NAFLD Is More Severe in Diabetes Patients, Bariatric Surgery May Help

The prevalence of non-alcoholic fatty liver disease (NAFLD) is significantly higher among patients with diabetes who are undergoing bariatric surgery, according to a recent study. These findings suggest that intraoperative liver biopsy should be considered for these patients.

Bariatric surgery has been considered as a potential option for the treatment of NAFLD. Since individuals with NAFLD and diabetes have demonstrated accelerated progression from liver disease to cirrhosis, bariatric surgery could potentially benefit patients with lower degrees of obesity and diabetes.
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For their study, the researchers examined intraoperative liver biopsies from 521 patients with obesity who were undergoing bariatric surgery. Upon assessment of preoperative glucose levels, patients were categorized as having either type 2 diabetes (n = 167), prediabetes (n = 132), or normoglycemia (n = 222) prior to surgery.

Brunt and Clinical Research Network Nonalcoholic Steatohepatitis (NASH CRN) criteria were used to classify tissue samples.

Results indicated that 95% of patients had NAFLD. A total of 56.4% of patients with diabetes had hepatic fibrosis, compared with 29.9% of patients with prediabetes and 28.6% of patients with normoglycemia. Furthermore, NASH was diagnosed in 59.4% of patients with diabetes, 49.2% with prediabetes, and 36% with normoglycemia with obesity.

The researchers noted that only 1.5% of patients with diabetes had no histological hepatic alterations.

“NAFLD is markedly more severe in diabetic patients,” the researchers concluded. “Our data suggest that intraoperative liver biopsy should be considered for diabetic patients undergoing bariatric surgery. Early bariatric surgery should be investigated as a means to prevent progression of NAFLD.”

—Christina Vogt

Reference:

Souto KP, Meinhardt NG, Ramos MJ, Ulbrich-Kulkzynski JM, Stein AT, Damin DC. Nonalcoholic fatty liver disease in patients with different baseline glucose status undergoing bariatric surgery: analysis of intraoperative liver biopsies and literature review [Published online September 26, 2017]. Surg Obes Rel Dis.  http://dx.doi.org/10.1016/j.soard.2017.09.527.