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Akhtar A, Ijaz H, Waseem M, Khan MI, Saif Y, Iqbal H, Batool SA, Kumari U, Surani S, Khan A. The interplay between diabetes and non-alcoholic fatty liver disease: a cross-sectional study from Pakistan. Ann Med Surg (Lond) 2024; 86:1929-1932. [PMID: 38576946 PMCID: PMC10990318 DOI: 10.1097/ms9.0000000000001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
Background and objectives Non-alcoholic fatty liver disease (NAFLD) is characterized by ectopic deposition of fat in the liver, in the absence of other secondary causes of fat buildup. The relationship between NAFLD, including alanine aminotransferase (ALT), and glycated haemoglobin (HbA1c), is important for predicting the severity of disease and prognosis. This study aims to investigate the association of HbA1c in type 2 diabetes mellitus (T2DM) patients with NAFLD via measuring the ALT levels. Materials and methods This retrospective cross-sectional study enroled 130 patients with T2DM and NAFLD. The association between levels of HbA1c and ALT in patients of NAFLD with controlled and uncontrolled T2DM, respectively, was investigated. Stratification was done based on gender and diabetic control, using HbA1c levels as a marker of glycemic control. Serum ALT levels were also compared in both groups. Results The mean age of the participants was 50.2±5.7 years. The total participants were 130, of which 77 (59.3%) were females and 53 (40.7%) were males. The numbers of patients having uncontrolled T2DM (HbA1c>7%), and controlled T2DM (HbA1c <7%) were 78 (60%) and 52 (40%), respectively. Moreover, 46 (35.3%) females and 32 (24.7%) males had uncontrolled T2DM, and 31 (23.8%) females and 21 (16.2%) males had controlled T2DM. The mean ALT level for uncontrolled and controlled T2DM in female patients was found to be 24.6±3.4 and 13.5±2.4, respectively, (P <0.05). For male patients, it was found to be 54.0±4.9 and 29.1±5.4, respectively (P=0.008). Conclusion There is a positive association between elevated HbA1c and ALT levels in T2DM patients with NAFLD.
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Affiliation(s)
- Ayesha Akhtar
- Internal Medicine, Khyber Teaching Hospital, Peshawar
| | - Huda Ijaz
- Internal Medicine, Allama Iqbal Medical College
| | | | | | - Yasir Saif
- Internal Medicine, University Hospital Kerry, Kerry, Ireland
| | | | | | - Usha Kumari
- Medicine, Dow University of Health Sciences, Karachi
| | - Salim Surani
- Texas A&M University, College Station, TX
- Research Collaborator, Mayo Clinic, Rochester, MN
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Xiao J, Zhang X, Zhu C, Gu Y, Sun L, Liang X, He Q. Development, Validation, and Application of a Scoring Model for Non-alcoholic Steatohepatitis. Obes Surg 2023; 33:3246-3255. [PMID: 37644345 DOI: 10.1007/s11695-023-06804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The aim of this study was to explore risk factors of NASH and then develop a non-invasive scoring model in Chinese patients with obesity. A scoring system was then applied to assess the effect of sleeve gastrectomy on NASH. METHODS A total of 243 patients with obesity were included and divided into NASH group and non-NASH group according to the pathological results of liver biopsy. Logistic regression was used to determine risk factors of NASH. A scoring model was derived by risk factors of NASH. Then, postoperative follow-up was performed in 70 patients. RESULTS Among the 243 patients, 118 (48.56%) patients showed NASH. Multivariate logistic regression identified aspartate aminotransferase (AST) (>21.50 IU/L), high-density lipoprotein cholesterol (HDL-C) (<1.155mmol/L), and homeostasis model assessment (HOMA-IR) (>9.368) as independent risk factors of NASH. The model included above risk factors showed a negative predictive value (NPV) of 70.38% in the low-risk category and a positive predictive value (PPV) of 85.71% in the high-risk category, with the area under the receiver operator curve (AUROC) of 0.737. Bariatric surgery resulted in a sharp decline in AST and HOMA-IR and a significant increase of HDL-C. The points of scoring model were improved at 6 months after surgery. CONCLUSION A non-invasive scoring model was derived by the risk factors of NASH included AST, HDL-C, and HOMA-IR and applied to the postoperative follow-up. After sleeve gastrectomy, the above risk factors and points of scoring model were significantly improved.
