Hepatic histology in obese patients undergoing bariatric surgery.
OBJECTIVE
Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis (NASH). Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population.


METHODS
Review of available studies on prevalence of NAFLD/NASH in severely obese patients submitted to bariatric surgery.


RESULTS
Twelve observational and transversal studies were included, with consecutive recruitment, and prospective evaluation of data, summing 1620 patients with severe obesity. Prevalence of steatosis and NASH was 91% (range: 85-98%) and 37% (24-98%), respectively, with unexpected cirrhosis in 1.7% (1-7%). NASH was not related with age or body mass index, but there was an association between male sex and NASH/hepatic fibrosis. Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH, and hypertension with advanced hepatic fibrosis.


CONCLUSIONS
There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients, more than one-third presenting histological criteria for NASH. This review underscores the large variations in prevalence of NASH between studies, calling for the need for a better agreement in the use of the histological criteria.
Machado
Mariana
M
Departamento de Gastrenterologia, Instituto de Medicina Molecular (IMM), Faculdade de Medicina da Universidade de Lisboa, Portugal.
Marques-Vidal
Pedro
P
Cortez-Pinto
Helena
H
D000328:Adult; D017677:Age Distribution; D050110:Bariatric Surgery; D015992:Body Mass Index; D050171:Dyslipidemias / Q000453:epidemiology; D005234:Fatty Liver / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D015995:Prevalence; D012720:Severity of Illness Index; D017678:Sex Distribution; D000637:Transaminases / Q000097:blood
D000637:Transaminases