Abstract
PurposeIt is currently unknown whether NASH (nonalcoholic steatohepatitis), as compared to simple steatosis, is associated with impaired postoperative weight loss and metabolic outcomes after RYGB surgery. To compare the effectiveness of Roux-en-Y gastric bypass (RYGB) on patients with NASH versus those with simple nonalcoholic fatty liver (NAFL).Materials and MethodsWe retrospectively retrieved data from 515 patients undergoing RYGB surgery with concomitant liver biopsy. Clinical follow-up and metabolic assessment were performed prior to surgery and 12 months after surgery. We used multivariate analysis of variance (MANOVA) and propensity score matching and we assessed for changes in markers of hepatocellular injury and metabolic outcomes.ResultsThere were 421 patients with simple NAFL, and 94 with NASH. Baseline alanine and aspartate aminotransferases were significantly higher in patients with NASH (p < 0.01). Twelve months after the RYGB surgery, as determined by both MANOVA and propensity score matching, patients with NASH exhibited a significantly greater reduction in alanine aminotransferase (ß-coefficient − 12 iU/l [− 22 to − 1.83], 95% CI, adjusted p = 0.021) compared to their NAFL counterparts (31 matched patients in each group with no loss to follow-up at 12 months). Excess weight loss was similar in both groups (ß-coefficient 4.54% [− 3.12 to 12.21], 95% CI, adjusted p = 0.244). Change in BMI was comparable in both groups (− 14 (− 16.6 to − 12.5) versus − 14.3 (− 17.3 to − 11.9), p = 0.784).ConclusionAfter RYGB surgery, patients with NASH experience a greater reduction in markers for hepatocellular injury and similar weight loss compared to patients with simple steatosis.
Highlights
The SAF score attributes points according to the grade of liver steatosis, the degree of lobular inflammation, and the extension of fibrosis, while the severity of lobular inflammation determines whether steatohepatitis is present
We found that, compared to patients with simple steatosis, patients with nonalcoholic steatohepatitis (NASH) experienced a significantly greater adjusted decrease in alanine aminotransferase (ALT) (β coefficient − 12 iU/l [− 22 to − 1.83], p = 0.021), insulinemia (β coefficient − 10.76 mIU/l [− 17.01 to − 4.51], p = 0.001), and homeostatic model assessment for insulin resistance (Homa-IR) (β coefficient − 5.01 [− 7.06 to − 2.95], p < 0.001)
The present study uses two different statistical approaches to adjust for baseline imbalance between groups, and results consistently indicate that patients with NASH experience similar excess weight loss as patients with simple steatosis, but a significantly greater reduction in alanine aminotransferase, 12 months post-surgery
Summary
The primary aim of this study was to compare the effects of RYGB surgery in a large cohort of patients with either simple NAFL or established NASH
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