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Predictors of nonalcoholic steatohepatitis in patients undergoing bariatric surgery: when is liver biopsy indicated?
Surg Obes Relat Dis. 2008 Sep-Oct; 4(5):612-7.SO

Abstract

BACKGROUND

Nonalcoholic fatty liver disease is a frequent accompaniment of morbid obesity. A component of nonalcoholic fatty liver disease, steatosis, can, on occasion, lead to nonalcoholic steatohepatitis (NASH). Bariatric surgery has been shown to alter the course of this disease. Intraoperative liver biopsies might identify patients with NASH for more careful follow-up. We sought to determine noninvasive preoperative indicators of NASH.

METHODS

The patients scheduled for bariatric surgery underwent a preoperative assessment. The study variables included age, gender, race, body mass index, diabetes mellitus, hypertension, and the results of serum liver function tests and triglyceride, cholesterol, iron, and prealbumin measurements. Univariate and multivariate analyses were performed to identify significant variables associated with NASH as determined by subsequent core liver biopsies taken during open Roux-en-Y gastric bypass.

RESULTS

A total of 139 patients were entered into the study. NASH or NASH-associated fibrosis was found in 57 patients (41%). On univariate analyses, male gender (odds ratio [OR] 2.46, P = .06), diabetes mellitus (OR 2.60, P = .009), elevated serum triglyceride levels (OR 1.003, P = .02), elevated gamma glutamyl transferase (OR 1.015, P = .01), and decreased prealbumin (OR 0.94, P = .04) correlated with the presence of NASH. On multivariate analysis, only increased triglycerides (OR 1.004, P = .04) and decreased prealbumin (OR 0.88, P = .005) correlated with the presence of NASH.

CONCLUSION

NASH is a frequent accompaniment of morbid obesity in patients undergoing bariatric surgery. Univariate and multivariate analyses of the clinical parameters studied could not identify strong predictors of biopsy-verified NASH. Therefore, intraoperative biopsy remains instrumental in diagnosing NASH and providing information for additional follow-up.

Authors+Show Affiliations

Department of Surgery, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri, USA. thelling@conemaugh.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18226970

Citation

Helling, Thomas S., et al. "Predictors of Nonalcoholic Steatohepatitis in Patients Undergoing Bariatric Surgery: when Is Liver Biopsy Indicated?" Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 4, no. 5, 2008, pp. 612-7.
Helling TS, Helzberg JH, Nachnani JS, et al. Predictors of nonalcoholic steatohepatitis in patients undergoing bariatric surgery: when is liver biopsy indicated? Surg Obes Relat Dis. 2008;4(5):612-7.
Helling, T. S., Helzberg, J. H., Nachnani, J. S., & Gurram, K. (2008). Predictors of nonalcoholic steatohepatitis in patients undergoing bariatric surgery: when is liver biopsy indicated? Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 4(5), 612-7. https://doi.org/10.1016/j.soard.2007.11.007
Helling TS, et al. Predictors of Nonalcoholic Steatohepatitis in Patients Undergoing Bariatric Surgery: when Is Liver Biopsy Indicated. Surg Obes Relat Dis. 2008 Sep-Oct;4(5):612-7. PubMed PMID: 18226970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of nonalcoholic steatohepatitis in patients undergoing bariatric surgery: when is liver biopsy indicated? AU - Helling,Thomas S, AU - Helzberg,John H, AU - Nachnani,Jagdish S, AU - Gurram,Krishna, Y1 - 2008/01/28/ PY - 2007/07/19/received PY - 2007/11/06/revised PY - 2007/11/14/accepted PY - 2008/1/30/pubmed PY - 2008/12/17/medline PY - 2008/1/30/entrez SP - 612 EP - 7 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 4 IS - 5 N2 - BACKGROUND: Nonalcoholic fatty liver disease is a frequent accompaniment of morbid obesity. A component of nonalcoholic fatty liver disease, steatosis, can, on occasion, lead to nonalcoholic steatohepatitis (NASH). Bariatric surgery has been shown to alter the course of this disease. Intraoperative liver biopsies might identify patients with NASH for more careful follow-up. We sought to determine noninvasive preoperative indicators of NASH. METHODS: The patients scheduled for bariatric surgery underwent a preoperative assessment. The study variables included age, gender, race, body mass index, diabetes mellitus, hypertension, and the results of serum liver function tests and triglyceride, cholesterol, iron, and prealbumin measurements. Univariate and multivariate analyses were performed to identify significant variables associated with NASH as determined by subsequent core liver biopsies taken during open Roux-en-Y gastric bypass. RESULTS: A total of 139 patients were entered into the study. NASH or NASH-associated fibrosis was found in 57 patients (41%). On univariate analyses, male gender (odds ratio [OR] 2.46, P = .06), diabetes mellitus (OR 2.60, P = .009), elevated serum triglyceride levels (OR 1.003, P = .02), elevated gamma glutamyl transferase (OR 1.015, P = .01), and decreased prealbumin (OR 0.94, P = .04) correlated with the presence of NASH. On multivariate analysis, only increased triglycerides (OR 1.004, P = .04) and decreased prealbumin (OR 0.88, P = .005) correlated with the presence of NASH. CONCLUSION: NASH is a frequent accompaniment of morbid obesity in patients undergoing bariatric surgery. Univariate and multivariate analyses of the clinical parameters studied could not identify strong predictors of biopsy-verified NASH. Therefore, intraoperative biopsy remains instrumental in diagnosing NASH and providing information for additional follow-up. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/18226970/Predictors_of_nonalcoholic_steatohepatitis_in_patients_undergoing_bariatric_surgery:_when_is_liver_biopsy_indicated L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(07)00779-4 DB - PRIME DP - Unbound Medicine ER -