time interval between biopsies was 15 +/- 9 months. There was a reduction in prevalence of metabolic syndrome, from 70% to 14% (P < 0.001), and a marked improvement in liver steatosis (from 88% to 8%), inflammation (from 23% to 2%), and fibrosis (from 31% to 13%; all P < 0.001). Inflammation and fibrosis resolved in 37% and 20% of patients, respectively, corresponding to improvement of 82% (P < 0.001) in grade and 39% (P < 0.001) in stage of liver disease.


CONCLUSIONS
Surgical weight loss results in significant improvement of liver morphology in severely obese patients. These beneficial changes may be associated with a significant reduction in the prevalence of the metabolic syndrome.
Mattar
Samer G
SG
Department of Surgery, University of Pittsburgh and Veteran Affairs Administration, Pittsburgh, PA, USA.
Velcu
Laura M
LM
Rabinovitz
Mordechai
M
Demetris
A J
AJ
Krasinskas
A M
AM
Barinas-Mitchell
Emma
E
Eid
George M
GM
Ramanathan
Ramesh
R
Taylor
Debra S
DS
Schauer
Philip R
PR
D001706:Biopsy; D015992:Body Mass Index; D005234:Fatty Liver / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss