Vargas V, Allende H, Lecube A, Salcedo MT, Baena-Fustegueras JA, Fort JM, Rivero J, Ferrer R, Catalán R, Pardina E, Ramón y Cajal S, Guardia J, Peinado-Onsurbe J. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol 2012; 4(12): 382-388 [PMID: 23355916 DOI: 10.4254/wjh.v4.i12.382]
Corresponding Author of This Article
Dr. Julia Peinado-Onsurbe, Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Diagonal 645, 08028 Barcelona, Spain. jpeinado@ub.edu
Article-Type of This Article
Brief Article
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World J Hepatol. Dec 27, 2012; 4(12): 382-388 Published online Dec 27, 2012. doi: 10.4254/wjh.v4.i12.382
Table 1 Criteria used for histological scoring[21]
Steatosis:
0 : None
1: up to 33%
2: 33%-66%
3: > 66%
Hepatocyte ballooning
0: None
1: Occasional, Zone 3
2: “Obvious” Zone 3
3: Marked, predominantly Zone 3
Mallory bodies
0: No Mallory bodies
1: Fewer than two in 10 to 20 × fields
2: More than two in 10 to 20 × fields
Glycogenated nuclei
0: Absent
1: Occasional
2: Several
Lobular inflammation (inflammatory foci per 20 × with a 20 × ocular)
0: None
1: 1 to 2/20
2: Up to 4/20
3: More than 4/20
Portal inflammation
0: None
1: Mild
2: Moderate
3: Severe
Fibrosis score:
Stage 0: No fibrosis
Stage 1: Zone 3 perisinusoidal/pericellular fibrosis; focally or extensively present
Stage 2: Zone 3 perisinusoidal/pericellular fibrosis with focal or extensive periportal fibrosis
Stage 3: Zone 3 perisinusoidal/pericellular fibrosis and portal fibrosis with a focal or extensive bridging fibrosis
Stage 4: Cirrhosis
Table 2 Changes in anthropometric measurements and biochemistry between the patients’ first and second liver biopsy
Pre bariatric surgery
Post bariatric surgery
P value
Weight (kg)
130.8 ± 20.1
82.3 ± 13.7
< 0.001
BMI (kg/m2)
49.3 ± 4.8
30.9 ± 4.3
< 0.001
% excess weight loss
72.1 ± 6.6
Waist (cm)
137.1 ± 12.6
97.3 ± 11.0
< 0.001
Diabetic (%)
12 (46.1)
6 (23)
0.14
Hypertensive (%)
17 (65.4)
7 (26.9)
0.012
Metabolic syndrome
15 (57.7)
2 (7.7)
< 0.001
Cholesterol (mmol/L)
5.44 ± 1.00
4.29 ± 0.85
< 0.001
HDL-C (mmol/L)
1.24 ± 0.21
1.40 ± 0.19
0.005
LDL-C (mmol/L)
3.47 ± 0.76
2.46 ± 0.75
< 0.001
Triglycerides (mmol/L)
1.60 ± 0.63
0.93 ± 0.29
< 0.001
AST (μkat/L)
0.35 ± 0.09
0.36 ± 0.17
0.862
ALT (μkat/L)
0.49 ± 0.20
0.37 ± 0.31
0.143
GGT (U/L)
40.2 ± 17.4
19.2 ± 12.8
< 0.001
Fasting glucose (mmol/L)
6.46 ± 2.3
4.96 ± 0.55
0.001
Insulin (pmol/L)
235.2 ± 7.2
56.1 ± 7.2
0.006
Insulin resistance (HOMA)
9.99 ± 13.3
1.8 ± 1.4
0.006
Table 3 Histological scores for the 26-paired biopsies
Scores
P value
Feature
0
1
2
3
4
Steatosis
< 0.001
Pre
0
13
8
5
-
Post
24
2
0
0
-
Ballooning degeneration
< 0.001
Pre
10
8
7
1
-
Post
25
1
0
0
-
Mallory bodies
0.005
Pre
18
8
0
Post
26
0
0
Glycogen nuclei
0.001
Pre
8
7
11
Post
13
8
5
Lobular inflammation
< 0.001
Pre
1
23
2
0
Post
15
11
0
0
Portal inflammation
0.05
Pre
1
23
2
0
Post
7
19
0
0
Fibrosis
0.001
Pre
1
17
6
2
0
Post
9
12
4
1
0
Table 4 Scoring for the grade and stage of non alcoholic steatohepatitis n (%)
Scores
0
1
2
3
P value
Grade
At surgery
1 (3.8)
12 (46.1)
11 (42.3)
2 (7.7)
0.001
Follow up biopsy
22 (84.6)
4 (15.4)
0 (0)
0 (0)
Stage
At surgery
1 (3.8)
17 (65.4)
6 (23.1)
2 (7.7)
0.001
Follow up biopsy
9 (34.6)
12 (46.1)
4 (15.4)
1 (3.8)
Table 5 Factors associated with significant fibrosis (F > 1) after bariatric surgery
Variable
F 0-1 post surgery (n = 21)
F > 1 post surgery (n = 5)
P value
Mean steatosis score at surgery
1.5 ± 0.7
2.6 ± 0.5
0.002
Mean fibrosis score at surgery
1.1 ± 0.4
2.4 ± 0.5
< 0.001
Mean serum AST level at surgery (IU ± SD)
22.8 ± 11.6
11.6 ± 4.0
0.034
Citation: Vargas V, Allende H, Lecube A, Salcedo MT, Baena-Fustegueras JA, Fort JM, Rivero J, Ferrer R, Catalán R, Pardina E, Ramón y Cajal S, Guardia J, Peinado-Onsurbe J. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol 2012; 4(12): 382-388