title: Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery.
abstract: BACKGROUND
  Numerous studies worldwide have identified a high prevalence of non-alcoholic fatty liver disease (NAFLD) among morbidly obese subjects. Several predictors have been found to be associated with NAFLD and its histological high-risk components. Similar data from India is lacking. We aimed to determine the prevalence and the predictors of NAFLD and its histological high-risk components in a cohort of Indians with morbid obesity undergoing bariatric surgery. Safety of a routine intraoperative liver biopsy was also assessed.
  
  
  METHODS
  There were 134 morbidly obese patients who underwent bariatric surgery with concomitant liver biopsy. These were assessed for NAFLD and its histological high-risk components. Clinical, biochemical, and histological features were evaluated, and predictors of NAFLD, non-alcoholic steatohepatitis (NASH), fibrosis, and advanced fibrosis were identified.
  
  
  RESULTS
  Mean BMI was 44.66 ± 9.81. Eighty-eight (65.7 %) showed NAFLD. Forty-five (33.6 %) showed NASH and 42 (31.3 %) showed fibrosis both not mutually exclusive. Nineteen (14.1 %) showed advanced fibrosis. Higher alanine aminotransferase (ALT) independently predicted NAFLD and was significantly associated with NASH and fibrosis. Type 2 diabetes mellitus (T2DM) and the metabolic syndrome were significantly associated with fibrosis. Systemic hypertension (HT) independently predicted NASH and fibrosis. There were no intraoperative or postoperative complications related to the liver biopsy.
  
  
  CONCLUSIONS
  NAFLD has a high prevalence among morbidly obese patients. Elevated ALT, HT, T2DM, and the metabolic syndrome are predictors for NAFLD and its high-risk histological components. Routine intraoperative liver biopsy is safe in morbidly obese undergoing bariatric surgery for diagnosing NAFLD.
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. praveenraj@me.com.
authors.forename: Palanivelu
authors.initials: P
authors.lastname: Praveenraj
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. dr.gomes@rediffmail.com.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Gomes
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. titusaku@gmail.com.
authors.forename: Saravana
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Hepatology, Gem Hospital and Research Centre, Coimbatore, 641045, India. drpkarthikeyan@rediffmail.com.
authors.forename: Purushothaman
authors.initials: P
authors.lastname: Karthikeyan
authors.affiliation: Department of Pathology, Gem Hospital and Research Centre, Coimbatore, 641045, India. dr_annapoorni@rediffmail.com.
authors.forename: Annapoorni
authors.initials: A
authors.lastname: Shankar
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. drparthu@geminstitute.in.
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Parthasarathi
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. senthilnathan94@yahoo.com.
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Senthilnathan
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. srajapandian@rediffmail.com.
authors.forename: Subbiah
authors.initials: S
authors.lastname: Rajapandian
authors.affiliation: Department of Minimal Access Surgery, Gem Hospital and Research Centre, 45, Pankaja Mill Road, Coimbatore, 641045, India. palanivelu@mac.com.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology*; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Bariatric surgery; Cirrhosis; Metabolic syndrome; Morbid obesity; Non-alcoholic liver disease; Non-alcoholic steatohepatitis
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