title: The effect of surgically induced weight loss on nonalcoholic fatty liver disease in morbidly obese Indians: "NASHOST" prospective observational trial.
abstract: BACKGROUND
  Surgically induced weight loss improves nonalcoholic fatty liver disease (NAFLD) in morbidly obese Caucasian patients. Similar data are lacking from India.
  
  
  OBJECTIVE
  To compare the histologic features of NAFLD in morbidly obese Indian patients before and 6 months after bariatric surgery. Histologic changes were also separately assessed according to the type of bariatric intervention.
  
  
  METHODS
  Teaching institution, India; private practice.
  
  
  METHODS
  All patients undergoing bariatric surgery from July 2012 to July 2013 underwent a routine liver biopsy at the time of bariatric surgery. If the biopsy specimen indicated NAFLD, patients were asked to undergo a second biopsy after 6 months. Baseline anthropometry, clinical data, biochemistry, and pathology were recorded and repeated at follow-up.
  
  
  RESULTS
  Eighty-eight of 134 index biopsy specimens indicated NAFLD. Thirty patients had paired liver biopsies. Steatosis was present in all, 14 had lobular inflammation, 10 had ballooning degeneration, and 14 had fibrosis. Mean time between the biopsies was 7.1 months (range 6-8 months). At the second biopsy, steatosis had resolution in 19 and improvement in 11, lobular inflammation had resolution in 12 and improvement in 2, ballooning had resolution in 9 and improvement in 1 and fibrosis had resolution in 11 and improvement in 3 (P<0.05 for all). Improvement was greater among those who underwent a sleeve gastrectomy in comparison to a Roux-en-Y gastric bypass, although this difference was not statistically significant. None had worsening of liver histologic results.
  
  
  CONCLUSIONS
  Surgically induced weight loss significantly and rapidly improves liver histology in morbidly obese Indians with NAFLD.
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India. Electronic address: praveenraj@me.com.
authors.forename: P
authors.initials: P
authors.lastname: Praveen Raj
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Gomes
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India.
authors.forename: Saravana
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India.
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Senthilnathan
authors.affiliation: Department of Hepatology, GEM Hospital and Research Centre, Tamil Nadu, India.
authors.forename: Purushothaman
authors.initials: P
authors.lastname: Karthikeyan
authors.affiliation: Department of Pathology, GEM Hospital and Research Centre, Tamil Nadu, India.
authors.forename: Annapoorni
authors.initials: A
authors.lastname: Shankar
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Tamil Nadu, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D001706:Biopsy; D015992:Body Mass Index; D018450:Disease Progression; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D007194:India; D009017:Morbidity / Q000639:trends; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Cirrhosis; Metabolic syndrome; Morbid obesity; Nonalcoholic liver disease; Nonalcoholic steatohepatitis