Hepatic histology in obese patients undergoing bariatric surgery

Background/Aims

Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis (NASH). Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population.

Methods

Review of available studies on prevalence of NAFLD/NASH in severely obese patients submitted to bariatric surgery.

Results

Twelve observational and transversal studies were included, with consecutive recruitment, and prospective evaluation of data, summing 1620 patients with severe obesity. Prevalence of steatosis and NASH was 91% (range: 85–98%) and 37% (24–98%), respectively, with unexpected cirrhosis in 1.7% (1–7%). NASH was not related with age or body mass index, but there was an association between male sex and NASH/hepatic fibrosis. Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH, and hypertension with advanced hepatic fibrosis.

Conclusions

There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients, more than one-third presenting histological criteria for NASH. This review underscores the large variations in prevalence of NASH between studies, calling for the need for a better agreement in the use of the histological criteria.

Abbreviations: NAFLD, non-alcoholic fatty liver disesase, NASH, non-alcoholic steatohepatitis, IR, insulin resistance, BMI, body mass index, DM, diabetes mellitus, WHR, waist to hip ratio, AST, alanine aminotransferase, ALT, aspartate aminotransferase

Keywords: Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Morbid obesity, Bariatric surgery