Liver Histology Abnormalities in the Morbidly Obese

Abstract

A prospective study was undertaken in order to investigate the association between clinical and biochemical parameters and the histopathological findings in liver biopsies in the morbidly obese. Wedge liver biopsy specimens were taken at the beginning of the surgical procedure from 100 consecutive morbidly obese patients undergoing Roux-en-Y gastric bypass. Histological abnormalities were found in almost all of the examined material (98 of 100), which ranged from mild fatty infiltration through inflammatory change and alcoholic hepatitis-like change to fibrosis and cirrhosis. The patients with abnormalities were divided into two groups: those with a single abnormality (n = 56) and those with two or more histopathological findings (n = 42). Age, excess body weight, total cholesterol and triglyceride levels were significantly higher in the group with more than one histopathological finding. In a discriminant function analysis, it was found that the preoperatively available measures of age, sex and excess body weight, as well as ALT and triglyceride levels, could discriminate between the two patient groups. A model which uses these variables has been described which correctly assigns the patients to their histology groups in 73% of the cases. This model could provide a useful noninvasive clinical tool for the preoperative evaluation of possible hepatic damage in morbidly obese patients in whom there is no other known cause of possible liver disease.

Nonalcoholic Steatohepatitis: Summary of An Aasld Single Topic Conference

“…Among obese patients, the prevalence of class 1 NAFLD (simple steatosis) is about 60%, whereas NASH is found in 20% to 25% and 2% to 3% have cirrhosis. 5,[25][26][27][28][29][30][31] Among type 2 diabetic patients, it is estimated that 75% have some form of fatty liver. [32][33][34][35] A number of reports have addressed clinical predictors of more advanced histology on the initial diagnostic biopsy.…”

Obesity and liver disease

“…As recently reviewed 55 , these findings were confirmed in further studies. 44,56,57 In an autopsy study, steatohepatitis was found in 18.5% of markedly obese patients in contrast to only 2.7% of lean patients, while severe fibrosis was found in 13.8% versus 6.6% respectively. 58 Large series of liver biposies performed in severely obese subjects submitted to bariatric surgery have been recently published.…”

Nonalcoholic fatty liver disease in a district general hospital: clinical presentation and risk factors

“…Up to 75% of patients with type II diabetes mellitus and over 50% of patients with a history of myocardial infarct have NAFLD [31,42,43]. Many patients undergoing bariatric surgery will also have NAFLD [44][45][46]. With the rapidly increasing prevalence of obesity and diabetes [13,15], the overall number of patients who will develop NAFLD will only increase.…”