Nonalcoholic fatty liver disease in patients with morbid obesity
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 4
Abstract
<b>Introduction. </b>Accumulation of fat in obese individuals can impact hepatocytes and contributes to the inflammatory process, which in extreme cases results in fibrosis, cirrhosis, and failure of the liver.<br><b>Aim.</b> The aim of this study was to assess the prevalence of nonalcoholic fatty liver disease (NAFLD), biochemical abnormalities accompanying this pathology, as well as the development of diagnostic method allowing the prediction of NAFLD or nonalcoholic steatohepatitis (NASH) among pathologically obese patients.<br><b>Material and methods.</b> We retrospectively analyzed blood chemistry and liver biopsies obtained during surgery from 144 bariatric surgery patients. We also included 54 patients with evaluated blood levels of pro-inflammatory cytokines and their receptors.<br><b>Results.</b> Out of 144 liver biopsies the 23% were normal, and isolated fibrosis was found in 5%, NAFLD was found in 72% of biopsies (where the isolated steatosis – NAS occurred in 28% and NASH – in 44%). Comparison of the data between the group with normal histopathology and with NAS showed that the second group had a significantly higher ALT and triglyceride levels but lower HDL. Comparison of subjects with normal liver and with NASH, we found that the first group had the lower concentration of ALT and GGTP, as well as lower levels of serum triglycerides. The average concentration of ALT in NASH group exceeded the normal limits. In assessing the concentrations of cytokines and their receptors we were able to develop formulas, which allow prediction of the NAFLD and NASH occurrence in a group of morbidly obese patients.<br><b>Conclusions.</b> NAFLD occurs in most patients awaiting bariatric surgery. Elevation of ALT and AST activity, elevated concentrations of TNF-α and leptin and lower adiponectin levels in pathologically obese people are risk factors for NAFLD. Logistic regression model that applies above parameters allows prediction of the occurrence of obesity-related histological changes in the liver, without need for performing the liver biopsy.
Authors and Affiliations
Wojciech Lisik, Paweł Ziemiański, Rafał Marszałek, Maciej Kosieradzki, Tomasz Gryczewski, Zbigniew Wierzbicki, Agnieszka Perkowska-Ptasińska, Justyna Domienik-Karłowicz, Piotr Pruszczyk, Andrzej Chmura
Keywords
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