Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Obesity Surgery
Erschienen in: Obesity Surgery 11/2015

01.11.2015 | Original Contributions

Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery

verfasst von: Palanivelu Praveenraj, Rachel M. Gomes, Saravana Kumar, Purushothaman Karthikeyan, Annapoorni Shankar, Ramakrishnan Parthasarathi, Palanisamy Senthilnathan, Subbiah Rajapandian, Chinnusamy Palanivelu

Erschienen in: Obesity Surgery | Ausgabe 11/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

Numerous studies worldwide have identified a high prevalence of non-alcoholic fatty liver disease (NAFLD) among morbidly obese subjects. Several predictors have been found to be associated with NAFLD and its histological high-risk components. Similar data from India is lacking. We aimed to determine the prevalence and the predictors of NAFLD and its histological high-risk components in a cohort of Indians with morbid obesity undergoing bariatric surgery. Safety of a routine intraoperative liver biopsy was also assessed.

Methods

There were 134 morbidly obese patients who underwent bariatric surgery with concomitant liver biopsy. These were assessed for NAFLD and its histological high-risk components. Clinical, biochemical, and histological features were evaluated, and predictors of NAFLD, non-alcoholic steatohepatitis (NASH), fibrosis, and advanced fibrosis were identified.

Results

Mean BMI was 44.66 ± 9.81. Eighty-eight (65.7 %) showed NAFLD. Forty-five (33.6 %) showed NASH and 42 (31.3 %) showed fibrosis both not mutually exclusive. Nineteen (14.1 %) showed advanced fibrosis. Higher alanine aminotransferase (ALT) independently predicted NAFLD and was significantly associated with NASH and fibrosis. Type 2 diabetes mellitus (T2DM) and the metabolic syndrome were significantly associated with fibrosis. Systemic hypertension (HT) independently predicted NASH and fibrosis. There were no intraoperative or postoperative complications related to the liver biopsy.

