title: Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique.
abstract: OBJECTIVE
  While traditional risk factors for the development of nonalcoholic fatty liver disease (NAFLD) relate to metabolic syndrome, several Asian studies have suggested a high rate of de novo NAFLD following pancreaticoduodenectomy (PD). The aim of this study is to identify de novo NAFLD after pancreatic surgery and its associated risk factors.
  
  
  METHODS
  A retrospective cohort of patients at a single center that underwent PD or distal pancreatectomy (DP) over 7 years was identified. Pre- and postoperative contrast-enhanced computed tomography scans of the abdomen were reviewed, including attenuation measurements of the liver, spleen, and muscle. Primary outcomes included hepatic attenuation, liver to muscle ratio (LMR), and liver to spleen ratio (LSR).
  
  
  RESULTS
  Of the 96 patients (mean age 64.3) included, 70% underwent PD, and 30% underwent DP. The mean LMR decreased significantly from 1.81 to 1.66 (p=0.02), noted only in men. No interaction effect with LMR was observed with surgical type, chemotherapy, blood loss, pancreatic enzyme replacement, or transaminases. LMR decreased in 55% of subjects.
  
  
  CONCLUSIONS
  Increased fatty infiltration, as evidence by decreased LMR, was found among men that underwent PD and DP within a year of surgery. This may be related to weight loss and malabsorption and deserves further investigation.
authors.affiliation: Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Sidney
authors.initials: S
authors.lastname: Olefson
authors.affiliation: Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Grand
authors.affiliation: Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Charpentier
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Makwana
authors.affiliation: Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Kittichai
authors.initials: K
authors.lastname: Promrat
keywords: Distal pancreatectomy; NAFLD; Retrospective cohort; Whipple