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The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features

Practitioners routinely perform intraoperative liver biopsies during laparoscopic sleeve gastrectomy (LSG) to evaluate nonalcoholic fatty liver disease (NAFLD). In some patients, hepatocyte ballooning, inflammation, and fibrosis without steatosis are observed, even in the absence of other etiologies...

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Autores principales: Sasaki, Akira, Umemura, Akira, Ishida, Kazuyuki, Takahashi, Naoto, Nikai, Haruka, Nitta, Hiroyuki, Takikawa, Yasuhiro, Kakisaka, Keisuke, Abe, Tamami, Nishiya, Masao, Sugai, Tamotsu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962337/
https://www.ncbi.nlm.nih.gov/pubmed/35203662
http://dx.doi.org/10.3390/biomedicines10020453
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author Sasaki, Akira
Umemura, Akira
Ishida, Kazuyuki
Takahashi, Naoto
Nikai, Haruka
Nitta, Hiroyuki
Takikawa, Yasuhiro
Kakisaka, Keisuke
Abe, Tamami
Nishiya, Masao
Sugai, Tamotsu
author_facet Sasaki, Akira
Umemura, Akira
Ishida, Kazuyuki
Takahashi, Naoto
Nikai, Haruka
Nitta, Hiroyuki
Takikawa, Yasuhiro
Kakisaka, Keisuke
Abe, Tamami
Nishiya, Masao
Sugai, Tamotsu
author_sort Sasaki, Akira
collection PubMed
description Practitioners routinely perform intraoperative liver biopsies during laparoscopic sleeve gastrectomy (LSG) to evaluate nonalcoholic fatty liver disease (NAFLD). In some patients, hepatocyte ballooning, inflammation, and fibrosis without steatosis are observed, even in the absence of other etiologies. We call this finding indeterminable nonalcoholic steatohepatitis (Ind-NASH). In this study, we clarified the prevalence, as well as histopathological and clinical features, of Ind-NASH through intraoperative liver biopsy in Japanese patients presenting with severe obesity. We enrolled 63 patients who had undergone LSG and intraoperative liver biopsy. In patients diagnosed with histopathological NASH, we performed protocol liver biopsies at 6 and 12 months after LSG. We statistically analyzed these histopathological findings and clinical parameters and found the prevalence rate of Ind-NASH discovered through intraoperative biopsy to be 15.9%. Protocol liver biopsy also revealed that Ind-NASH was an intermediate condition between NASH and normal liver. The clinical features of patients with Ind-NASH are a higher body weight compared to NASH (134.9 kg vs. 114.7 kg; p = 0.0245), stronger insulin resistance compared to nonalcoholic fatty liver (homeostasis model assessment–insulin resistance: 7.1 vs. 4.9; p = 0.0188), and mild liver dysfunction compared to NASH. Patients with Ind-NASH observed positive weight-loss effects from a preoperative diet compared to the postoperative course (percentage total weight loss: 32.0% vs. 26.7%; p < 0.0001). Patients with Ind-NASH may also be good candidates for metabolic surgery owing to their good treatment response; therefore, efforts should be made by specialists in the near future to deeply discuss and define Ind-NASH.
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spelling pubmed-89623372022-03-30 The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features Sasaki, Akira Umemura, Akira Ishida, Kazuyuki Takahashi, Naoto Nikai, Haruka Nitta, Hiroyuki Takikawa, Yasuhiro Kakisaka, Keisuke Abe, Tamami Nishiya, Masao Sugai, Tamotsu Biomedicines Article Practitioners routinely perform intraoperative liver biopsies during laparoscopic sleeve gastrectomy (LSG) to evaluate nonalcoholic fatty liver disease (NAFLD). In some patients, hepatocyte ballooning, inflammation, and fibrosis without steatosis are observed, even in the absence of other etiologies. We call this finding indeterminable nonalcoholic steatohepatitis (Ind-NASH). In this study, we clarified the prevalence, as well as histopathological and clinical features, of Ind-NASH through intraoperative liver biopsy in Japanese patients presenting with severe obesity. We enrolled 63 patients who had undergone LSG and intraoperative liver biopsy. In patients diagnosed with histopathological NASH, we performed protocol liver biopsies at 6 and 12 months after LSG. We statistically analyzed these histopathological findings and clinical parameters and found the prevalence rate of Ind-NASH discovered through intraoperative biopsy to be 15.9%. Protocol liver biopsy also revealed that Ind-NASH was an intermediate condition between NASH and normal liver. The clinical features of patients with Ind-NASH are a higher body weight compared to NASH (134.9 kg vs. 114.7 kg; p = 0.0245), stronger insulin resistance compared to nonalcoholic fatty liver (homeostasis model assessment–insulin resistance: 7.1 vs. 4.9; p = 0.0188), and mild liver dysfunction compared to NASH. Patients with Ind-NASH observed positive weight-loss effects from a preoperative diet compared to the postoperative course (percentage total weight loss: 32.0% vs. 26.7%; p < 0.0001). Patients with Ind-NASH may also be good candidates for metabolic surgery owing to their good treatment response; therefore, efforts should be made by specialists in the near future to deeply discuss and define Ind-NASH. MDPI 2022-02-15 /pmc/articles/PMC8962337/ /pubmed/35203662 http://dx.doi.org/10.3390/biomedicines10020453 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sasaki, Akira
Umemura, Akira
Ishida, Kazuyuki
Takahashi, Naoto
Nikai, Haruka
Nitta, Hiroyuki
Takikawa, Yasuhiro
Kakisaka, Keisuke
Abe, Tamami
Nishiya, Masao
Sugai, Tamotsu
The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features
title The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features
title_full The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features
title_fullStr The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features
title_full_unstemmed The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features
title_short The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features
title_sort concept of indeterminable nash inducted by preoperative diet and metabolic surgery: analyses of histopathological and clinical features
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962337/
https://www.ncbi.nlm.nih.gov/pubmed/35203662
http://dx.doi.org/10.3390/biomedicines10020453
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