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Affiliation(s)
- Jinfeng Xiao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xinxin Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Chonggui Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yian Gu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Longhao Sun
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xiaoyu Liang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.
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Hatto M, Ivano VK, Gestic MA, Utrini MP, Chaim FDM, Callejas-Neto F, Chaim EA, Cazzo E. Application of Scores Assessing Histological Activity and Estimated Long-Term Risk Analysis of Hepatic Decompensation of Non-Alcoholic Fatty Liver Disease in Individuals Undergoing Bariatric Surgery. Obes Surg 2023; 33:1580-1586. [PMID: 37004688 DOI: 10.1007/s11695-023-06568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Histological scores can estimate disease staging, allowing a standardization of the assessment of non-alcoholic fatty liver disease (NAFLD). The prediction of risk of NAFLD progression is relevant to allow the planning of interventions. OBJECTIVE To analyze the application of the Iowa NAFLD decompensation risk score, the NAFLD activity score (NAS), and steatosis-activity-fibrosis score (SAF) and to assess correlations between these scores. METHODS This is a retrospective cross-sectional study enrolling 76 individuals who underwent bariatric surgery at a tertiary university hospital. Liver biopsy was performed during procedures; histological scores were then assessed. The Iowa score was calculated using age, diabetes, and platelet count. RESULTS 89.5% were female and mean age was 39.1 ± 9.6 years. Mean BMI was 38.2 ± 3.7 kg/m2. Steatosis (92.1%), hepatocellular ballooning (93.4%), lobular inflammation (93.4%), and fibrosis (97.4%) were the commonest histopathological findings. According to NAS, 22.4% had definite non-alcoholic steatohepatitis (NASH). According to SAF, 89.5% had moderate or severe NAFLD. The mean risks of NAFLD decompensation at 5, 10, and 12 years were 0.8%, 2.5%, and 2.9%, respectively. The group whose risk of decompensation was above 10% comprised 2.6% and 5.3% at 10 and 12 years, respectively. The severity assessed by SAF significantly associated with definite NASH diagnosis through NAS (p < 0.001). Iowa score did not correlate with both NAS/SAF scores. CONCLUSION The Iowa score demonstrated that individuals with obesity present with a significant long-term risk of NAFLD-related events. There were high rates of moderate/severe forms of NAFLD assessed by NAS and SAF scores. There were no significant correlations between Iowa and NAS/SAF scores.
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Affiliation(s)
- Marcelo Hatto
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Victor Kenzo Ivano
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Martinho Antonio Gestic
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Murillo Pimentel Utrini
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Felipe David Mendonça Chaim
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Francisco Callejas-Neto
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Elinton Adami Chaim
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil
| | - Everton Cazzo
- Depatment of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Sao Paulo, Campinas, Brazil.
- Rua Alexander Fleming, S/No Cidade Universitária Zeferino Vaz, Sao Paulo, CEP, Campinas, 13085-000, Brazil.
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Sabry K, Elmaleh HM, El-Swaify ST, Refaat MA, Atiya MAN, Alazab E, El-Abbassy I. Surgical Management Algorithm for Intrathoracic Sleeve Migration: A Retrospective Series and Literature Review. J Laparoendosc Adv Surg Tech A 2022; 32:1078-1091. [PMID: 36074085 DOI: 10.1089/lap.2022.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: With the increase in utilization of laparoscopic sleeve gastrectomy (LSG), intrathoracic sleeve migration (ITSM) has introduced a novel challenge for bariatric surgeons. Despite being an underreported complication, effective and safe solutions for ITSM are being sought. The aim of this study is to present our center's experience as well as a comprehensive review of the literature on ITSM. Accordingly, we propose an algorithm for the surgical management of ITSM. Methods: We conducted a retrospective chart review of 4000 patients who underwent LSG at our center. ITSM was clinically suspected with gastroesophageal reflux disease (GERD) symptoms and/or epigastric pain resistant to proton pump inhibitors. Diagnosis of ITSM was confirmed in all patients by three-dimensional computed tomography (3D-CT) volumetry. Several corrective procedures were offered based on the findings of the 3D-CT volumetry, esophagogastroduodenoscopy, and the diaphragmatic pillars' condition: cruroplasty with gastropexy, one anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass (RYGB) with or without re-sleeve gastrectomy, omentopexy, or ligamentum teres augmentation. We conducted a literature review of ITSM using several databases. Results: Fifteen patients were diagnosed with postoperative ITSM. The most common presenting complaint was severely worsened GERD symptoms not responding to medical treatment. The mean time interval between the primary operation and diagnosis of ITSM was 38.8 ± 29.1 months. Three patients had re-sleeve gastrectomy and gastropexy, 5 patients had OAGB, and 7 patients had RYGB. The mean postoperative body mass index was 31.2 ± 4.9 kg/m2. No case of recurrent ITSM was detected during follow-up. Our electronic database search yielded 19 studies to be included in our review, which included 201 patients. Conclusion: A high index of suspicion is required to diagnose ITSM. CT volumetry with 3D reconstruction may be the most sensitive diagnostic modality. ITSM management should depend on the results of the diagnostic workup and the condition of the diaphragmatic pillars during surgery.
