1
|
Schmitz SM, Storms S, Koch A, Stier C, Kroh A, Rheinwalt KP, Schipper S, Hamesch K, Ulmer TF, Neumann UP, Alizai PH. Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery. Biomedicines 2023; 11:1595. [PMID: 37371690 DOI: 10.3390/biomedicines11061595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Metabolically healthy obesity (MHO) is a concept that applies to obese patients without any elements of metabolic syndrome (metS). In turn, metabolically unhealthy obesity (MUO) defines the presence of elements of metS in obese patients. The components of MUO can be divided into subgroups regarding the elements of inflammation, lipid and glucose metabolism and cardiovascular disease. MUO patients appear to be at greater risk of developing non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) compared to MHO patients. The aim of this study was to evaluate the influence of different MUO components on NAFLD and NASH in patients with morbid obesity undergoing bariatric surgery. (2) Methods: 141 patients undergoing bariatric surgery from September 2015 and October 2021 at RWTH Aachen university hospital (Germany) were included. Patients were evaluated pre-operatively for characteristics of metS and MUO (HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension). Intraoperatively, a liver biopsy was taken from the left liver lobe and evaluated for the presence of NAFLD or NASH. In ordinal regression analyses, different factors were evaluated for their influence on NAFLD and NASH. (3) Results: Mean BMI of the patients was 52.3 kg/m2 (36-74.8, SD 8.4). Together, the parameters HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension accounted for a significant amount of variance in the outcome, with a likelihood ratio of χ2 (9) = 41.547, p < 0.001, for predicting the presence of NASH. Only HOMA was an independent predictor of NASH (B = 0.102, SE = 0.0373, p = 0.007). Evaluation of steatosis showed a similar trend (likelihood ratio χ2 (9) = 40.272, p < 0.001). Independent predictors of steatosis were HbA1c (B = 0.833, SE = 0.343, p = 0.015) and HOMA (B = 0.136, SE = 0.039, p < 0.001). (4) Conclusions: The above-mentioned model, including components of MUO, was significant for diagnosing NASH in patients with morbid obesity undergoing bariatric surgery. Out of the different subitems, HOMA independently predicted the presence of NASH and steatosis, while HbA1c independently predicted steatosis and fibrosis. Taken together, the parameter of glucose metabolism appears to be more accurate for the prediction of NASH than the parameters of lipid metabolism, inflammation or the presence of cardiovascular disease.
Collapse
Affiliation(s)
- Sophia M Schmitz
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Sebastian Storms
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Alexander Koch
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Christine Stier
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
- Department of General-, Visceral-, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
- Department of Surgical Endoscopy, Sana Hospital Huerth, 50354 Huerth, Germany
| | - Andreas Kroh
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Karl P Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825 Cologne, Germany
| | - Sandra Schipper
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Karim Hamesch
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Tom F Ulmer
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825 Cologne, Germany
| | - Patrick H Alizai
- Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
- Gemeinschaftskrankenhaus Bonn, Klinik für Allgemein- und Viszeralchirurgie, 53113 Bonn, Germany
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Blank V, Petroff D, Boehlig A, Heinze A, Karlas T, Berg T, Wiegand J. Clinical implications of hepatic structure and function evaluation based on vibration-controlled transient elastography and liver maximum function capacity test in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2022; 34:686-692. [PMID: 35102112 DOI: 10.1097/meg.0000000000002347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Transient elastography [vibration-controlled transient elastography (VCTE)] noninvasively guides risk stratification in patients with nonalcoholic fatty liver disease (NAFLD). Patients with nonalcoholic steatohepatitis (NASH) and fibrosis can be identified using the FAST-score. The liver maximum function test (LiMAx) could be helpful in more precise risk stratification. This pilot study evaluated VCTE, FAST-score, and LiMAx in NAFLD patients. METHODS NAFLD patients prospectively underwent VCTE and LiMAx. The cutoffs for high fibrosis risk were 9.3/9.6 kPa (M/XL-probe) and 331 dB/m for steatosis. A FAST-score greater than 0.67 was used to identify patients with NASH and LiMAx values below 315 μg/kg/h for impaired liver function. RESULTS In total, 57 NAFLD patients (BMI 32 ± 6 kg/m2; 60% diabetes) were included. High risk for fibrosis and steatosis was observed in 26/57 and 28/57 cases, respectively. Overall, 19/57 patients presented impaired liver function. However, 14/26 of patients with a high risk for fibrosis had impaired liver function compared to 5/31 of those without (P = 0.0026). Similarly, 12/18 patients at high risk for NASH had impaired liver function compared to 7/39 without (P < 0.001). The subgroup with diabetes had a liver stiffness a factor of 1.8 higher, FAST-score was 0.13 higher and LiMAx values were 66 μg/kg/h lower compared to nondiabetics. CONCLUSION There is a significant correlation between the functional liver capacity (LiMAx) and the structural liver assessment by VCTE. In cases with high liver stiffness or FAST-score, low LiMAx results may identify NAFLD patients at risk for disease progression and reduce the risk of false-positive categorization.
