Long-term effect of bariatric surgery on resolution of nonalcoholic steatohepatitis (NASH): An external validation and application of a clinical NASH score
Journal
Surgery for Obesity and Related Diseases
Journal Volume
14
Journal Issue
10
Pages
1600-1606
Date Issued
2018
Author(s)
Abstract
Background: Nonalcoholic steatohepatitis (NASH) is an important etiology of end-stage liver disease. Long-term effect of bariatric surgery in improvement of NASH is not clear. Objectives: To validate a scoring system for predicting NASH in morbidly obese patients and using it to evaluate the long-term effect of bariatric surgery on NASH. Setting: Tertiary referral hospital, Taiwan. Methods: A new 5-point clinical NASH (C-NASH) score incorporating body mass index, alanine aminotransferase, and triglyceride was validated in a group of 307 bariatric patients (mean age 30.2 years, incorporating body mass index 45.0 kg/m2) with concurrent liver biopsy from 2003 to 2008. Remission of NASH in 5741 obese patients undergoing bariatric/metabolic surgery with long-term follow-up was then evaluated using the C-NASH score. Results: Among 307 patients with liver biopsy, the prevalence of NASH was 44.0%. At baseline, the NASH group had significantly worse fasting glucose levels, triglycerides, uric acid, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and glycated hemoglobin. The diagnostic sensitivity of C-NASH score was 84.4%, and the accuracy was 68.4%. Among 5741 bariatric patients, the prevalence of high risk for NASH evaluated by C-NASH score was 40.9%. Postoperative follow-up showed good weight loss and almost complete remission of high risk for NASH up to 10 years. Patients with gastric banding had less weight loss, higher mean level of C-NASH score, and a higher incidence of high risk for NASH compared with other procedures at follow-up. Conclusion: This study demonstrated that improvement in C-NASH score suggesting remission of NASH is durable up to 10 years in all kinds of bariatric procedures. ? 2018 American Society for Bariatric Surgery
Subjects
alanine aminotransferase; albumin; alkaline phosphatase; aspartate aminotransferase; C peptide; C reactive protein; gamma glutamyltransferase; glucose; hemoglobin A1c; high density lipoprotein cholesterol; triacylglycerol; uric acid; alanine aminotransferase; triacylglycerol; adult; alanine aminotransferase blood level; albumin blood level; alkaline phosphatase blood level; Article; aspartate aminotransferase blood level; bariatric surgery; body mass; body weight loss; cholesterol blood level; clinical Nonalcoholic Steatohepatitis score; diastolic blood pressure; digestive system disease assessment; female; follow up; gamma glutamyl transferase blood level; gastric banding; glucose blood level; hemoglobin blood level; high risk patient; human; liver biopsy; major clinical study; male; morbid obesity; nonalcoholic fatty liver; obese patient; priority journal; remission; scoring system; systolic blood pressure; Taiwan; tertiary care center; triacylglycerol blood level; uric acid blood level; validation study; waist hip ratio; blood; diet restriction; evaluation study; metabolism; morbid obesity; nonalcoholic fatty liver; sensitivity and specificity; severity of illness index; treatment outcome; Adult; Alanine Transaminase; Bariatric Surgery; Blood Glucose; Body Mass Index; Fasting; Female; Humans; Male; Non-alcoholic Fatty Liver Disease; Obesity, Morbid; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome; Triglycerides
SDGs
Type
journal article