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Affiliation(s)
- Karim Sabry
- Division of Bariatric Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | | | | | - Mazen A Refaat
- Department of Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | | | - Emad Alazab
- Department of Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | - Islam El-Abbassy
- Division of Bariatric Surgery, Ain Shams University Hospitals, Cairo, Egypt.,Department of Surgery, Raigmore Hospital, Inverness, United Kingdom.,Institute of Medical Sciences, King's College, University of Aberdeen, Aberdeen, United Kingdom
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Okut G, Turgut E, Kaplan K, Bag YM, Sumer F, Kayaalp C. Is It Possible to Estimate the Liver Left Lobe Volume Using Preoperative Data Before Bariatric Surgery? Obes Surg 2022; 32:2696-2705. [PMID: 35689141 DOI: 10.1007/s11695-022-06143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Retraction of the left lobe of the liver (LLL) is an important step in bariatric surgical procedures. A good liver retraction will both facilitate the operation and reduce complications. The aim of the study is to identify patients with large LLL with preoperative anthropometric and laboratory data, and to reveal complications due to large LLL. MATERIALS AND METHODS The data of 245 patients who underwent bariatric surgery in our department between April 2019 and March 2021 were retrospectively analyzed. The patients were divided into two groups according to the visibility of the caudate lobe of the liver, the left diaphragmatic artery-vein, and the fat pad on the esophagus after liver retraction. RESULTS Univariate analyses revealed significant differences in BMI, waist and hip circumferences, TG, DM, and HbA1c values, but only BMI (p = 0.001) and the presence of DM (p = 0.017) were found to be independent predictors of LLL size. BMI ≥ 42.1 kg/m2 indicates the size of LLL with 83% sensitivity and 49% specificity. Retractor-related complications were significantly higher in the large LLL group (p = 0.036). There was no difference between the two groups in terms of complications related to trocar insertion (p = 0.014) and postoperative liver enzyme levels (p = 0.714). The operation time (laparoscopic sleeve gastrectomy [LSG]; p = 0.021) (laparoscopic Roux-N-Y gastric bypass [LRYGB]; p = 0.020) and the amount of bleeding (LSG; p < 0.001) (LRYGB; p = 0.011) are higher in patients with large LLL. CONCLUSION Large LLL can be predicted and complications may be reduced with the help of preoperative data.
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Affiliation(s)
- Gokalp Okut
- Gastroenterology Surgery Department, Inonu University Turgut Ozal Medical Center, Bulgurlu Mahallesi, Elazığ Yolu 15. Km, 44280, Merkez/Battalgazi/Malatya, Turkey.
