title: Preoperative liver reduction utilizing a novel nutritional supplement.
abstract: BACKGROUND
  One of the most common reasons for conversion in bariatric surgery is hepatomegaly caused by inadequate exposure of the proximal stomach. This study utilizes a novel nutritional supplement with a calorie-restricted diet to reduce liver volume preoperatively.
  
  
  METHODS
  A consecutive series of morbidly obese patients consumed a nutritional supplement called Nuvista(®) for 4 weeks preoperatively. Preoperatively, each patient completed baseline demographics, blood work, urine ketone analysis, ultrasonography of the left lateral segment, and multiple questionnaires. At the time of surgery, these studies were repeated. Data were analyzed using a paired t-test and bivariate analysis where appropriate. A P<.05 was considered significant.
  
  
  RESULTS
  Four men and 17 women were recruited with a mean preoperative weight and body mass index of 122.7±15.9  kg and 44.5±3.9, respectively. Mean preoperative liver volume of the left lateral segment was 562.5±291.3  cm(3). After 4 weeks of Nuvista, the mean weight and body mass index decreased significantly to 118.9±15.5  kg and 43.1±3.4, respectively (P<.001). The mean liver volume of the left lateral segment was significantly reduced to 299.9±162.1  cm(3) (P<.001). Mean liver reduction was 43.4%±17.2% (13.6%-81.9%, P<.05). Urinary ketone scores did not show any evidence of starvation. No preoperative factors correlated with liver volume reduction.
  
  
  CONCLUSIONS
  Utilizing Nuvista, as part of a preoperative 4-week calorie-restricted regimen, significantly reduced lateral segment liver volume by 43.4%. This preoperative regimen incorporates healthy behavioral changes that are necessary to sustain long-term weight loss.
authors.affiliation: Department of Surgery, The George Washington University Medical Center, Washington, DC 20037, USA. fbrody@mfa.gwu.edu
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
authors.forename: Khashayar
authors.initials: K
authors.lastname: Vaziri
authors.forename: Cathy
authors.initials: C
authors.lastname: Garey
authors.forename: Ravi
authors.initials: R
authors.lastname: Shah
authors.forename: Claire
authors.initials: C
authors.lastname: LeBrun
authors.forename: Faith
authors.initials: F
authors.lastname: Takurukura
authors.forename: Michael
authors.initials: M
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D031204:Caloric Restriction; D019587:Dietary Supplements; D005260:Female; D006529:Hepatomegaly / Q000178:diet therapy* / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D009929:Organ Size; D011300:Preoperative Care; D011446:Prospective Studies; D015431:Weight Loss; D055815:Young Adult