1696-P: Changes in Clinical and Metabolic Parameters Related to NAFLD in Obese Subjects Who Underwent Laparoscopic Sleeve Gastrectomy

Abstract

More research is needed on the effect of laparoscopic sleeve gastrectomy (LSG) on NAFLD and related parameters. A total of 51 morbidly obese subjects with NAFLD who would undergo LSG were included, with liver biopsy performed during LSG in 46 patients. Various clinical parameters and blood biomarkers related to NAFLD were measured before and 6 months after LSG, which included fat content in the liver (LFC) and pancreas (PFC) by MRI-PDFF, liver stiffness measurement by MR elastography (MRE-LSM), and others. After LSG, there was a significant decrease in body weight and LFC: 102.0 ± 15.3 vs. 76.3 ± 14.3 kg and 19.4 ± 9.1% vs. 5.7 ± 2.9%, respectively, p <0.001 each. And, body fat on DXA, PFC, and visceral fat area measured by MRI, and, fasting plasma levels of total GIP and glucagon decreased significantly after bariatric surgery, with no change in total GLP-1 and peptide YY levels. Notably, there was a marked increase in plasma levels of FGF21 (547.1 ± 890.5 pg/ml vs. 1085 pg/ml ± 1883.75, p<0.05) and oxyntomodulin (436.0 ± 351.4 pg/ml vs. 1533.6 ± 624.4 pg/ml, p<0.001). These changes were accompanied by a significant reduction of NASH blood biomarkers such AKR1B10, cytokeratin 18, and complement C3. And, MRE-LSM, a marker of liver fibrosis, decreased significantly after LSG (3.1 ± 0.8 kPa vs. 2.7 ± 0.1 kPa, p <0.01), but enhanced liver fibrosis score did not. Only 15.2% of patients with biopsy-proven NAFLD showed more than 25% decrease in MRE-LSM, and baseline fibrosis degree was only the predictor of this decrease in MRE-LSM after LSG. Our results show that in patients with morbid obesity, marked reduction of body weight and LFC and a significant increase in plasma FGF21 and oxyntomodulin levels were observed 6 months after LSG, with the reduction of several markers of NASH. However, a meaningful MRE-LSM improvement was observed only in a small proportion of patients, which warrants long-term follow-up of patients with NASH/fibrosis who underwent LSG. Disclosure D.Lee: None. I.Park: None. Funding National Research Foundation of Korea (2021R1A5A2030333, 2019R1I1A2A02062305)