Association of Histopathological and Biochemical Aspects of NAFLD With the Severity of Liver Fibrosis in Individuals With Obesity: Cross-sectional Study.
Bariatric surgery
Fibrosis
Liver biopsy
Non-alcoholic fatty liver disease
Obesity
Journal
Obesity surgery
ISSN: 1708-0428
Titre abrégé: Obes Surg
Pays: United States
ID NLM: 9106714
Informations de publication
Date de publication:
19 Mar 2024
19 Mar 2024
Historique:
received:
25
01
2024
accepted:
14
03
2024
revised:
14
03
2024
medline:
19
3
2024
pubmed:
19
3
2024
entrez:
19
3
2024
Statut:
aheadofprint
Résumé
Given the importance of fibrosis in the progression of non-alcoholic fatty liver disease (NAFLD), identifying biochemical and histopathological aspects associated with its severity is important to determine the course of disease in high-risk populations. The study aims to investigate correlations between biochemical and histopathological variables associated with the occurrence and severity of NAFLD-related liver fibrosis in individuals with obesity. This is a cross-sectional study which enrolled 171 individuals who underwent bariatric surgery at a tertiary university hospital. Clinical, laboratory, and histopathological hepatic characteristics were analyzed. Univariate and multivariate analyses were carried out to identify factors associated with the outcomes studied (severity of fibrosis staging) through simple and multiple regression models. Female were 87.7%, and the mean age was 38.4 ± 9.3 years. The most common histopathological abnormalities were macrovesicular steatosis (74.9%) and hepatocellular ballooning (40.4%). In the histopathological univariate analysis, liver fibrosis significantly correlated with severities of microvesicular steatosis (p = 0.003), lobular inflammation (p = 0.001), and NAS (p < 0.001). In the multivariate analysis, the degrees of microvesicular steatosis (p < 0.001) and NAS (p < 0.001) independently correlated with fibrosis severity. In the univariate biochemical analysis, fibrosis severity significantly correlated with levels of hemoglobin A1c (p = 0.004) and glucose (p = 0.01). In the multivariate analysis, glucose levels independently correlated with liver fibrosis degree (p = 0.007). Significant and independent associations were observed between the intensities of microvesicular steatosis, NAS, and glucose levels and the severity degree of liver fibrosis in individuals with obesity.
Sections du résumé
BACKGROUND
BACKGROUND
Given the importance of fibrosis in the progression of non-alcoholic fatty liver disease (NAFLD), identifying biochemical and histopathological aspects associated with its severity is important to determine the course of disease in high-risk populations.
OBJECTIVES
OBJECTIVE
The study aims to investigate correlations between biochemical and histopathological variables associated with the occurrence and severity of NAFLD-related liver fibrosis in individuals with obesity.
METHODS
METHODS
This is a cross-sectional study which enrolled 171 individuals who underwent bariatric surgery at a tertiary university hospital. Clinical, laboratory, and histopathological hepatic characteristics were analyzed. Univariate and multivariate analyses were carried out to identify factors associated with the outcomes studied (severity of fibrosis staging) through simple and multiple regression models.
RESULTS
RESULTS
Female were 87.7%, and the mean age was 38.4 ± 9.3 years. The most common histopathological abnormalities were macrovesicular steatosis (74.9%) and hepatocellular ballooning (40.4%). In the histopathological univariate analysis, liver fibrosis significantly correlated with severities of microvesicular steatosis (p = 0.003), lobular inflammation (p = 0.001), and NAS (p < 0.001). In the multivariate analysis, the degrees of microvesicular steatosis (p < 0.001) and NAS (p < 0.001) independently correlated with fibrosis severity. In the univariate biochemical analysis, fibrosis severity significantly correlated with levels of hemoglobin A1c (p = 0.004) and glucose (p = 0.01). In the multivariate analysis, glucose levels independently correlated with liver fibrosis degree (p = 0.007).
CONCLUSION
CONCLUSIONS
Significant and independent associations were observed between the intensities of microvesicular steatosis, NAS, and glucose levels and the severity degree of liver fibrosis in individuals with obesity.
Identifiants
pubmed: 38502518
doi: 10.1007/s11695-024-07180-x
pii: 10.1007/s11695-024-07180-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Sheka AC, Adeyi O, Thompson J, et al. Nonalcoholic steatohepatitis: a review. JAMA. 2020;323(12):1175–83.
doi: 10.1001/jama.2020.2298
pubmed: 32207804
Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313(22):2263–73.
doi: 10.1001/jama.2015.5370
pubmed: 26057287
Cheung A, Figueredo C, Rinella ME. Nonalcoholic fatty liver disease: identification and management of high-risk patients. Am J Gastroenterol. 2019;114(4):579–90.
doi: 10.14309/ajg.0000000000000058
pubmed: 30839326
Cazzo E, Pareja JC, Chaim EA. Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review. Sao Paulo Med J. 2017;135(3):277–95.
doi: 10.1590/1516-3180.2016.0306311216
pubmed: 28562737
pmcid: 10019840
Brunt EM, Kleiner DE, Carpenter DH, et al. American association for the study of liver diseases NASH task force. NAFLD: reporting histologic findings in clinical practice. Hepatology. 2021;73(5):2028–38.
doi: 10.1002/hep.31599
pubmed: 33111374
Lazarus JV, Mark HE, Allen AM, et al. Healthy Livers, healthy lives collaborators. A global research priority agenda to advance public health responses to fatty liver disease. J Hepatol. 2023;79(3):618–34.
