Introduction: Obese patients are at an increased risk of develop nonalcoholic fatty liver disease. Evidence supports that bariatric surgery might have an important impact on hepatic profile in obese adults. Literature suggests that bariatric surgery in adolescents might decrease the prevalence of some comorbidities, but information about its impact on liver profile and steatosis and fibrosis risk remains scarce.
Aim: To evaluate the impact of bariatric surgery on liver parameters and on Hepatic Steatosis Index (HSI, predictor of hepatic steatosis) and AST to Platelet Ratio Index (APRI, predictor of hepatic fibrosis) in adolescents.
Material and methods: We conducted an observational retrospective cohort study in obese adolescents who underwent sleeve gastrectomy in our center between 2013 and 2021. Clinical and laboratorial parameters were evaluated before surgery, and at 6 months, 12 months, and 24 months after surgery. The variation after surgery of anthropometric parameters, lipid profile, liver parameters, HIS and APRI were evaluated with paired t-tests.
Results: The population included (n=22) had an average age of 18.0 [17.0; 18.0] years at the time of the surgery, a body mass index of 47.0±5.4 Kg/m2 and 70.4% were female. In the pre-operative study, 44.4% used metformin, 37.0% had hypertension, and 48.1% dyslipidemia. Six months after the surgery, there was a clinically significant decrease in weight (127.8±17.5 vs 96.6±16.3 Kg, P<0.01), body mass index (46.9±5.3 vs 34.9±5.2 Kg/m2, P<0.01), and percentage of fat mass (47.7±7.6 vs 38.0±12.1 %, P<0.01). There was also a decrease in GGT (34.0±22.5 vs 20.0±12.0, P<0.01). HSI score, which predicts hepatic steatosis, was also markedly decreased (60.0±6.7 vs 45.5±7.6, P<0.01). One year after surgery, there was still a noticeable decrease in weight, body mass index, percentage of fat mass and HSI score. There was also an increase of HDL (P=0.03) and a decrease of triglycerides (116.4±57.6 vs 81.7±36.8 mg/dl, P<0.01). After a two-year follow-up period years after the surgery, the reduction of HSI, weight, body mass index, and percentage of fat mass remained significant (P<0.01). There were no statistically significant differences in the hepatic fibrosis score (APRI), AST, ALT, FA, total bilirubin, direct bilirubin, total cholesterol, and LDL levels during follow-up.
Conclusions: Among severely obese adolescents, sleeve gastrectomy is associated with an improvement of steatosis and triglycerides levels, and this might have a long-term impact on the progression of nonalcoholic fatty liver disease.
21 May 2022 - 24 May 2022