Collapse
Affiliation(s)
- Valentin Blank
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Faculty of Medicine, University of Leipzig
| | - David Petroff
- Clinical Trial Centre Leipzig, University of Leipzig
| | - Albrecht Boehlig
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Aileen Heinze
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center
| | - Thomas Berg
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
4
|
The triglycerides and glucose (TyG) index: A new marker associated with nonalcoholic steatohepatitis (NASH) in obese patients. DIABETES & METABOLISM 2022; 48:101345. [PMID: 35339664 DOI: 10.1016/j.diabet.2022.101345] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
AIM Diagnosis of nonalcoholic steatohepatitis (NASH) relies on liver biopsy. Noninvasive tools would be useful to target patients to refer for a biopsy. We aimed to determine the diagnostic value of the triglycerides and glucose (TyG) index, an insulin-resistance indicator, to predict NASH. METHODS Our study included grade II-III obese patients aged 18-65 years undergoing bariatric surgery and included in the COMET (COllection of MEtabolic Tissues) biobank (NCT02861781). Liver biopsies performed during bariatric surgery were collected from the biobank along with blood derivatives. Biopsies were analysed according to the steatosis, activity and fibrosis (SAF) scoring system to diagnose NASH, nonalcoholic fatty liver disease (NAFLD), and fibrosis. Logistic regression models were performed to identify factors predicting NASH, NAFLD, and fibrosis. RESULTS Of 238 analysed subjects (mean age 43±12 years, 33.6% men), 29% had type 2 diabetes. Steatosis was present in 67.2%, while NASH and advanced fibrosis (stage F3) were diagnosed in 18.1% and 2.9% respectively. TyG index was independently associated with NASH (odds ratio (OR): 4.7 [95% confidence interval: 2.3;9.5] P < 0.0001), NAFLD (OR: 2.0 [1.1;3.7] P = 0.03) and stages 2-3 fibrosis (OR: 4.0 [1.5;10.8] P = 0.007). NASH was also predicted by gamma-glutamyl transferase (GGT) with an area under the ROC curve: 0.79 [0.71;0.87 P = 0.04] for GGT and TyG index combined. CONCLUSION In our cohort of severely obese patients, TyG index, when associated with GGT level, exhibited high diagnostic performance to predict NASH. Although validation in larger populations is needed, this result may be of considerable clinical value to predict need for liver biopsy.
Collapse
|
5
|
El Kassas M, Alboraie M, El-Sayed M, Elbehiry S, Sherief A, Youssef M, Moaz I, El Tahan A, Abdeen N, Eysa B, Aziz AA, Tawheed A, Ezzat S, Hassany M. Effect of disease stage and treatment outcomes on the dynamics of liver functions during and after treatment of hepatitis C with directly acting antivirals. Eur J Gastroenterol Hepatol 2021; 33:e302-e307. [PMID: 34080825 DOI: 10.1097/meg.0000000000002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Virus C infection is recently treated successfully with plenty of direct antiviral agents (DAAs). We aimed to evaluate the effect of disease stage and treatment outcome on the dynamics of liver functions during treatment of hepatitis C with DAAs. METHODS We reported the liver function in 2354 subjects diagnosed as chronic hepatitis C before, during and after treatment with different DAAs regimens. Patients were classified into two groups according to treatment response with further subclassification according to the presence or absence of cirrhosis, and changes in liver functions were compared in each group and subgroup. RESULTS Totally 2213 (94%) achieved sustained virological response (SVR) to DAAs therapy with significant improvement in all liver biochemistry. Also, there was an improvement in the non-SVR group's liver enzymes in relapsers during and after treatment; however, there was no improvement in serum albumin. We noticed a slight increase in serum bilirubin at weeks 4 and 8 for both groups. CONCLUSION DAAs therapy is associated with improvement of the liver biochemical profile and improved outcome in the majority of chronic hepatitis C virus patients due to suppression of viral replication. However, the long-term impact of DAAs therapy needs to be further evaluated.