| | - Emre Turgut
- Gastroenterology Surgery Department, Inonu University Turgut Ozal Medical Center, Bulgurlu Mahallesi, Elazığ Yolu 15. Km, 44280, Merkez/Battalgazi/Malatya, Turkey
| | - Kuntay Kaplan
- Gastroenterology Surgery Department, Inonu University Turgut Ozal Medical Center, Bulgurlu Mahallesi, Elazığ Yolu 15. Km, 44280, Merkez/Battalgazi/Malatya, Turkey
| | - Yusuf Murat Bag
- Gastroenterology Surgery Department, Inonu University Turgut Ozal Medical Center, Bulgurlu Mahallesi, Elazığ Yolu 15. Km, 44280, Merkez/Battalgazi/Malatya, Turkey
| | - Fatih Sumer
- Gastroenterology Surgery Department, Inonu University Turgut Ozal Medical Center, Bulgurlu Mahallesi, Elazığ Yolu 15. Km, 44280, Merkez/Battalgazi/Malatya, Turkey
| | - Cuneyt Kayaalp
- Gastroenterology Surgery Department, Inonu University Turgut Ozal Medical Center, Bulgurlu Mahallesi, Elazığ Yolu 15. Km, 44280, Merkez/Battalgazi/Malatya, Turkey
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Meneses D, Olveira A, Corripio R, Méndez MDC, Romero M, Calvo-Viñuelas I, Herranz L, Vicent D, de-Cos-Blanco AI. Prevalence and predictors of non-alcoholic steatohepatitis in patients with morbid obesity. ENDOCRINOL DIAB NUTR 2022; 69:178-188. [PMID: 35396116 DOI: 10.1016/j.endien.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in morbid obesity (MO). A considerable proportion of patients with MO have non-alcoholic steatohepatitis (NASH). Liver biopsy (LB) is the only procedure that reliably differentiates NASH from other stages of NAFLD, but its invasive nature prevents it from being generalisable. Hence, non-invasive assessment is critical in this group of patients. OBJECTIVES To report NAFLD/NASH prevalence in a cohort of patients with MO and to identify predictors of NASH. METHODS Fifty-two consecutive patients subjected to bariatric surgery in a University hospital in Spain underwent LB. Anthropometric, clinical and biochemical variables were registered. According of the results of the LB, individuals were classified by whether they had NASH or not. Multiple logistic regression analysis was performed to identify independent factors associated with NASH. RESULTS NAFLD was reported in 94.2% of the patients, simple steatosis was present in 51.92% and NASH in 42.31%. Meanwhile, 17.3% of patients exhibited significant fibrosis (≥F2). HIGHT score for NASH risk was established using five independent predictors: systemic Hypertension, Insulin resistance, Gamma-glutamyl transferase, High density lipoprotein cholesterol and alanine Transaminase. This score ranges from 0 to 7 and was used to predict NASH in our cohort (area under the receiver operator characteristic curve 0.846). A score of 4 or greater implied high risk (sensitivity 77.3%, specificity 73.3%, positive predictive value 68%, negative predictive value 81.5%, accuracy 75%). CONCLUSIONS NAFLD is practically a constant in MO with a considerable proportion of patients presenting NASH. The combination of five independent predictors in a scoring system may help the clinician optimise the selection of patients with MO for LB.
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Affiliation(s)
- Diego Meneses
- Obesity Unit, Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Antonio Olveira
- Liver Unit, Department of Gastroenterology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ramón Corripio
- Metabolic Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Del Carmen Méndez
- Department of Pathology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Míriam Romero
- Liver Unit, Department of Gastroenterology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Isabel Calvo-Viñuelas
- Obesity Unit, Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucrecia Herranz
- Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - David Vicent
- Instituto de Investigación Sanitaria [Health Research Institute] of Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ana Isabel de-Cos-Blanco
- Obesity Unit, Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
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Joshi K, Chandrakar S, Patil S. Baseline Values of Nonalcoholic Fatty Liver Disease Scores and Its Risk Assessment in Patients with Type 2 Diabetes Mellitus. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2021. [DOI: 10.1159/000518155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing and is fueled by a twin-epidemic of obesity and diabetes mellitus in India. The objective of the study was to estimate various noninvasive NAFLD scores (NINS) for the baseline risk-assessment of NAFLD in patients with type 2 diabetes mellitus (T2DM). <b><i>Methods:</i></b> An observational, cross-sectional, open label, study of investigator-rated NINS was conducted ensuring adherence to relevant ethical standards. <b><i>Results:</i></b> In a 3-month period, 29 patients with T2DM were enrolled (age [mean ± SD]: 55.8 ± 9.72 years; men [<i>n</i>, %]: 18, 62%). One patient (3.45%) by fibrosis-4 index (cutoff for advanced fibrosis ≥2.67) and by AST to platelet ratio index (cutoff ≥0.98); 2 (6.90%) by NAFLD fibrosis score (cutoff ≥0.676); 20 (69%) by body mass index (BMI), AST to ALT ratio, and DM score (BARD; cuff-off ≥2); and 27 (93.10%) by BMI, age, ALT, triglyceride score (cutoff ≥1) indicated high risk for advanced hepatic fibrosis. Only the BARD score (median [min-max]: 3 [1–4]) was elevated above the cutoff values while other scores were below cutoff values. The study failed to demonstrate any correlation between age, gender, anthropometric and metabolic parameters, and NINS. <b><i>Conclusion:</i></b> While this study did not demonstrate significant elevation of NINS, scores were found be elevated in some T2DM patients and they may be at high risk of advanced liver fibrosis. Further well-designed studies in this domain are required for early detection, management, and reducing the burden of liver disease in Indian patients with diabetes.
