Prevalence of Non-alcoholic Fatty Liver Disease and Steatohepatitis Risk Factors in Patients Undergoing Bariatric Surgery.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) associated with obesity comprises pathological changes ranging from steatosis to steatohepatitis; these can evolve to cirrhosis and hepatocellular carcinoma.


OBJECTIVE
The objectives of this study are to assess the prevalence of and predictive markers for steatohepatitis in obese patients undergoing bariatric surgery.


METHODS
A prospective study of 184 morbidly obese patients undergoing bariatric surgery formed the study cohort. Patients taking potentially hepatotoxic medications and those with viral diseases and a history of excessive alcohol consumption were excluded. Liver biopsies were performed during surgery with a "Trucut" needle. Patients were classified into the following groups according to the histopathological findings: normal, steatosis, mild steatohepatitis, and moderate-severe steatohepatitis. Factors associated with steatohepatitis were evaluated using logistic regression. p values <0.05 were considered significant.


RESULTS
The prevalence of NAFLD was 84 % (steatosis, 22.0 %; mild steatohepatitis, 30.8 %; moderate-severe steatohepatitis, 32.0 %). Independent predictive factors for steatohepatitis were age (odds ratio (OR), 1.05; 95 % confidence interval (CI), 1.01-1.09; p = 0.011), waist circumference (OR, 1.03; 95 % CI, 1.00-1.06; p = 0.021), serum alanine aminotransferase (ALT) levels (OR, 1.04; 95 % CI, 1.01-1.08; p = 0.005), and serum triglyceride levels (OR, 1.01; 95 % CI, 1.00-1.01; p = 0.042). Score values for each predictor were derived from regression coefficients and odds ratio, and a total (risk) score was obtained from the sum of the points to evaluate the probability of having steatohepatitis.


CONCLUSIONS
Age, waist circumference, serum ALT levels, and serum triglyceride levels are efficient and non-invasive predictive markers for the diagnosis and management of steatohepatitis in morbidly obese patients.
Surgery Department, Bariatric and Metabolic Surgery Services, Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil. s-morita@uol.com.br.|, Rua Las Vegas 444, Bairro Debora Cristina, 15093-010, São José do Rio Preto, SP, Brazil. s-morita@uol.com.br.
Shinhiti
S
Morita
Pathology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil. dalisius@gmail.com.
Dalísio De Santi
Dde S
Neto
Surgery Department, Bariatric and Metabolic Surgery Services, Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil. flaviomorita@hotmail.com.
Flávio Hiroshi Ananias
FH
Morita
Surgery Department, Bariatric and Metabolic Surgery Services, Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil. ninakm1994@hotmail.com.
Nina Kimie
NK
Morita
Division of Intensive Care, Internal Medicine Department, Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil. suzanalobo@gmail.com.
Suzana Margareth Ajeje
SM
Lobo
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D050110:Bariatric Surgery / Q000706:statistics & numerical data; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D015995:Prevalence; D012307:Risk Factors
D000410:Alanine Transaminase
Morbid obesity; Non-alcoholic fatty liver disease; Steatohepatitis; Steatosis