Collapse
Affiliation(s)
| | | | | | | | - Ahmed Sherief
- Tropical Medicine Department, Faculty of Medicine Ain Shams University, Cairo
| | | | - Inas Moaz
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia
| | - Adel El Tahan
- New Cairo Viral Hepatitis, Treatment Unit, New Cairo Hospital, Cairo
| | - Nermeen Abdeen
- Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria
| | - Basem Eysa
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute
| | - Ayman A Aziz
- Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Ahmed Tawheed
- Endemic Medicine Department, Faculty of Medicine, Helwan University
| | - Sameera Ezzat
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia
| | - Mohamed Hassany
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute
| |
Collapse
|
6
|
Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass. Obes Surg 2021; 31:3218-3226. [PMID: 33813683 PMCID: PMC8175244 DOI: 10.1007/s11695-021-05390-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a common condition in patients with obesity. Bariatric surgery has often been proposed as a viable treatment option, but the ideal surgical procedure remains unclear. Inconsistently, reports on postoperative deterioration of liver function put further doubt on which technique to apply. Aim of this study was to assess the impact of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on the postoperative recovery of liver function. METHODS A total of 175 patients with obesity that underwent bariatric surgery in our institution were included in this prospective cohort study. BMI, laboratory values, and liver function capacity (using LiMAx) were assessed preoperatively and at 6 and 12 months postoperatively. Generalized linear model (GLM) was performed to determine variables influencing liver function capacity after the operation. RESULTS Prior to operations, 64% of patients presented with a diminished liver function capacity, as measured by LiMAx test. Liver function capacity significantly recovered after 12 months in the SG group (300 μg/kg/h preop vs. 367 μg/kg/h postop) but not in the RYGB group (306 μg/kg/h preop vs. 349 μg/kg/h). Preoperative factors impeding liver function recovery included type 2 diabetes mellitus (T2DM), weight, male sex, AST/thrombocyte ratio (APRI), and gamma-glutamyltransferase (GGT). CONCLUSION Bariatric surgery, especially sleeve gastrectomy, leads to an improvement of liver function. However, in some patients with T2DM, higher preoperative weight and male sex postoperative deterioration of liver function capacity may occur.
Collapse
|
7
|
Billeter AT, Wloka S, Behnisch R, Albrecht T, Roessler S, Goeppert B, Mueller S, Nickel F, Müller B. Development and Validation of a Novel Scoring System for Noninvasive Nonalcoholic Steatohepatitis Detection in Bariatric Patients. Obes Facts 2021; 14:490-500. [PMID: 34419953 PMCID: PMC8546458 DOI: 10.1159/000517383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Nonalcoholic fatty liver disease covers a broad spectrum. Simple steatosis has usually a benign course while nonalcoholic steatohepatitis (NASH) can progress into hepatocellular carcinoma, and cirrhosis. Therefore, differentiating patients with benign steatosis and NASH is crucial. Liver biopsy, the usual gold standard for NASH diagnosis, cannot be used as a screening method due to its associated risks. This is especially problematic for obese patients with a prevalence of nonalcoholic fatty liver disease (NAFLD) in >80% of patients. The aim of this study was therefore to develop and validate a noninvasive NASH screening test in a cohort of high-risk, morbidly obese patients. METHODS This prospective study examined diagnostic accuracy in accordance with STARD guidelines. 112 liver biopsies were consecutively assigned to either a training or validation cohort. Using the Bedossa histological scoring system, the cohorts were subdivided into NASH versus NAFLD/No NAFLD. Predictors of NASH were evaluated with receiver operating characteristic (ROC) curves. A model was then constructed using a backward stepwise logistic regression and evaluated in an independent validation cohort. RESULTS 53.5% of the patients had NASH and 4 patients had cirrhosis. Mean body mass index (BMI) was 49.8 ± 7.5 kg/m2. Backward stepwise logistic regression identified 4 parameters associated with the presence of NASH: alanin-aminotransferase, albumin, BMI, and triglycerides. The noninvasive NASH detection score (NI-NASH-DS) had an ROC of 0.851 and 0.727 in the training and validation cohorts, respectively. Sensitivity and specificity were 77.1% and 88% in the training cohort and 88% and 48% in the validation cohort which was much better than the established noninvasive scores. DISCUSSION/CONCLUSION The NI-NASH-DS is easy-to-use, inexpensive, and noninvasive and can reliably detect NASH in patients with morbid obesity. Due to its simplicity, it can be used frequently and repeatedly.
