Abstract
Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity. Methods. We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation. Results. A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea. The accuracy of a multiple logistic regression model for presence of liver fat was 81% and for severity of liver fat accumulation was 77%. Conclusions. A limited set of clinical factors can be used to model hepatic fat accumulation with moderate accuracy and may provide potential mechanistic insights in the setting of extreme obesity.
Highlights
Obesity is associated with fat accumulation in the liver, diagnosed as nonalcoholic fatty liver disease, and considered a manifestation of the metabolic syndrome [1, 2]
Liver fat accumulation is clinically important because a substantial subset of patients will develop inflammation as nonalcoholic steatohepatitis (NASH) with necroinflammatory changes that can progress to fibrosis, cirrhosis, and liver failure [8]
Participants who had a primary bariatric surgery performed between 9/1/2002 and 2/28/2013, preoperative body mass index (BMI) >35 kg/m2, no evidence of hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV), evaluable liver biopsy results, and no diagnosis of alcohol abuse were included in this study
Summary
Obesity is associated with fat accumulation in the liver, diagnosed as nonalcoholic fatty liver disease, and considered a manifestation of the metabolic syndrome [1, 2]. Hepatic lipid accumulation has been proposed as a cause, rather than a consequence, for the development of hepatic insulin resistance [3], but the molecular mechanism by which this occurs is not yet known. Both environmental and genetic factors play a significant role in mediating risk for development of increased fat in the liver [4]. Defining the clinical context in which hepatic fat accumulates in extreme obesity may have significant implications for several clinically important conditions
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