title: Nonalcoholic fatty liver disease after pancreatoduodenectomy is closely associated with postoperative pancreatic exocrine insufficiency.
abstract: BACKGROUND
  In recent years, nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) has become increasingly problematic. Our aims were to clarify the relationship between NAFLD and postoperative pancreatic exocrine function and to identify the risk factors for NAFLD after PD.
  
  
  METHODS
  Patients who underwent PD (n = 104) were assessed with abdominal unenhanced computed tomography (CT) to determine the fatty liver changes and were given a (13) C-labeled mixed triglyceride breath test to measure pancreatic exocrine function. The percent (13) CO2 cumulative dose at 7 hr (% dose (13) C cum 7 hr) <5% was considered diagnostic for pancreatic exocrine insufficiency (PEI). Relationships between the occurrence of NAFLD and clinical factors including postoperative pancreatic exocrine function were analyzed.
  
  
  RESULTS
  Twenty-six of 104 patients (25%) developed postoperative NAFLD. The postoperative CT attenuation of the liver (R = 0.326, P < 0.001) and the liver-to-spleen attenuation ratio (R = 0.315, P = 0.001) significantly correlated with the postoperative values of % dose (13) C cum 7 hr. Multivariate analysis determined that postoperative PEI was the only independent risk factor for NAFLD (P = 0.025).
  
  
  CONCLUSIONS
  NAFLD frequently occurs postoperatively after PD. NAFLD after PD may be closely associated with postoperative PEI.
authors: Department of Surgery, Applied Life Sciences, Institute of Biochemical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Naoya
authors: N
authors: Nakagawa
authors: Yoshiaki
authors: Y
authors: Murakami
authors: Kenichiro
authors: K
authors: Uemura
authors: Takeshi
authors: T
authors: Sudo
authors: Yasushi
authors: Y
authors: Hashimoto
authors: Naru
authors: N
authors: Kondo
authors: Hayato
authors: H
authors: Sasaki
authors: Keisuke
authors: K
authors: Okano
authors: Taijiro
authors: T
authors: Sueda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests / Q000379:methods; D002247:Carbon Isotopes; D004067:Digestive System Neoplasms / Q000601:surgery; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D002247:Carbon Isotopes
keywords: 13C-labeled mixed triglyceride breath test; computed tomography attenuation; nonalcoholic fatty liver disease; pancreatic exocrine insufficiency; pancreatoduodenectomy