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Clinical Question: Is surgical weight loss effective in
patient with Nonalcoholic fatty liver disease (NAFLD) and metabolic
syndrome?
Bottom Line: Surgical weight loss results in significant
improvement of liver morphology in severely obese patients. These beneficial
changes may be associated with a significant reduction in the prevalence of
the metabolic syndrome.
Reference: Surgically-Induced Weight Loss Significantly
Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome.Mattar
SG, Velcu LM, Rabinovitz M, Demetris AJ, Krasinskas AM, Barinas-Mitchell E,
Eid GM, Ramanathan R, Taylor DS, Schauer PR.Ann Surg. 2005
Oct;242(4):610-620
Synopsis: Nonalcoholic fatty liver disease (NAFLD), a
spectrum that extends to liver fibrosis and cirrhosis, is rising at an
alarming rate. This increase is occurring in conjunction with the rise of
severe obesity and is probably mediated in part by metabolic syndrome (MS).
Surgical weight loss operations, probably by reversing MS, have been shown
to result in improvement in liver histology. To evaluate the effects of
surgical weight loss on fatty liver disease in severely obese patients.
Patients who underwent laparoscopic surgical weight loss operations from
March 1999 through August 2004, and who agreed to have an intraoperative
liver biopsy followed by at least one postoperative liver biopsy, were
included. There were 70 patients who were eligible. All patients underwent
laparoscopic operations, the majority being laparoscopic Roux-en-Y gastric
bypass. The mean excess body weight loss at time of second biopsy was 59%
+/- 22% and the time interval between biopsies was 15 +/- 9 months. There
was a reduction in prevalence of metabolic syndrome, from 70% to 14% (P <
0.001), and a marked improvement in liver steatosis (from 88% to 8%),
inflammation (from 23% to 2%), and fibrosis (from 31% to 13%; all P <
0.001). Inflammation and fibrosis resolved in 37% and 20% of patients,
respectively, corresponding to improvement of 82% (P < 0.001) in grade and
39% (P < 0.001) in stage of liver disease.
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