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Outcomes after curative therapy for hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: a meta-analysis and review of current literature. HPB (Oxford) 2021; 23:1164-1174. [PMID: 33608215 DOI: 10.1016/j.hpb.2021.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/02/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to compare the outcomes of curative therapy (resection, transplantation, ablation) for hepatocellular carcinoma (HCC) arising from non-alcoholic fatty liver disease (NAFLD) and non-NAFLD etiologies. METHODS A systematic search of PubMed, EMBASE and Cochrane Library was conducted for studies comparing survival, peri- and post-operative outcomes. Quality assessment was performed using the Newcastle-Ottawa scale. RESULTS Findings for 5579 patients were pooled across 9 studies and examined. Analysis demonstrated improved disease-free survival (DFS; HR 0.85, 95% CI 0.74-0.98, p = 0.03) and overall survival (OS; HR 0.87; 95% CI 0.81-0.93; p < 0.0001) in NAFLD-HCC patients undergoing liver resection as compared to non-NAFLD HCC patients. NAFLD-HCC patients undergoing all forms of curative therapy were similarly associated with improved OS (HR 0.96; 95% CI 0.86-1.06; p = 0.40) and DFS (HR 0.85; 95% CI 0.74-0.98; p = 0.03), albeit results being significant only for DFS. Only 2 studies reported higher rates of peri- and post-operative complications in patients with NAFLD-HCC. Significant inter-study heterogeneity precluded further analysis. CONCLUSION NAFLD-HCC patients can enjoy long-term survival benefit with aggressive curative therapy. Peri- and post-operative morbidity should be mitigated with pre-operative optimization of comorbidities, and deliberately close post-operative monitoring.
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Meneses D, Olveira A, Corripio R, Méndez MDC, Romero M, Calvo-Viñuelas I, Herranz L, Vicent D, de-Cos-Blanco AI. Prevalence and predictors of non-alcoholic steatohepatitis in patients with morbid obesity. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00180-4. [PMID: 34340957 DOI: 10.1016/j.endinu.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in morbid obesity (MO). A considerable proportion of patients with MO have non-alcoholic steatohepatitis (NASH). Liver biopsy (LB) is the only procedure that reliably differentiates NASH from other stages of NAFLD, but its invasive nature prevents it from being generalisable. Hence, non-invasive assessment is critical in this group of patients. OBJECTIVES To report NAFLD/NASH prevalence in a cohort of patients with MO and to identify predictors of NASH. METHODS Fifty-two consecutive patients subjected to bariatric surgery in a University hospital in Spain underwent LB. Anthropometric, clinical and biochemical variables were registered. According of the results of the LB, individuals were classified by whether they had NASH or not. Multiple logistic regression analysis was performed to identify independent factors associated with NASH. RESULTS NAFLD was reported in 94.2% of the patients, simple steatosis was present in 51.92% and NASH in 42.31%. Meanwhile, 17.3% of patients exhibited significant fibrosis (≥F2). HIGHT score for NASH risk was established using five independent predictors: systemic Hypertension, Insulin resistance, Gamma-glutamyl transferase, High density lipoprotein cholesterol and alanine Transaminase. This score ranges from 0 to 7 and was used to predict NASH in our cohort (area under the receiver operator characteristic curve 0.846). A score of 4 or greater implied high risk (sensitivity 77.3%, specificity 73.3%, positive predictive value 68%, negative predictive value 81.5%, accuracy 75%). CONCLUSIONS NAFLD is practically a constant in MO with a considerable proportion of patients presenting NASH. The combination of five independent predictors in a scoring system may help the clinician optimise the selection of patients with MO for LB.