doi: 10.1016/j.jhep.2023.04.035
pubmed: 37353401
Lekakis V, Papatheodoridis GV. Natural history of metabolic dysfunction-associated steatotic liver disease. Eur J Intern Med. 2023;S0953–6205(23):00397–407.
de Souza EL, Mounzer DLS, Gestic MA, et al. Fibrotic NASH in individuals with obesity: a cross-sectional analysis of the prevalence of this significant milestone of disease progression and accuracy of a non-invasive marker for its screening. Obes Surg. 2023. https://doi.org/10.1007/s11695-023-06998-1 .
doi: 10.1007/s11695-023-06998-1
Talha M, Ali MH. Obesity, type 2 diabetes, NASH, and the promising role of bariatric surgery: insights from the BRAVES trial. Obes Surg. 2023;33(12):4181–2.
doi: 10.1007/s11695-023-06930-7
pubmed: 37943423
Jimenez LS, Mendonça Chaim FH, Mendonça Chaim FD, et al. Impact of weight regain on the evolution of non-alcoholic fatty liver disease after Roux-en-Y gastric bypass: a 3-year follow-up. Obes Surg. 2018;28(10):3131–5.
doi: 10.1007/s11695-018-3286-9
pubmed: 29725976
Kreve F, Callejas GH, Jimenez LS, et al. Trajectory of NAFLD characteristics after Roux-en-Y gastric bypass: a five-year historical cohort study. Sao Paulo Med J. 2022;140(6):739–46.
doi: 10.1590/1516-3180.2021.0828.07012022
pubmed: 36102453
pmcid: 9671569
Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467–74.
doi: 10.1111/j.1572-0241.1999.01377.x
pubmed: 10484010
Kleiner DE, Brunt EM, Van Natta M, et al. Nonalcoholic steatohepatitis clinical research network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.
doi: 10.1002/hep.20701
pubmed: 15915461
Ekstedt M, Hagström H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–54.
doi: 10.1002/hep.27368
pubmed: 25125077
Hagström H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265–73.
doi: 10.1016/j.jhep.2017.07.027
pubmed: 28803953
Germano CW, Mega PF, Mattosinho TJAP, et al. Microvesicular steatosis in individuals with obesity: a histological marker of non-alcoholic fatty liver disease severity. Obes Surg. 2023;33(3):813–20.
doi: 10.1007/s11695-023-06467-9
pubmed: 36694089
Celebi G, Cicek AF, Gurel H, et al. Microvesicular steatosis: a missed item in the management of nonalcoholic fatty liver disease? Acta Gastroenterol Belg. 2020;83(4):565–70.
pubmed: 33321012
Tandra S, Yeh MM, Brunt EM, et al. Presence and significance of microvesicular steatosis in nonalcoholic fatty liver disease. J Hepatol. 2011;55(3):654–9.
doi: 10.1016/j.jhep.2010.11.021
pubmed: 21172393
Tamaki N, Munaganuru N, Jung J, et al. Clinical utility of change in nonalcoholic fatty liver disease activity score and change in fibrosis in NAFLD. Clin Gastroenterol Hepatol. 2021;19(12):2673–4.
doi: 10.1016/j.cgh.2020.11.005
pubmed: 33157318
Kleiner DE, Brunt EM, Wilson LA, et al. Nonalcoholic steatohepatitis clinical research network. Association of histologic disease activity with progression of nonalcoholic fatty liver disease. JAMA Netw Open. 2019;2(10):e1912565.
doi: 10.1001/jamanetworkopen.2019.12565
pubmed: 31584681
pmcid: 6784786
Haukeland JW, Konopski Z, Linnestad P, et al. Abnormal glucose tolerance is a predictor of steatohepatitis and fibrosis in patients with non-alcoholic fatty liver disease. Scand J Gastroenterol. 2005;40(12):1469–77.
doi: 10.1080/00365520500264953
pubmed: 16293559
Ayres ABS, Carneiro CRG, Gestic MA, et al. Identification of predictors of non-alcoholic steatohepatitis and its severity in individuals undergoing bariatric surgery. Obes Surg. 2024;34(2):456–66.
doi: 10.1007/s11695-023-06986-5
pubmed: 38097891
Siddiqui MT, Amin H, Garg R. Medications in type-2 diabetics and their association with liver fibrosis. World J Gastroenterol. 2020;26(23):3249–59.
doi: 10.3748/wjg.v26.i23.3249
pubmed: 32684739
pmcid: 7336333
Jimenez LS, Marques RA, Gestic MA, et al. Non-invasive markers in non-alcoholic fatty liver disease: reliability is variable according to BMI status. Obes Surg. 2021;31(8):3888–92.
doi: 10.1007/s11695-021-05429-3
pubmed: 33913073
Concon MM, Gestic MA, Utrini MP, et al. Should routine liver biopsy be considered in bariatric surgical practice? An analysis of the limitations of non-invasive NAFLD markers. Arq Gastroenterol. 2022;59(1):110–6.
doi: 10.1590/s0004-2803.202200001-19
pubmed: 35442320
Cazzo E, Gestic MA, Utrini MP, et al. 2017 Bariatric surgery in individuals with liver cirrhosis: a narrative review. Rev Assoc Med Bras. 1992;63(2):190–4.
doi: 10.1590/1806-9282.63.02.190