Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients

Table 1 Criteria used for histological scoring[21]

Steatosis:

0 : None

1: up to 33%

2: 33%-66%

3: > 66%

Hepatocyte ballooning

0: None

1: Occasional, Zone 3

2: “Obvious” Zone 3

3: Marked, predominantly Zone 3

Mallory bodies

0: No Mallory bodies

1: Fewer than two in 10 to 20 × fields

2: More than two in 10 to 20 × fields

Glycogenated nuclei

0: Absent

1: Occasional

2: Several

Lobular inflammation (inflammatory foci per 20 × with a 20 × ocular)

0: None

1: 1 to 2/20

2: Up to 4/20

3: More than 4/20

Portal inflammation

0: None

1: Mild

2: Moderate

3: Severe

Fibrosis score:

Stage 0: No fibrosis

Stage 1: Zone 3 perisinusoidal/pericellular fibrosis; focally or extensively present

Stage 2: Zone 3 perisinusoidal/pericellular fibrosis with focal or extensive periportal fibrosis

Stage 3: Zone 3 perisinusoidal/pericellular fibrosis and portal fibrosis with a focal or extensive bridging fibrosis

Stage 4: Cirrhosis

Table 2 Changes in anthropometric measurements and biochemistry between the patients’ first and second liver biopsy

	Pre bariatric surgery	Post bariatric surgery	P value
Weight (kg)	130.8 ± 20.1	82.3 ± 13.7	< 0.001
BMI (kg/m2)	49.3 ± 4.8	30.9 ± 4.3	< 0.001
% excess weight loss		72.1 ± 6.6
Waist (cm)	137.1 ± 12.6	97.3 ± 11.0	< 0.001
Diabetic (%)	12 (46.1)	6 (23)	0.14
Hypertensive (%)	17 (65.4)	7 (26.9)	0.012
Metabolic syndrome	15 (57.7)	2 (7.7)	< 0.001
Cholesterol (mmol/L)	5.44 ± 1.00	4.29 ± 0.85	< 0.001
HDL-C (mmol/L)	1.24 ± 0.21	1.40 ± 0.19	0.005
LDL-C (mmol/L)	3.47 ± 0.76	2.46 ± 0.75	< 0.001
Triglycerides (mmol/L)	1.60 ± 0.63	0.93 ± 0.29	< 0.001
AST (μkat/L)	0.35 ± 0.09	0.36 ± 0.17	0.862
ALT (μkat/L)	0.49 ± 0.20	0.37 ± 0.31	0.143
GGT (U/L)	40.2 ± 17.4	19.2 ± 12.8	< 0.001
Fasting glucose (mmol/L)	6.46 ± 2.3	4.96 ± 0.55	0.001
Insulin (pmol/L)	235.2 ± 7.2	56.1 ± 7.2	0.006
Insulin resistance (HOMA)	9.99 ± 13.3	1.8 ± 1.4	0.006

BMI: Body mass index; HDL-C: High density lipoprotein cholesterol; LDL-C: Low density lipoprotein cholesterol; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; HOMA: Homeostatic model assessment method.

Table 3 Histological scores for the 26-paired biopsies

	Scores					P value
Feature	0	1	2	3	4
Steatosis						< 0.001
Pre	0	13	8	5	-
Post	24	2	0	0	-
Ballooning degeneration						< 0.001
Pre	10	8	7	1	-
Post	25	1	0	0	-
Mallory bodies						0.005
Pre	18	8	0
Post	26	0	0
Glycogen nuclei						0.001
Pre	8	7	11
Post	13	8	5
Lobular inflammation						< 0.001
Pre	1	23	2	0
Post	15	11	0	0
Portal inflammation						0.05
Pre	1	23	2	0
Post	7	19	0	0
Fibrosis						0.001
Pre	1	17	6	2	0
Post	9	12	4	1	0

Table 4 Scoring for the grade and stage of non alcoholic steatohepatitis n (%)

	Scores
	0	1	2	3	P value
Grade
At surgery	1 (3.8)	12 (46.1)	11 (42.3)	2 (7.7)	0.001
Follow up biopsy	22 (84.6)	4 (15.4)	0 (0)	0 (0)
Stage
At surgery	1 (3.8)	17 (65.4)	6 (23.1)	2 (7.7)	0.001
Follow up biopsy	9 (34.6)	12 (46.1)	4 (15.4)	1 (3.8)

Table 5 Factors associated with significant fibrosis (F > 1) after bariatric surgery

Variable	F 0-1 post surgery (n = 21)	F > 1 post surgery (n = 5)	P value
Mean steatosis score at surgery	1.5 ± 0.7	2.6 ± 0.5	0.002
Mean fibrosis score at surgery	1.1 ± 0.4	2.4 ± 0.5	< 0.001
Mean serum AST level at surgery (IU ± SD)	22.8 ± 11.6	11.6 ± 4.0	0.034

AST: Aspartate aminotransferase.