Collapse
Affiliation(s)
- Adrian T. Billeter
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
- *Adrian T. Billeter,
| | - Sarah Wloka
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Thomas Albrecht
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | | | - Benjamin Goeppert
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Mueller
- Department of Internal Medicine, Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Müller
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
8
|
Rheinwalt KP, Drebber U, Schierwagen R, Klein S, Neumann UP, Ulmer TF, Plamper A, Kroh A, Schipper S, Odenthal M, Uschner FE, Lingohr P, Trebicka J, Brol MJ. Baseline Presence of NAFLD Predicts Weight Loss after Gastric Bypass Surgery for Morbid Obesity. J Clin Med 2020; 9:jcm9113430. [PMID: 33114543 PMCID: PMC7693802 DOI: 10.3390/jcm9113430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background. Bariatric surgery is a widely used treatment for morbid obesity. Prediction of postoperative weight loss currently relies on prediction models, which mostly overestimate patients’ weight loss. Data about the influence of Non-alcoholic fatty liver disease (NAFLD) on early postoperative weight loss are scarce. Methods. This prospective, single-center cohort study included 143 patients receiving laparoscopic gastric bypass surgery (One Anastomosis-Mini Gastric Bypass (OAGB-MGB) or Roux-en-Y Gastric Bypass (RYGB)). Liver biopsies were acquired at surgery. NAFLD activity score (NAS) assigned patients to “No NAFLD”, “NAFL” or “NASH”. Follow up data were collected at 3, 6 and 12 months. Results. In total, 49.7% of patients had NASH, while 41.3% had NAFL. Compared with the No NAFLD group, NAFL and NASH showed higher body-mass-index (BMI) at follow-up (6 months: 31.0 kg/m2 vs. 36.8 kg/m2 and 36.1 kg/m2, 12 months: 27.0 kg/m2 vs. 34.4 and 32.8 kg/m2) and lower percentage of total body weight loss (%TBWL): (6 months: 27.1% vs. 23.3% and 24.4%; 12 months: 38.5% vs. 30.1 and 32.6%). Linear regression of NAS points significantly predicts percentage of excessive weight loss (%EWL) after 6 months (Cologne-weight-loss-prediction-score). Conclusions. Histopathological presence of NAFLD might lead to inferior postoperative weight reduction after gastric bypass surgery. The mechanisms underlying this observation should be further studied.
Collapse
Affiliation(s)
- Karl Peter Rheinwalt
- Department of Bariatric, Metabolic, and Plastic Surgery, St. Franziskus-Hospital, 50825 Cologne, Germany; (K.P.R.); (A.P.)
| | - Uta Drebber
- Department of Pathology, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (U.D.); (M.O.)
| | - Robert Schierwagen
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
| | - Sabine Klein
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
| | - Ulf Peter Neumann
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
- Department of Surgery, Maastricht University Medical Centre (MUMC), P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Tom Florian Ulmer
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
| | - Andreas Plamper
- Department of Bariatric, Metabolic, and Plastic Surgery, St. Franziskus-Hospital, 50825 Cologne, Germany; (K.P.R.); (A.P.)
| | - Andreas Kroh
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
| | - Sandra Schipper
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, RWTH University Clinic and Helmholtz Institute for Biomedical Engineering, 52074 Aachen, Germany
| | - Margarete Odenthal
- Department of Pathology, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (U.D.); (M.O.)
