title: The evolution of severe steatosis after bariatric surgery is related to insulin resistance.
abstract: OBJECTIVE
  In severely obese patients, factors implicated in the evolution of severe steatosis after bariatric surgery remain unresolved. Our aim was to determine whether insulin resistance (IR) influences the histologic effects induced by bariatric surgery.
  
  
  METHODS
  We prospectively included 185 severely obese patients (body mass index >/=35 kg/m(2)) referred for bariatric surgery. The evolution of IR (IR index = 1/quantitative insulin sensitivity check index) and liver injury with consecutive biopsy was concomitantly assessed before and 1 year after surgery.
  
  
  RESULTS
  At preoperative biopsy, 27% of severely obese patients disclosed severe steatosis (>/=60%). The alanine aminotransferase (P = .01) and IR indexes (P = .04) were independent predictive factors of severe steatosis at baseline. One year after surgery, surgical treatment induced a decrease in body mass index (9.5 kg/m(2); P < .0001), steatosis score (8.5%; P < .0001), and IR index (0.29; P < .0001). The preoperative IR index (P = .01) and preoperative steatosis (P = .006) were independent predictive factors in the persistence of severe steatosis after surgery. Moderate or severe steatosis was more frequently observed in patients who had conserved a higher IR index after surgery than in patients who had improved their IR index (44% vs 20.2%; P = .04).
  
  
  CONCLUSIONS
  IR was independently associated with severe steatosis and predicted its persistence after surgery. The amelioration of IR after surgery is associated with a decrease in the amount of fat. Taken together, the results of this prospective study in severely obese patients demonstrate that severe steatosis and its evolution after surgery are intimately connected with IR.
authors.affiliation: Service Maladie de l'Appareil digestif, Hôpital Huriez, CHRU Lille, Lille, France. p-mathurin@chru-lille.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Florent
authors.initials: F
authors.lastname: Gonzalez
authors.forename: Olivier
authors.initials: O
authors.lastname: Kerdraon
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leteurtre
authors.forename: Laurent
authors.initials: L
authors.lastname: Arnalsteen
authors.forename: Antoine
authors.initials: A
authors.lastname: Hollebecque
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.forename: Perrine
authors.initials: P
authors.lastname: Cocq
authors.forename: Thomas
authors.initials: T
authors.lastname: Jany
authors.forename: Jeanne
authors.initials: J
authors.lastname: Boitard
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.forename: Monique
authors.initials: M
authors.lastname: Romon
authors.forename: François
authors.initials: F
authors.lastname: Pattou
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D015331:Cohort Studies; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007333:Insulin Resistance; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D016015:Logistic Models; D008297:Male; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome