Fatty Liver Disease in Morbidly Obese Patients in Correlation to Obesity Related Co-Morbidities

Obesity is a major risk factor for fatty liver disease. The purpose of this study was to determine the degree of steatosis, inflammation and fibrosis in liver biopsies of morbidly obese patients, along with potential contributors to pathologies of serum insulin, glucose, leptin, triglycerides, HDL-cholesterol. The study population included 179 morbidly obese patients (82% females and 18% males with a mean age of 39±9 (SD) years, a BMI of 52±8kg/m2 and an excess body weight of 80±24kg). All patients were tested negative for hepatitis and HIV pre-operatively. Liver biopsies were taken intra-operatively during bariatric surgery and the degree of steatosis, inflammation and fibrosis determined. Liver enzyme activities were measured along with serum insulin, fasting glucose, leptin, triglycerides and HDL-cholesterol. We found that 53% of the morbidly obese females and 93% of the males suffered from severe steatosis (>30% of hepatocytes filled with fat droplets). The degree of steatosis was significantly (p<0.01) associated with metabolic aberrations, i.e. hypertriglyceridemia, hyperglycemia, liver enzyme activities which were more severe among males (p<0.05) than females. Hepatic inflammation was described in 47% of the females and 56% of the males. No patient had severe fibrosis and only a few had moderate fibrosis, 6% females and 12% males. Post-operatively, liver enzyme activities declined concomitant to weight loss with normalization of values at an excess weight loss of 50% or more (p<0.0001). The majority of morbidly obese patients have a non-alcoholic fatty liver, the incidence of which is higher for males than females, possibly due to their visceral adiposity and associated metabolic aberrations.

Key words

bariatric surgery - fatty liver disease - morbid obesity