Correlation Between Sex Hormones and Non-alcoholic Fatty Liver Disease Before and After Laparoscopic Sleeve Gastrectomy

Effect of Bariatric Surgery on the Sonographic Grade of Metabolic-Associated Fatty Liver Disease at 12-Month Follow-Up

BACKGROUND

Metabolic-associated fatty liver disease (MAFLD) is the most prevalent liver disease across the globe. One of the most effective treatments for this disease is weight loss. This study aimed to determine how metabolic and bariatric surgery (MBS) affects MAFLD sonographic grades.

METHODS

In 2021, a pre-post study was conducted on 73 patients who underwent MBS. The study collected demographic information and ultrasound grades of MAFLD before and after MBS.

RESULTS

A total of 73 patients underwent MBS, with 58 females and 15 males. The patients had a mean age of 39.8 ± 8.88 years and a mean BMI of 42.12 ± 5.98 kg/m2. Of these patients, 53 (72.6%) underwent SG, while 20 (27.4%) underwent RYGB. The preoperative BMI for females and males decreased significantly at the 12-month follow-up (P = 0.0001). However, males experienced more prominent weight changes (P = 0.009), but there was no statistically significant difference in fatty liver grade changes after MBS between males and females (P = 0.056), which suggests that the effect of MBS on fatty liver grades is not gender-specific. There was a significant reduction in BMI and fatty liver grade for patients under and over 40 years old after surgery (P = 0.0001). However, there was no statistically significant difference in fatty liver grade and BMI changes after MBS between the two age groups. RYGB was found to be more effective than SG in reducing fatty liver grade, BMI, and %TWL (P < 0.05).

CONCLUSION

Bariatric surgery can play a vital role in reducing the weight and severity of metabolic-associated fatty liver disease.

Non-alcoholic fatty liver disease through the female lifespan: the role of sex hormones

The prevalence of non-alcoholic fatty liver disease (NAFLD) differs between various stages of the female lifespan. The aim of this review is to summarize current evidence on the association of NAFLD and circulating sex hormones and to explore the pathogenesis of NAFLD within the context of (1) sex hormone changes during the reproductive, post-reproductive female life and beyond and (2) the in vitro and in vivo evidence on pharmacological modulation in women on menopausal hormone treatment (MHT) or endocrine therapy after breast cancer. The fluctuation in estrogen concentrations, the relative androgen excess, and the age-related reduction in sex hormone-binding globulin are related to increased NAFLD risk. Moreover, the peri-menopausal changes in body composition and insulin resistance might contribute to the increased NAFLD risk. Whether MHT prevents or improves NAFLD in this population remains an open question. Studies in women with breast cancer treated with tamoxifen or non-steroidal aromatase inhibitors point to their adverse effects on NAFLD development, although a more pronounced effect of tamoxifen is reported. Future studies focusing on the underlying pathogenesis should identify subgroups with the highest risk of NAFLD development and progression into more aggressive forms, as well as elucidate the role of hormone therapies, such as MHT.

Serum Fibrinogen-Like Protein 1 Levels in Obese Patients Before and After Laparoscopic Sleeve Gastrectomy: A Six-Month Longitudinal Study

PURPOSE

Fibrinogen-like protein (FGL)-1 is an original hepatokine with a critical role in developing hepatic steatosis. This study intends to examine the pre- and postoperative serum FGL-1 levels in bariatric patients and identify its relationship with other clinical indicators.

PATIENTS AND METHODS

Ninety-two individuals (60 bariatric patients and 32 people with normal weight) were enrolled in this research between July 2018 and April 2021. All bariatric patients finished follow-up visits 6 months after laparoscopic sleeve gastrectomy (LSG). Clinical data, anthropometric parameters, biochemical variables, FibroScan, and serum FGL-1 levels were collected at baseline and 6 months after LSG.

RESULTS

FGL-1 levels in patients with obesity (44.66±20.03 ng/mL) were higher than in individuals with normal weight (20.73±9.73 ng/mL, p < 0.001). After LSG, FGL-1 levels were significantly decreased (27.53±11.45 ng/mL, p < 0.001). Besides, body mass index (BMI), liver enzyme levels, glucose metabolism, lipid metabolism, uric acid (UA), controlled attenuation parameter (CAP), and liver stiffness measurement (LSM) were significantly improved. After adjusting possible confounders, FGL-1 levels at baseline were negatively associated with changes in LSM levels; changes in FGL-1 levels showed positive correlations with changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and UA levels at 6 months after surgery.

CONCLUSION

Serum FGL-1 levels were significantly decreased following LSG in patients with obesity. The preoperative serum FGL-1 levels could be a predictor of postoperative liver fibrosis improvement. Furthermore, the decreased FGL-1 levels were associated with improved liver enzymes and UA but not with bodyweight or glucolipid metabolism.