| | - Frank Erhard Uschner
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany;
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
- European Foundation for the Study of Chronic Liver Failure-EF Clif, 08021 Barcelona, Spain
- Correspondence: ; Tel.: +49-(0)-69-6301-4256; Fax: +49-(0)-69-6301-84441
| | - Maximilian Joseph Brol
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
- Department of Internal Medicine I, University Clinic, 53127 Bonn, Germany
| |
Collapse
|
9
|
Schmitz SMT, Kroh A, Ulmer TF, Andruszkow J, Luedde T, Brozat JF, Neumann UP, Alizai PH. Evaluation of NAFLD and fibrosis in obese patients - a comparison of histological and clinical scoring systems. BMC Gastroenterol 2020; 20:254. [PMID: 32758151 PMCID: PMC7405451 DOI: 10.1186/s12876-020-01400-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients. Methods In a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score. Results APRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC = 0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score. Conclusions APRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.
Collapse
Affiliation(s)
- Sophia Marie-Therese Schmitz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr.30, 52074, Aachen, Germany.
| | - Andreas Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr.30, 52074, Aachen, Germany
| | - Tom Florian Ulmer
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr.30, 52074, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, Maastricht, HX, Netherlands
| | - Julia Andruszkow
- Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstr, 30, 52074, Aachen, Germany
| | - Tom Luedde
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of the Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Jonathan Frederik Brozat
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr.30, 52074, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, Maastricht, HX, Netherlands
| | - Patrick Hamid Alizai
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr.30, 52074, Aachen, Germany
| |
Collapse
|
10
|
Mani VR, Kalabin A, Nwakanama C, Suman P, Ahmed L. Preoperative versus intraoperative diagnosis of hiatal hernia in bariatric population. Surg Obes Relat Dis 2019; 15:1949-1955. [PMID: 31648979 DOI: 10.1016/j.soard.2019.08.553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/26/2019] [Accepted: 08/31/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hiatal hernia is frequently encountered intraoperatively during bariatric surgery. There is scarce research pertaining to the diagnostic accuracy of a preoperative diagnostic modality in comparison to intraoperative diagnosis, along with patient characteristics and related factors contributing to hiatal hernia. OBJECTIVE To identify the prevalence and associations of hiatal hernia in the bariatric patient population, we compared the diagnostic accuracy of upper gastrointestinal series and esophagogastroduodenoscopy with the intraoperative findings across various patient characteristics. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, Teaching Hospital, New York, USA. METHODS Retrospective study of patients from 2015 to 2018 who met National Institutes of Health criteria for bariatric surgery. RESULTS There were 1094 patients included (135 males, 959 females), with an age range of 18 to 74 years. The diagnostic accuracy was determined by a sensitivity of 64.71% (95% confidence interval [CI] .55-.70), specificity of 74.38% (95% CI .71-.70), positive predictive value of 29.86% (95% CI .24-.30), negative predictive value of 92.59% (95%CI .89-90), likelihood ratio of 2.526, and P value < .0001 for esophagogastroduodenoscopy; a sensitivity of 14.02% (95% CI .08-0), specificity of 98.23% (95% CI .96-.90), positive predictive value of 71.43% (95% CI .50-.80), negative predictive value of 78.35% (95% CI .74-.80), likelihood ratio 7.921, and P value < .0001 were used for upper gastrointestinal series. Hiatal hernia with age <60 years was 17.09% versus 48.44% at >60 years (P < .0001). Hiatal hernia incidence was 17% in Hispanics, 22.5% in Caucasians, and 23.10% in blacks. CONCLUSION The prevalence of hiatal hernia is 18.92%. There is strong association between hiatal hernia and age and ethnicity and no association based on sex and body mass index. The diagnostic accuracy of upper gastrointestinal series is very low compared with that of esophagogastroduodenoscopy for hiatal hernia. Preoperative diagnosis of hiatal hernia in the bariatric population is not required based on our study. Not only does it lessen the economic burden, patient wait time, and discomfort of an additional study, but preoperative diagnosis does not change, alter, or aid in the intraoperative management of hiatal hernia considering the suboptimal accuracy of preoperative diagnostics, thus deeming them unwarranted.
Collapse
Affiliation(s)
- Vishnu R Mani
- Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, New York.
| | - Aleksandr Kalabin
- Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, New York
| | - Chiagozie Nwakanama
- Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, New York
| | | | - Leaque Ahmed
- Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, New York; Wyckoff Heights Medical Center, Brooklyn, New York
| |
Collapse
|