Effects of Weight Loss Surgeries on Liver Disease

ABSTRACT

Obesity is the single most significant risk factor for the development of nonalcoholic fatty liver disease (NAFLD) in children and adults. NALFD is estimated to occur in 30 to 100% of obese adults, and in ∼53% of obese children. The majority of obese patients have ultrasonographic evidence of fatty liver; 30% have histologically documented nonalcoholic steatohepatitis (NASH). Up to 25% of patients with NASH may progress to cirrhosis. In the United States, an estimated 65% of adults are overweight and 31% are obese. Between 2001 and 2002, the number of people with severe obesity, who are more than 100 pounds overweight, rose to nearly 11 million. Since 1970, levels of childhood and teen overweight have climbed to ∼16% in those aged 6 to 19 years. Recent findings indicate that key features of NAFLD and NASH improve or resolve dramatically with weight loss. This article discusses weight loss surgeries and their effects on liver disease.

Bariatric surgery - gastric bypass - gastroplasty - laparoscopic adjustable gastric banding - nonalcoholic steatohepatitis - nonalcoholic fatty liver disease

REFERENCES

• 1 Luyckx F H, Desaive C, Thiry A et al.. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty.  Int J Obes Relat Metab Disord. 1998;  22 222-226
• 2 Franzese A, Vajro P, Argenziano A et al.. Liver involvement in obese children. Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population.  Dig Dis Sci. 1997;  42 1428-1432
• 3 Rashid M, Roberts E A. Nonalcoholic steatohepatitis in children.  J Pediatr Gastroenterol Nutr. 2000;  30 48-53
• 4 Festi D, Colecchia A, Sacco T, Bondi M, Roda E, Marchesini G. Hepatic steatosis in obese patients: clinical aspects and prognostic significance.  Obes Rev. 2004;  5 27-42
• 5 Gholam P M, Kotler D P, Flancbaum L J. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery.  Obes Surg. 2002;  12 49-51
• 6 Scheen A J, Luyckx F H. Obesity and liver disease.  Best Pract Res Clin Endocrinol Metab. 2002;  16 703-716
• 7 Sabir N, Sermez Y, Kazil S, Zencir M. Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasonographic and anthropometric measurements.  Eur J Ultrasound. 2001;  14 121-128
• 8 Bellentani S, Saccoccio G, Masutti F et al.. Prevalence of and risk factors for hepatic steatosis in Northern Italy.  Ann Intern Med. 2000;  132 112-117
• 9 Yu A S, Keeffe E B. Nonalcoholic fatty liver disease.  Rev Gastroenterol Disord. 2002;  2 11-19
• 10 Ludwig J, Viggiano T R, McGill D B, Oh B J. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.  Mayo Clin Proc. 1980;  55 434-438
• 11 Ratziu V, Bonyhay L, Di Martino V et al.. Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis.  Hepatology. 2002;  35 1485-1493
• 12 Hui J M, Kench J G, Chitturi S et al.. Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C.  Hepatology. 2003;  38 420-427
• 13 Angulo P, Keach J C, Batts K P, Lindor K D. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis.  Hepatology. 1999;  30 1356-1362
• 14 Rinella M E, Alonso E, Rao S et al.. Body mass index as a predictor of hepatic steatosis in living liver donors.  Liver Transpl. 2001;  7 409-414
• 15 Klain J, Fraser D, Goldstein J et al.. Liver histology abnormalities in the morbidly obese.  Hepatology. 1989;  10 873-876
• 16 Marchesini G, Bugianesi E, Forlani G et al.. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome.  Hepatology. 2003;  37 917-923
• 17 Busetto L, Tregnaghi A, De Marchi F et al.. Liver volume and visceral obesity in women with hepatic steatosis undergoing gastric banding.  Obes Res. 2002;  10 408-411
• 18 Dixon J B, Bhathal P S, O'Brien P E. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese.  Gastroenterology. 2001;  121 91-100
• 19 Raynard B, Balian A, Fallik D et al.. Risk factors of fibrosis in alcohol-induced liver disease.  Hepatology. 2002;  35 635-638
• 20 Dixon J B, Bhathal P S, Hughes N R, O'Brien P E. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss.  Hepatology. 2004;  39 1647-1654
• 21 Ong J P, Younossi Z M, Speer C, Olano A, Gramlich T, Boparai N. Chronic hepatitis C and superimposed nonalcoholic fatty liver disease.  Liver. 2001;  21 266-271
• 22 Zein N N, Abdulkarim A S, Wiesner R H, Egan K S, Persing D H. Prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C, alcohol, or cholestatic disease.  J Hepatol. 2000;  32 209-217
• 23 Hickman I J, Clouston A D, Macdonald G A et al.. Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C.  Gut. 2002;  51 89-94
