Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome

Samer G. Mattar, Laura M. Velcu, Mordechai Rabinovitz, A. J. Demetris, A. M. Krasinskas, Emma Barinas-Mitchell, George M. Eid, Ramesh Ramanathan, Debra S. Taylor, Philip R. Schauer, Harvey J. Sugerman, Bruce M. Wolfe, Nancy L. Ascher, Michael G. Sarr, Carlos A. Pellegrini

Research output: Contribution to journalArticle

241 Citations (Scopus)

Abstract

Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients. Summary Background Data: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)610-620
Number of pages11
JournalAnnals of Surgery
Volume242
Issue number4
DOIs
StatePublished - Oct 2005
Externally publishedYes

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Weight Loss
Biopsy
Liver
Fatty Liver
Liver Cirrhosis
Liver Diseases
Fibrosis
Inflammation
Gastric Bypass
Morbid Obesity
Non-alcoholic Fatty Liver Disease
Histology
Body Weight

ASJC Scopus subject areas

  • Surgery

Cite this

Mattar, S. G., Velcu, L. M., Rabinovitz, M., Demetris, A. J., Krasinskas, A. M., Barinas-Mitchell, E., ... Pellegrini, C. A. (2005). Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Annals of Surgery, 242(4), 610-620. https://doi.org/10.1097/01.sla.0000179652.07502.3f

Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. / Mattar, Samer G.; Velcu, Laura M.; Rabinovitz, Mordechai; Demetris, A. J.; Krasinskas, A. M.; Barinas-Mitchell, Emma; Eid, George M.; Ramanathan, Ramesh; Taylor, Debra S.; Schauer, Philip R.; Sugerman, Harvey J.; Wolfe, Bruce M.; Ascher, Nancy L.; Sarr, Michael G.; Pellegrini, Carlos A.

In: Annals of Surgery, Vol. 242, No. 4, 10.2005, p. 610-620.

Research output: Contribution to journalArticle

Mattar, SG, Velcu, LM, Rabinovitz, M, Demetris, AJ, Krasinskas, AM, Barinas-Mitchell, E, Eid, GM, Ramanathan, R, Taylor, DS, Schauer, PR, Sugerman, HJ, Wolfe, BM, Ascher, NL, Sarr, MG & Pellegrini, CA 2005, 'Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome', Annals of Surgery, vol. 242, no. 4, pp. 610-620. https://doi.org/10.1097/01.sla.0000179652.07502.3f
Mattar, Samer G. ; Velcu, Laura M. ; Rabinovitz, Mordechai ; Demetris, A. J. ; Krasinskas, A. M. ; Barinas-Mitchell, Emma ; Eid, George M. ; Ramanathan, Ramesh ; Taylor, Debra S. ; Schauer, Philip R. ; Sugerman, Harvey J. ; Wolfe, Bruce M. ; Ascher, Nancy L. ; Sarr, Michael G. ; Pellegrini, Carlos A. / Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. In: Annals of Surgery. 2005 ; Vol. 242, No. 4. pp. 610-620.
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abstract = "Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients. Summary Background Data: 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. Methods: 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. Results: 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. Conclusion: 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.",
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T1 - Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome

AU - Mattar, Samer G.

AU - Velcu, Laura M.

AU - Rabinovitz, Mordechai

AU - Demetris, A. J.

AU - Krasinskas, A. M.

AU - Barinas-Mitchell, Emma

AU - Eid, George M.

AU - Ramanathan, Ramesh

AU - Taylor, Debra S.

AU - Schauer, Philip R.

AU - Sugerman, Harvey J.

AU - Wolfe, Bruce M.

AU - Ascher, Nancy L.

AU - Sarr, Michael G.

AU - Pellegrini, Carlos A.

PY - 2005/10

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N2 - Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients. Summary Background Data: 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. Methods: 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. Results: 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. Conclusion: 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.

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