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Affiliation(s)
- Diego Meneses
- Obesity Unit, Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Antonio Olveira
- Liver Unit, Department of Gastroenterology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ramón Corripio
- Metabolic Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Del Carmen Méndez
- Department of Pathology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Míriam Romero
- Liver Unit, Department of Gastroenterology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Isabel Calvo-Viñuelas
- Obesity Unit, Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucrecia Herranz
- Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - David Vicent
- Instituto de Investigación Sanitaria [Health Research Institute] of Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ana Isabel de-Cos-Blanco
- Obesity Unit, Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
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Performance of Noninvasive Liver Fibrosis Scores in the Morbid Obese Patient, Same Scores but Different Thresholds. Obes Surg 2020; 30:2538-2546. [DOI: 10.1007/s11695-020-04509-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Panjeshahin A, Mollahosseini M, Panbehkar‐Jouybari M, Kaviani M, Mirzavandi F, Hosseinzadeh M. Effects of garlic supplementation on liver enzymes: A systematic review and meta‐analysis of randomized controlled trials. Phytother Res 2020; 34:1947-1955. [DOI: 10.1002/ptr.6659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 01/20/2020] [Accepted: 02/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Asieh Panjeshahin
- Nutrition and Food Security Research CenterShahid Sadoughi University of Medical Sciences Yazd Iran
- Department of Nutrition, School of Public HealthShahid Sadoughi University of Medical Sciences Yazd Iran
| | - Mehdi Mollahosseini
- Nutrition and Food Security Research CenterShahid Sadoughi University of Medical Sciences Yazd Iran
- Department of Nutrition, School of Public HealthShahid Sadoughi University of Medical Sciences Yazd Iran
| | - Monireh Panbehkar‐Jouybari
- Nutrition and Food Security Research CenterShahid Sadoughi University of Medical Sciences Yazd Iran
- Department of Nutrition, School of Public HealthShahid Sadoughi University of Medical Sciences Yazd Iran
| | - Mojtaba Kaviani
- Faculty of Pure & Applied Science, School of Nutrition and DieteticsAcadia University Wolfville Nova Scotia Canada
| | - Farhang Mirzavandi
- Nutrition and Food Security Research CenterShahid Sadoughi University of Medical Sciences Yazd Iran
- Department of Nutrition, School of Public HealthShahid Sadoughi University of Medical Sciences Yazd Iran
| | - Mahdieh Hosseinzadeh
- Nutrition and Food Security Research CenterShahid Sadoughi University of Medical Sciences Yazd Iran
- Department of Nutrition, School of Public HealthShahid Sadoughi University of Medical Sciences Yazd Iran
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Overview of the Pathogenesis, Genetic, and Non-Invasive Clinical, Biochemical, and Scoring Methods in the Assessment of NAFLD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193570. [PMID: 31554274 PMCID: PMC6801903 DOI: 10.3390/ijerph16193570] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. It represents a range of disorders, including simple steatosis, nonalcoholic steatohepatitis (NASH), and liver cirrhosis, and its prevalence continues to rise. In some cases, hepatocellular carcinoma (HCC) may develop. The develop;ment of non-invasive diagnostic and screening tools is needed, in order to reduce the frequency of liver biopsies. The most promising methods are those able to exclude advanced fibrosis and quantify steatosis. In this study, new perspective markers for inflammation, oxidative stress, apoptosis, and fibrogenesis; emerging scoring models for detecting hepatic steatosis and fibrosis; and new genetic, epigenetic, and multiomic studies are discussed. As isolated biochemical parameters are not specific or sensitive enough to predict the presence of NASH and fibrosis, there is a tendency to use various markers and combine them into mathematical algorithms. Several predictive models and scoring systems have been developed. Current data suggests that panels of markers (NAFLD fibrosis score, Fib-4 score, BARD score, and others) are useful diagnostic modalities to minimize the number of liver biopsies. The review unveils pathophysiological aspects related to new trends in current non-invasive biochemical, genetic, and scoring methods, and provides insight into their diagnostic accuracies and suitability in clinical practice.
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