Abstract
Non-alcoholic fatty liver disease (NAFLD) is a chronic disease with several degrees of histological features which may progress to cirrhosis. Obesity is an important risk factor and although NAFLD has no specific pharmacological treatment, bariatric surgery has been associated with NAFLD regression in severely obese patients. However, few longitudinal histological studies support this finding. Therefore, firstly, a retrospective study was performed including clinical and histological data of 895 obese patients who underwent bariatric surgery. In addition, histological analyses of 30 patient’s liver biopsies were evaluated at two timepoints (T1 and T2). The retrospective analysis of the total number of patients revealed that the average body mass index (BMI) was 35.91 ± 2.81 kg/m2. The liver biopsies during bariatric surgery showed that 53.52% did not present NAFLD, 30.16% had NASH, 15.98% isolated steatosis and 0.34% liver cirrhosis. The median BMI of the longitudinal cohort decreased from 37.9 ± 2.21 kg/m2 at the time of bariatric surgery (T1) to 25.69 ± 3.79 kg/m2 after 21 ± 22 months after the procedure (T2). The prevalence of NAFLD in T1 was 50%, and 16.67% in T2. The histological area of collagen fiber was lower in T2 compared to T1 (p = 0.0152) in the majority of patients, which was also illustrated by immunohistochemistry for Kupffer cell and myofibroblast formation markers. These findings confirmed the NAFLD regression after bariatric surgery and, for the first time, showed the amelioration of these features using more accurate histopathological techniques.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a chronic disease with several degrees of histological features which may progress to cirrhosis
There are four clinical-pathological features which are usually followed by NAFLD course: non-alcoholic steatosis (NAFL), non-alcoholic steatohepatitis (NASH), NASH-related cirrhosis and hepatocellular carcinoma (HCC)
NAFLD is strongly associated with insulin resistance, type 2 diabetes (T2D) and the incident cardiovascular disease (CVD)[4,5,6]
Summary
Non-alcoholic fatty liver disease (NAFLD) is a chronic disease with several degrees of histological features which may progress to cirrhosis. The histological area of collagen fiber was lower in T2 compared to T1 (p = 0.0152) in the majority of patients, which was illustrated by immunohistochemistry for Kupffer cell and myofibroblast formation markers These findings confirmed the NAFLD regression after bariatric surgery and, for the first time, showed the amelioration of these features using more accurate histopathological techniques. By leading to significant weight loss and metabolic changes related to the release of incretins and adipokines, as well as decreasing chronic inflammation, can lead to a reduction of hepatic fat deposits It is currently considered the gold standard treatment option for refractory morbid obesity, as it leads to a significant improvement and/or resolution of several obesity-related comorbidities[9,10,11,12]. This study aimed to characterize the NAFLD of obese Brazilian patients and to analyze the histologic evolution throughout the spectrum of NAFLD, while assessing the effects of bariatric surgery on the attenuation of this liver disease
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