• 24 Hourigan L F, Macdonald G A, Purdie D et al.. Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis.  Hepatology. 1999;  29 1215-1219
• 25 Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput J C. Excess weight risk factor for alcoholic liver disease.  Hepatology. 1997;  25 108-111
• 26 Tiikkainen M, Bergholm R, Vehkavaara S et al.. Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content.  Diabetes. 2003;  52 701-707
• 27 Bradbury M W, Berk P D. Lipid metabolism in hepatic steatosis.  Clin Liver Dis. 2004;  8 639-671
• 28 Day C. Pathogenesis of steatohepatitis.  Best Pract Res Clin Gastroenterol. 2002;  16 663-678
• 29 Yahagi N, Shimano H, Matsuzaka T et al.. p53 involvement in the pathogenesis of fatty liver disease.  J Biol Chem. 2004;  279 20571-20575 , E-pub Feb 25, 2004
• 30 Pagano G, Pacini G, Musso G et al.. Nonalcoholic steatohepatitis, insulin resistance, and metabolic syndrome: further evidence for an etiologic association.  Hepatology. 2002;  35 367-372
• 31 Marchesini G, Brizi M, Bianchi G et al.. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome.  Diabetes. 2001;  50 1844-1850
• 32 Chitturi S, Abeygunasekera S, Farrell G C et al.. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome.  Hepatology. 2002;  35 373-379
• 33 Marchesini G, Brizi M, Morselli-Labate A M et al.. Association of nonalcoholic fatty liver disease with insulin resistance.  Am J Med. 1999;  107 450-455
• 34 Choudhury J, Sanyal A J. Insulin resistance and the pathogenesis of nonalcoholic fatty liver disease.  Clin Liver Dis. 2004;  8 575-594
• 35 Diehl -M A. Tumor necrosis factor and its potential role in nonalcoholic fatty liver disease.  Clin Liver Dis. 2004;  8 619-638
• 36 Harrison S A, Kadakia S, Lang K A, Schenker S. Nonalcoholic steatohepatitis: what we know in the new millennium.  Am J Gastroenterol. 2002;  97 2714-2724
• 37 Bjorkegren J, Beigneux A, Bergo M O, Maher J J, Young S G. Blocking the secretion of hepatic very low density lipoproteins renders the liver more susceptible to toxin-induced injury.  J Biol Chem. 2002;  277 5476-5483 , E-pub Dec 5, 2001
• 38 McCullough A J. Update on nonalcoholic fatty liver disease.  J Clin Gastroenterol. 2002;  34 255-262
• 39 Mun E C, Blackburn G L, Matthews J B. Current status of medical and surgical therapy for obesity.  Gastroenterology. 2001;  120 669-681
• 40 Palmer M, Schaffner F. Effect of weight reduction on hepatic abnormalities in overweight patients.  Gastroenterology. 1990;  99 1408-1413
• 41 Park H S, Kim M W, Shin E S. Effect of weight control on hepatic abnormalities in obese patients with fatty liver.  J Korean Med Sci. 1995;  10 414-421
• 42 Andersen T, Gluud C, Franzmann M B, Christoffersen P. Hepatic effects of dietary weight loss in morbidly obese subjects.  J Hepatol. 1991;  12 224-229
• 43 Drenick E J, Simmons F, Murphy J F. Effect on hepatic morphology of treatment of obesity by fasting, reducing diets and small-bowel bypass.  N Engl J Med. 1970;  282 829-834
• 44 Ueno T, Sugawara H, Sujaku K et al.. Therapeutic effects of restricted diet and exercise in obese patients with fatty liver.  J Hepatol. 1997;  27 103-107
• 45 Lee R G. Nonalcoholic steatohepatitis: tightening the morphological screws on a hepatic rambler.  Hepatology. 1995;  21 1742-1743
• 46 Kral J G, Thung S N, Biron S et al.. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis.  Surgery. 2004;  135 48-58
• 47 Marceau P, Hould F S, Potvin M, Lebel S, Biron S. Biliopancreatic diversion (duodenal switch procedure).  Eur J Gastroenterol Hepatol. 1999;  11 99-103
• 48 Del Gaudio A, Boschi L, Del Gaudio G A, Mastrangelo L, Munari D. Liver damage in obese patients.  Obes Surg. 2002;  12 802-804
• 49 Silverman E M, Sapala J A, Appelman H D. Regression of hepatic steatosis in morbidly obese persons after gastric bypass.  Am J Clin Pathol. 1995;  104 23-31
• 50 Hsiao T J, Chen J C, Wang J D. Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients.  Int J Obes Relat Metab Disord. 2004;  28 167-172
• 51 Crespo J, Fernandez-Gil P, Hernandez-Guerra M et al.. Are there predictive factors of severe liver fibrosis in morbidly obese patients with non-alcoholic steatohepatitis?.  Obes Surg. 2001;  11 254-257
• 52 Bugianesi E, Manzini P, D'Antico S et al.. Relative contribution of iron burden, HFE mutations, and insulin resistance to fibrosis in nonalcoholic fatty liver.  Hepatology. 2004;  39 179-187
