Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022, 166(2):195-203 | DOI: 10.5507/bp.2021.021

Effect of bariatric surgery on fatty liver disease in obese patients: A prospective one year follow-up study

Daniel Toman^{a, b}, Petr Vavra^{a, b}, Petr Jelinek^{a, b}, Petr Ostruszka^{a, b}, Peter Ihnat^{a, b}, Ales Foltys^{a, b}, Anton Pelikan^{a, b, c, d}, Jan Roman^{a, b}

^a Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic

^b Department of Surgery, University Hospital Ostrava, Czech Republic

^c Department of Surgery, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom

^d Department of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlin, Czech Republic

Background: Non-alcoholic fatty liver disease (NAFLD), often associated with obesity and metabolic syndrome, manifests itself as steatosis, hepatic fibrosis, cirrhosis, or even end-stage liver disease. NAFLD causes inflammation, insulin resistance and cardiovascular complications. The current study aimed to evaluate the beneficial effects of bariatric surgery on biochemical parameters of hepatic functions in obese patients by comparing them before and one-year after the surgery.

Methods: A total of 72 morbidly obese patients underwent bariatric surgery between 2016 and 2018. The incidence of diabetes mellitus in this group was 29%, median body weight was 124.5 kg (109.0-140.0) and mean body mass index (BMI) was 44.38 ± 6.770 kg/m². The used surgical procedures included gastric bypass, sleeve gastrectomy, laparoscopic gastric plication, and single anastomosis duodeno-ileal bypass-sleeve gastrectomy. Biochemical parameters including ALT/AST ratio (AAR), NAFLD fibrosis score (NFS), hepatic fibrosis index (FIB-4) and Fatty Liver Index (FLI) were evaluated in all patients at the time of surgery and one year after the intervention.

Results: Significant improvement after the intervention was observed in 64 patients. A significant reduction in body weight (P<0.0001), waist circumference (P<0.0001), and body mass index (P<0.0001) were observed. NAFLD liver fibrosis index changed significantly (P<0.0001), suggesting a trend of improvement from advanced fibrosis towards stages 0-2. The FIB-4 fibrosis index indicated significant improvement (P=0.0136). Besides, a significant decline in hepatic steatosis (P<0.0001) was observed after bariatric surgery as compared to the pre-surgery fatty liver conditions.

Conclusion: Among the strategies to overcome NAFLD-associated impediments, bariatric surgery can be considered effective in reducing obesity and metabolic co-morbidities. Trial Registration: ClinicalTrials.gov (NCT04569396)

Keywords: NAFLD, bariatric surgery, obesity, liver fibrosis

Received: November 13, 2020; Revised: April 7, 2021; Accepted: April 7, 2021; Prepublished online: April 19, 2021; Published: May 13, 2022  Show citation