Predictors of Nonalcoholic Steatohepatitis and Advanced Fibrosis in Morbidly Obese Patients

Abstract

NAFLD and NASH are very common in morbidly obese patients undergoing bariatric surgery. Features associated with the metabolic syndrome and liver cell injury are independently associated with either NASH or advanced fibrosis.

Non-alcoholic Fatty Liver Disease: East Versus West

“…8 Prevalence of NASH in morbidly obese patients undergoing bariatric surgery was very high in USA with 48-60% of men and 20-31% of women having histological NASH. 18 Similar high prevalence of NAFLD in obese population has been shown in Asia, ranging from 50% to 80% in Japan, 70% to 80% in China, 10% to 50% in Korea, and 47% in Indonesia. 2,[19][20][21] One study from Taiwan in morbidly obese patients undergoing bariatric surgery found the prevalence of NASH to be as high as 80%.…”

Relationship of steatosis grade and zonal location to histological features of steatohepatitis in adult patients with non-alcoholic fatty liver disease

“…As it was recently demonstrated that degree of steatosis quantified by imaging correlates significantly with histological grading of steatosis (5,6), we propose that radiologically-evident severe steatosis should be explored as another variable increasing the risk for the presence of NASH and zone 3 fibrosis in patients with NAFLD. Previous studies have shown that diabetes, older age, and morbid obesity increase the likelihood of NASH in patients with NAFLD (7,8). Future studies should evaluate the role of steatosis severity (as assessed by imaging) in non-invasive prediction of NASH in patients with NAFLD.…”

Epidemiology and Natural History of Non-alcoholic Fatty Liver Disease

“…[4][5][6][7][8][9][10][11][12][13][14][15] It is difficult to quantify the true incidence of NAFLD because of the variation in diagnosis and also due to the fact that a large number of patients may be asymptomatic. Nevertheless, a review of literature showed that the reported incidence of NAFLD varies…”

“…13,14 A recently published NAFLD practice guideline states that as liver biochemistries can be within normal ranges in patients with NAFLD and NASH, they may not be sufficiently sensitive to serve as screening tests, whereas liver ultrasound is potentially more sensitive but is more expensive and cumbersome as a screening test. 15 A study based on the National Health and Nutrition Examination Surveys (NHANES) using liver enzymes, conducted between 1988 and 2008 in the United States, suggested that while the prevalence of other causes chronic liver disease remained stable, the prevalence of NAFLD doubled in that time period.…”

“…Ong et al reported that over 95% of bariatric surgery patients had fatty liver, 20-30% had NASH, and 10% had advanced fibrosis. 13 Depending on the group, the median prevalence of NASH in the obese population is 33%, with a range from 10% to 56%. [42][43][44][46][47][48][49][50][51] In addition, based on this large body of data from obese patients, the prevalence of simple steatosis ranges from 30% to 37%.…”