• 53 Fargion S, Mattioli M, Fracanzani A L et al.. Hyperferritinemia, iron overload, and multiple metabolic alterations identify patients at risk for nonalcoholic steatohepatitis.  Am J Gastroenterol. 2001;  96 2448-2455
• 54 Brolin R E, Bradley L J, Taliwal R V. Unsuspected cirrhosis discovered during elective obesity operations.  Arch Surg. 1998;  133 84-88
• 55 Dallal R M, Mattar S G, Lord J L et al.. Results of laparoscopic gastric bypass in patients with cirrhosis.  Obes Surg. 2004;  14 47-53
• 56 Luyckx F H, Scheen A J, Desaive C, Thiry A, Lefebvre P J. Parallel reversibility of biological markers of the metabolic syndrome and liver steatosis after gastroplasty-induced weight loss in severe obesity.  J Clin Endocrinol Metab. 1999;  84 4293
• 57 Beymer C, Kowdley K V, Larson A, Edmonson P, Dellinger E P, Flum D R. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery.  Arch Surg. 2003;  138 1240-1244
• 58 Spaulding L, Trainer T, Janiec D. Prevalence of non-alcoholic steatohepatitis in morbidly obese subjects undergoing gastric bypass.  Obes Surg. 2003;  13 347-349
• 59 Silverman J F, O'Brien K F, Long S et al.. Liver pathology in morbidly obese patients with and without diabetes.  Am J Gastroenterol. 1990;  85 1349-1355
• 60 Marceau P, Biron S, Hould F S et al.. Liver pathology and the metabolic syndrome X in severe obesity.  J Clin Endocrinol Metab. 1999;  84 1513-1517
• 61 [No authors listed] . Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report.  National Institutes of Health. Obes Res. 1998;  6(suppl 2) 51S-209S , Erratum in: Obes Res. 1998;  6 464
• 62 Steinbrook R. Surgery for severe obesity.  N Engl J Med. 2004;  350 1075-1079
• 63 Sugerman H J, Starkey J V, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters.  Ann Surg. 1987;  205 613-624
• 64 Pories W J, Swanson M S, MacDonald K G et al.. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.  Ann Surg. 1995;  222 339-352
• 65 Nguyen N T, Ho H S, Palmer L S, Wolfe B M. A comparison study of laparoscopic versus open gastric bypass for morbid obesity.  J Am Coll Surg. 2000;  191 147-155 , discussion 155-157
• 66 Schauer P, Ikramuddin S, Hamad G, Gourash W. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases.  Surg Endosc. 2003;  17 212-215
• 67 Brolin R E, Kenler H A, Gorman J H, Cody R P. Long-limb gastric bypass in the superobese.  A prospective randomized study. Ann Surg. 1992;  215 387-395
• 68 Wittgrove A C, Clark G W, Tremblay L J. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases.  Obes Surg. 1994;  4 353-357
• 69 Schauer P R, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.  Ann Surg. 2000;  232 515-529
• 70 DeMaria E J, Sugerman H J. A critical look at laparoscopic adjustable silicone gastric banding for surgical treatment of morbid obesity: does it measure up?.  Surg Endosc. 2000;  14 697-699
• 71 O'Brien P E, Dixon J B. Lap-band: outcomes and results.  J Laparoendosc Adv Surg Tech A. 2003;  13 265-270
• 72 O'Brien P E, Dixon J B. Laparoscopic adjustable gastric banding in the treatment of morbid obesity.  Arch Surg. 2003;  138 376-382
• 73 Ren C J, Fielding G A. Laparoscopic adjustable gastric banding: surgical technique.  J Laparoendosc Adv Surg Tech A. 2003;  13 257-263
• 74 Papadia F S, Marinari G M, Camerini G et al.. Liver damage in severely obese patients: a clinical-biochemical-morphologic study on 1,000 liver biopsies.  Obes Surg. 2004;  14 952-958
• 75 Shalhub S, Parsee A, Gallagher S F et al.. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients.  Obes Surg. 2004;  14 54-59
• 76 Marubbio Jr T A, Buchwald H, Schwartz M Z, Varco R. Hepatic lesions of central pericellular fibrosis in morbid obesity, and after jejunoileal bypass.  Am J Clin Pathol. 1976;  66 684-691
• 77 Deitel M, Shahi B, Anand P K, Deitel F H, Cardinell D L. Long-term outcome in a series of jejunoileal bypass patients.  Obes Surg. 1993;  3 247-252
• 78 Griffen Jr W O, Young V L, Stevenson C C. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity.  Ann Surg. 1977;  186 500-509
• 79 Sorensen L T, Jorgensen T. Short-term pre-operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial.  Colorectal Dis. 2003;  5 347-352
• 80 Moller A M, Villebro N, Pedersen T, Tonnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial.  Lancet. 2002;  359 114-117
• 81 Blackburn G L. Benefits of weight loss in the treatment of obesity.  Am J Clin Nutr. 1999;  69 347-349