Prevalence, patterns and predictive factors of non-alcoholic fatty liver disease among morbidly obese patients undergoing sleeve gastrectomy

Abdel Rahman Al Manasra, Mohammed Bani Hani, Haitham Qandeel, Mohammad Alqudah, Ruba Khasawneh, Mohammad Amir, Khalid Al-Sawalmeh, Hiba Al Zou’b


Obesity related non-alcoholic fatty liver disease (NAFLD) is increasingly recognized worldwide.

We aim to describe prevalence, histologic patterns, and risk factors of NAFLD in morbidly obese patients undergoing sleeve gastrectomy.

A prospective study included 49 obese patients undergoing sleeve gastrectomy, with concomitant true cut liver biopsy. Exclusion criteria included history of alcohol intake, liver disease, or hepatotoxic agents’ intake. Clinical, biochemical, and histological features were evaluated. Histological patterns were classified based on the NIH-sponsored NASH Clinical Research Network NAFLD Activity Score (NAS).

Seventy-three per cent were females, mean age 34 (range 17–58). Mean BMI was 43 (35–52). 45 patients (91.8 per cent) showed NAFLD. Nineteen (39 per cent) showed non-alcoholic steatohepatitis (NASH) and 5 (10 per cent) showed fibrosis. 4 biopsies (8 per cent) were normal. About 31 per cent of NAFLD patients had metabolic syndrome as defined by the international diabetes federation consensus. While nineteen patients (38.5 per cent) had abnormality in one or both transaminase levels, 71 per cent of patients with elevated AST had NASH. The prevalence of dyslipidaemia (abnormal lipid profile) in all study patients was found to be 47 per cent. 24 per cent of NAFLD patients and 16 per cent of NASH patients had DM.

NAFLD has a very high prevalence among our morbidly obese patients. Multiple biochemical abnormalities were evident in association with the histological changes detected in NAFLD categories. Intraoperative liver biopsy is safe during sleeve gastrectomy for the diagnosis of NAFLD.
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