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Mattar+et+al+Ann+Surg+2005

Mattar+et+al+Ann+Surg+2005 - ORIGINAL ARTICLES...

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O RIGINAL A RTICLES Surgically-Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome Samer G. Mattar, MD, FACS,* Laura M. Velcu, MD,† Mordechai Rabinovitz, MD,‡ A. J. Demetris, MD,§ A. M. Krasinskas, MD,§ Emma Barinas-Mitchell, PhD, George M. Eid, MD,* Ramesh Ramanathan, MD,* Debra S. Taylor, RN,* and Philip R. Schauer, MD† 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, proba- bly 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. ( Ann Surg 2005;242: 610–620) R esolutely, the incidence of obesity continues its steady rise towards most-lethal disease status. If the current trend continues, 40% of the US population will be obese by the year 2025. 1 Other indicators, such as the finding that 15% of children and adolescents are obese (body mass index BMI 95th percentile on the Centers for Disease Control and Prevention standard charts) and over 20% are “at risk” (BMI 85th percentile) are even more alarming harbingers of an impending health crisis. 2 Obesity is associated with numerous comorbid factors (most of which are life-threatening) and these disease processes, not unexpectedly, are also on the rise. One of these complexes, nonalcoholic fatty liver disease (NAFLD), now occurs in a range of 30% to 100% of obese adults. 3 Remarkably, it is prevalent in 53% of obese children.
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