Factors that predict the occurrence of and recovery from non-alcoholic fatty liver disease after pancreatoduodenectomy

Sato, Takafumi; Matsuo, Yoichi; Shiga, Kiyoto; Morimoto, Mamoru; Miyai, Hirotaka; Takeyama, Hiromitsu

doi:10.1016/j.surg.2016.04.009

Cited by 37 publications

(48 citation statements)

References 26 publications

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“…However, the association between post-gastrectomy complications and the incidence of NAFLD was not obvious in this study. It is reported that the patients who received pancreatic enzyme had a lesser rate of NAFLD compared with patients who did not receive pancreatic enzymes [22]. On the other hand, in our study, administration of pancreatic enzyme did not reduce the incidence of NAFLD.…”

Section: Discussioncontrasting

confidence: 80%

Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer

et al. 2019

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Background Nonalcoholic fatty liver disease (NAFLD) refers to hepatic steatosis caused by something other than alcoholic liver injury, and often occurs after gastrointestinal surgeries such as pancreatoduodenectomy and gastrectomy. This study aimed to identify the risk factors for NAFLD after gastrectomy for gastric cancer. Methods A total of 721 patients who underwent gastrectomy for gastric cancer and plane abdominal computed tomography (CT) preoperatively and 1 year after surgery were included in this study. NAFLD was defined as having a mean hepatic CT attenuation value of < 40 Hounsfield units. We retrospectively examined the relationship between the onset of NAFLD and clinicopathological findings to identify the risk factors associated with the development of NAFLD after gastrectomy. Results The incidence of postoperative NAFLD was 4.85% (35/721). The univariate analysis identified the following factors as being significantly associated with the incidence of NAFLD: age, preoperative BMI ≥ 25 kg/m 2 , tumor depth of pT3 ≤, lymph node metastasis grade of pN2 ≤, cholecystectomy, D2 lymphadenectomy, adjuvant chemotherapy, high preoperative cholinesterase serum level, and low grade of preoperative FIB-4 index. Adjuvant chemotherapy (p < 0.001) and high preoperative cholinesterase serum level (p = 0.021) were identified as independent risk factors for NAFLD 1 year after gastrectomy. Conclusion Our study showed that adjuvant chemotherapy with S-1 and high level of serum cholinesterase were considered as the risk factors for NAFLD occurring after gastrectomy for gastric cancer.

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Section: Discussioncontrasting

confidence: 80%

Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer

et al. 2019

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“…Recently, NAFLD after PD with malnutrition has become increasingly problematic. Studies exploring the mechanism of postoperative NAFLD have reported several risk factors, including pancreas cancer, postoperative diarrhea, blood loss, small remnant pancreatic volume, and a long operative time [5,6,19].…”

Section: Discussionmentioning

confidence: 99%

Effects of Zinc on Non-alcoholic Fatty Liver Disease After Pancreatoduodenectomy

Miyosh¹,

Koga²,

Nakamura³

et al. 2019

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Background: The etiology, treatment and prevention of Nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) remain largely unknown. We aimed to elucidate the risk factors for NAFLD after PD and investigate the nutritional effects of zinc medication. Methods: We retrospectively examined 109 patients who underwent PD between 2013 and 2017. We diagnosed the postoperative NAFLD using CT attenuation at six months later. We identified the risk factors for postoperative NAFLD among perioperative factors and analyzed the nutritional effect of zinc medication at six months after surgery. Results: We diagnosed 27 patients with NAFLD after PD. A univariate analysis showed that pancreas cancer (p = 0.029), operative time (p = 0.008), blood loss (p = 0.034), postoperative diarrhea (p < 0.001) and zinc medication (p < 0.001) were associated with postoperative NAFLD. A multivariate analysis demonstrated that zinc medication was the most important factor for the prevention of NAFLD after PD. All patients who received zinc also took pancreatic enzyme simultaneously and showed a significantly lower rate of body weight loss than in patients without zinc at six months after PD (p = 0.041). These patients showed a significantly higher total cholesterol level (p = 0.006) and higher serum zinc level (p<0.001). Furthermore, significantly fewer cases of postoperative NAFLD were noted among the patients who received zinc than among those who did not receive it (5.7% vs 33.8%: p = 0.001). Conclusion: These results suggest that zinc administration might improve the postoperative nutritional status and prevent NAFLD after PD.

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“…reported that postoperative pancreatic exocrine insufficiency measured by 13C‐labeled mixed triglyceride breath test was closely associated with NAFLD. Pancrelipase delayed‐release supplement (LipaCreon ® 1200 mg/day) could improve exocrine dysfunction and was reported to have a significant beneficial effect on NAFLD after PD 7, 13. However, the prevalence of NAFLD has not decreased since 2012 when we started giving pancrelipase supplements in our hospital.…”

Section: Discussionmentioning

confidence: 99%

“…This steatosis received little interest before the last decade because the patients did not usually have severe hepatic dysfunction clinically even though a few reports documented some cases of hepatic failure after pancreatic resection 8, 9, 10. The prevalence of this steatosis was reported to range from 7.8% to 37%,2, 3, 4, 5, 6, 11, 12 but a few reports are available on the time of occurrence and sequential change in the properties of this complication 13. Etiology of this steatosis may be different from that of conventional nonalcoholic fatty liver disease (NAFLD) related to obesity, dyslipidemia or diabetes mellitus (DM).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy

Fujii

Nanashima

Hiyoshi

et al. 2017

Annals of Gastroent Surgery

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Considerable attention has been focused on nonalcoholic fatty liver disease (NAFLD) which occasionally develops after pancreatoduodenectomy (PD). The present study aimed to clarify the prevalence, sequential change in properties and risk factors for NAFLD development after PD. We enrolled 196 patients who underwent PD and a computed tomography (CT) scan 1 month, 6 months and 1 year after surgery. NAFLD was defined as a liver‐to‐spleen attenuation ratio on plain CT of <0.9. We compared various clinical factors between the NAFLD group and the control group. Individual prevalence of NAFLD at 1 month, 6 months and 1 year after surgery was 12%, 21% and 15%. Significantly different factors by univariate analysis were as follows: 1 month: age, sex, total protein (TP), total cholesterol (TC) and copper (Cu); 6 months: sex, disease, surgical method, portal vein resection (PVR), frequency of defecation, TC and Cu; 1 year: age, sex, disease, surgical method, PVR, frequency of defecation, TP and Cu. Risk factors by multivariate analysis were as follows: 1 month: not elderly age, female sex and a decrease in Cu; 6 months: female sex and a decrease in Cu; 1 year: a decrease in Cu. NAFLD after PD frequently developed in women with a decrease in serum Cu and was influenced by various factors related to poor digestion and absorption associated with pancreatic exocrine insufficiency.

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Factors that predict the occurrence of and recovery from non-alcoholic fatty liver disease after pancreatoduodenectomy

Cited by 37 publications

References 26 publications

Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer

Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer

Effects of Zinc on Non-alcoholic Fatty Liver Disease After Pancreatoduodenectomy

Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy

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