Conclusions

NAFLD has a high prevalence among morbidly obese patients. Elevated ALT, HT, T2DM, and the metabolic syndrome are predictors for NAFLD and its high-risk histological components. Routine intraoperative liver biopsy is safe in morbidly obese undergoing bariatric surgery for diagnosing NAFLD.
Literatur
1.
2.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19(12):1605–11.CrossRefPubMed
3.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.CrossRefPubMed
4.
Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6(3):161–3.PubMed
5.
Singh SP, Nayak S, Swain M, et al. Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop Gastroenterol Off J Dig Dis Found. 2004;25(2):76–9.
6.
Mohan V, Farooq S, Deepa M, et al. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract. 2009;84(1):84–91.CrossRefPubMed
7.
Siraj P, Kohli N, Srivastava VK, et al. Relationship of nonalcoholic fatty liver disease with anthropometric measurement among patients attending a tertiary care hospital of Northern India. Indian J Community Health. 2013;25(3):208–12.
8.
Team R, LaBrecque DR, Abbas Z, et al. World Gastroenterology Organisation global guidelines: nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J Clin Gastroenterol. 2014;48(6):467–73.
9.
Nayak NC, Vasdev N, Saigal S, et al. End-stage nonalcoholic fatty liver disease: evaluation of pathomorphologic features and relationship to cryptogenic cirrhosis from study of explant livers in a living donor liver transplant program. Hum Pathol. 2010;41(3):425–30.CrossRefPubMed
10.
Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121(1):91–100.CrossRefPubMed
11.
Beymer C, Kowdley KV, Larson A, et al. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg Chic III 1960. 2003;138(11):1240–4.
12.
Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg. 2002;12(1):49–51.CrossRefPubMed
13.
Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol WJG. 2014;20(2):475–85.CrossRefPubMed
14.
Dolce CJ, Russo M, Keller JE, et al. Does liver appearance predict histopathologic findings: prospective analysis of routine liver biopsies during bariatric surgery. Surg Obes Relat Dis. 2009;5(3):323–8.CrossRefPubMed
15.
Duseja A. Nonalcoholic fatty liver disease in India—a lot done, yet more required! Indian J Gastroenterol. 2010;29(6):217–25.CrossRefPubMed
16.
Harrison SA, Oliver D, Arnold HL, et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57(10):1441–7.CrossRefPubMed
17.
Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15(3):310–5.CrossRefPubMed
18.
Abrams GA, Kunde SS, Lazenby AJ, et al. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatol Baltim Md. 2004;40(2):475–83.CrossRef
19.
Palekar NA, Naus R, Larson SP, et al. Clinical model for distinguishing nonalcoholic steatohepatitis from simple steatosis in patients with nonalcoholic fatty liver disease. Liver Int Off J Int Assoc Study Liver. 2006;26(2):151–6.CrossRef
20.
Frantzides CT, Carlson MA, Moore RE, et al. Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2004;8(7):849–55.CrossRef
21.
Duseja A, Das A, Das R, et al. The clinicopathological profile of Indian patients with nonalcoholic fatty liver disease (NAFLD) is different from that in the West. Dig Dis Sci. 2007;52(9):2368–74.CrossRefPubMed
22.
Amarapurkar DN, Patel ND. Prevalence of metabolic syndrome in non-diabetic and non-cirrhotic patients with non-alcoholic steatohepatitis. Trop Gastroenterol Off J Dig Dis Found. 2004;25(3):125–9.
23.
24.
Dixon JB, Bhathal PS, Jonsson JR, et al. Pro-fibrotic polymorphisms predictive of advanced liver fibrosis in the severely obese. J Hepatol. 2003;39(6):967–71.CrossRefPubMed
25.
Georgescu EF. Angiotensin receptor blockers in the treatment of NASH/NAFLD: could they be a first-class option? Adv Ther. 2008;25(11):1141–74.CrossRefPubMed
26.
Yokohama S, Tokusashi Y, Nakamura K, et al. Inhibitory effect of angiotensin II receptor antagonist on hepatic stellate cell activation in non-alcoholic steatohepatitis. World J Gastroenterol WJG. 2006;12(2):322–6.PubMed
27.
28.
Musso G, Cassader M, Olivetti C, et al. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev. 2013;14(5):417–31.CrossRefPubMed
29.
30.
Chang Y, Ryu S, Sung E, et al. Higher concentrations of alanine aminotransferase within the reference interval predict nonalcoholic fatty liver disease. Clin Chem. 2007;53(4):686–92.CrossRefPubMed
31.
Prati D, Taioli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137(1):1–10.CrossRefPubMed
32.
Amarapurkar DN, Patel ND. Clinical spectrum and natural history of non-alcoholic steatohepatitis with normal alanine aminotransferase values. Trop Gastroenterol Off J Dig Dis Found. 2004;25(3):130–4.
33.
34.
Shalhub S, Parsee A, Gallagher SF, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54–9.CrossRefPubMed
35.
Clark JM, Alkhuraishi ARA, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13(7):1180–6.CrossRefPubMed
36.
Dixon JB, Bhathal PS, Hughes NR, et al. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology. 2004;39(6):1647–54.CrossRefPubMed
37.
Stratopoulos C, Papakonstantinou A, Terzis I, et al. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg. 2005;15(8):1154–60.CrossRefPubMed
38.
Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135(1):48–58.CrossRefPubMed
Metadaten
Titel
Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery
verfasst von
Palanivelu Praveenraj
Rachel M. Gomes
Saravana Kumar
Purushothaman Karthikeyan
Annapoorni Shankar
Ramakrishnan Parthasarathi
Palanisamy Senthilnathan
Subbiah Rajapandian
Chinnusamy Palanivelu
Publikationsdatum
01.11.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 11/2015
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1655-1

Weitere Artikel der Ausgabe 11/2015

Obesity Surgery 11/2015 Zur Ausgabe

Letter to Editor/LED Reply

Optimal Drug Dosing in the Obese—Still Many Years Ahead

Letter to Editor\/LED Reply

Reply to Letter to the Editor: Bariatric Surgery Worldwide 2013 Reveals a Rise in Mini-Gastric Bypass

Original Contributions

Risk of Malnutrition, Trace Metal, and Vitamin Deficiency Post Roux-en-Y Gastric Bypass—a Prospective Study of 20 Patients with BMI <35 kg/m2

Original Contributions

Barriers in the Approach of Obese Patients Undergoing Bariatric Surgery in Flemish Hospitals

Original Contributions

Bariatric Surgery in Patients with Dialysis-Dependent Renal Failure

Review Article

The IFSO Website (www.ifso.com): the Online Gateway to Obesity and Metabolic Disorders for Bariatric Surgery Professionals and Patients

Neu im Fachgebiet Chirurgie

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Hochrisiko-Eingriffe für postoperative Übelkeit

16.04.2024 | Infektiologie | Nachrichten

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

10.04.2024 | Postoperative Schmerztherapie | Nachrichten

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

10.04.2024 | Narbenhernie | Nachrichten

Deutlich weniger Narbenhernien mit der Small-Bites-Technik
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom CME-Kurs
CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur CME-Kurs
CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis CME-Kurs
CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.