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Prevalence of biopsy‐proven non‐alcoholic fatty liver disease in severely obese subjects without metabolic syndrome
Author(s) -
Qureshi K.,
Abrams G. A.
Publication year - 2016
Publication title -
clinical obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.64
H-Index - 12
eISSN - 1758-8111
pISSN - 1758-8103
DOI - 10.1111/cob.12132
Subject(s) - medicine , fatty liver , metabolic syndrome , disease , alcoholic liver disease , obesity , liver biopsy , gastroenterology , biopsy , cirrhosis
Summary Obesity is a major risk factor for non‐alcoholic fatty liver disease ( NAFLD ). NAFLD encompasses simple fatty liver ( FL ) and non‐alcoholic steatohepatitis ( NASH ) in its spectrum. NASH can progress to liver cirrhosis and is associated with liver cancer. Not all obese subjects have insulin resistance ( IR ) or develop metabolic syndrome ( MS ). This study evaluates the prevalence of NAFLD in severely obese subjects without MS . We retrospectively reviewed 445 charts from our database of severely obese subjects with clinical suspicion of NAFLD and who were selected for laparoscopic Roux‐en‐ Y gastric bypass surgery. One hundred five subjects who did not have MS , as defined by the International Diabetes Foundation, based on comprehensive pre‐operative metabolic evaluation were included. Liver biopsy specimens were evaluated for NAFLD . 24% of morbidly obese (mean body mass index [ BMI ] 48 kg m −2 ) adult subjects (mean age 38 years) who underwent bariatric surgery did not have MS . NAFLD was identified in 77 (73%) on liver biopsy, out of which 59 (56%) were labelled as FL and 18 (17%) had histological diagnosis of NASH . Age, gender, race and BMI were the same among all groups. Among NAFLD subjects, 22% did not have any additional metabolic component of MS , while 36% had low high‐density lipoprotein, 27% had hypertension, 8% had high triglycerides and 6% had hyperglycaemia. IR calculated by HOMA‐IR (Homeostatic Model Assessment for Insulin Resistance) and diagnosis of hyperglycaemia was statistically higher in NASH group compared to those who did not have NASH . NAFLD is highly prevalent in morbidly obese individuals who undergo bariatric surgery despite the absence of MS . Diagnosis of hyperglycaemia in such subjects suggests the presence of IR and may have underlying NASH , which is a progressive form of NAFLD .