Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Bariatric Patients: Tehran Obesity Treatment Study (TOTS)

Alireza Khlaj | Maryam Barzin | Mohammad Ali Kalantar Motamedi | Sara Serahati | Davood Khalili | Arman Morakabati | Majid Valizadeh | Fereidoun Azizi | Farhad Hosseinpanah | Nasser Rakhshani

---

URL :   http://research.shahed.ac.ir/WSR/WebPages/Report/PaperView.aspx?PaperID=137952
Date :  2018/05/12
Publish in :    Hepatitis Monthly
DOI :  https://doi.org/10.5812/hepatmon.64380
Link :  http://dx.doi.org/10.5812/hepatmon.64380
Keywords : Non-AlcoholicFattyLiverDisease,LiverCirrhosis,MorbidObesity,BariatricSurgery,Biopsy

Abstract :

---

Background: Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver disease worldwide. We aimed tostudythisconditionandliverfibrosisinbariatricpatientsatbaselineusingultrasound,NAFLDfibrosisscore(NFS),andfibrosis index-4(FIB-4). Methods: Adult patients with morbid obesity without other possible causes of liver pathology were evaluated. Liver biopsy was performedinasubsetof patients. Diagnosticaccuracyof testswasassessedusingareaunderthereceiveroperating-characteristic curve(AUROC). Results: Overall, 1944 patients with mean age of 38.3±10.8 years and body mass index of 44.6±6.4 kg/m2 comprised the study population.LiverBiopsyshowedfeaturesofNAFLDin70;60.3 hadnonalcoholicfattyliverand9.6 steatohepatitis.Olderageand highertransaminaselevelswereassociatedwithhigherNAFLDactivityscore.Fibrosiswaspresentin23.3 withthemajorityhaving F1. Ultrasound detected steatosis in 76.8, with two-thirds having grade I to II fatty liver. Metabolic syndrome, hemoglobin A1c, age,andalaninetransaminasewerethestrongestriskfactorsforfattyliver. UltrasoundshowedanAUROCof 0.75(95 confidence interval 0.63-0.86) for NAFLD with a sensitivity and specificity of 72.5 and 68.2, respectively (cutoff of grade II). For diagnosis of fibrosis, FIB-4 had an AUROC of 0.72 (0.58-0.86) with 93.3 sensitivity and 43.1 specificity (cutoff of 0.50). NFS failed to show a significantAUROCcurvefordiagnosingfibrosis. Conclusions:OurfindingsconfirmedahighprevalenceofNAFLDinmorbidlyobesepatients.Despitethishighprevalence,fibrosis wasuncommonandlow-grade. Thisstudyquestionstheuseof currentcutoffsforNFSandFIB-4inallpatients.