Influence of type 2 diabetes mellitus on liver histology among morbidly obese individuals. A cross-sectional study

Authors

  • Everton Cazzo Universidade Estadual de Campinas
  • Laísa Simakawa Jimenez Universidade Estadual de Campinas
  • Fábio de Felice Gallo Universidade Estadual de Campinas
  • José Carlos Pareja Universidade Estadual de Campinas
  • Elinton Adami Chaim Universidade Estadual de Campinas

Keywords:

Fatty liver, Insulin resistance, Diabetes mellitus, Bariatric surgery, Obesity

Abstract

CONTEXT AND OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has become a public health concern. It encompasses a wide spectrum of histological abnormalities and has close relationships with insulin re- sistance and type 2 diabetes mellitus (T2DM). This study sought to compare the histological alterations observed in morbidly obese individuals with and without T2DM who underwent Roux-en-Y gastric bypass. DESIGN AND SETTING: Cross-sectional study in a tertiary-level public hospital. METHODS: This was a cross-sectional study on 197 individuals who underwent gastric bypass surgery between 2011 and 2013. NAFLD was assessed through liver biopsies. T2DM was diagnosed through the International Diabetes Federation criteria. RESULTS: Non-diabetics presented significantly more biopsies without any histological abnormalities, regarding steatosis (42.6% versus 25.5%; P = 0.0400), fibrosis (60.6% versus 36.2%; P = 0.0042) and ste- atohepatitis (27.3% versus 12.8%; P = 0.0495), while diabetics presented significantly higher frequency of moderate forms of steatosis (36.2% versus 20%; P = 0.0307) and fibrosis (23.4% versus 4%; P = 0.0002). DISCUSSION: T2DM was associated with more advanced forms of NAFLD within the population studied. NAFLD has previously been correlated with severe forms of heart disease. CONCLUSION: Screening for and early detecting of NAFLD in high-risk populations are important for avoiding further development of severe forms and the need for liver transplantation.

Downloads

Download data is not yet available.

Author Biographies

Everton Cazzo, Universidade Estadual de Campinas

MD, MSc. Assistant Lecturer, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.

Laísa Simakawa Jimenez, Universidade Estadual de Campinas

BM. Medical Student, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.

Fábio de Felice Gallo, Universidade Estadual de Campinas

MD. Resident Physician, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.

José Carlos Pareja, Universidade Estadual de Campinas

MD, PhD. Adjunct Professor, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.

Elinton Adami Chaim, Universidade Estadual de Campinas

MD, MSc, PhD. Associate Professor, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.

References

Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis. 2004;24(1):3-20.

Kuppan G, Anjana RM, Deepa M, et al. Inflammatory markers in relation to nonalcoholic fatty liver disease in urban South Indians. Diabetes Technol Ther. 2012;14(2):152-8.

Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142(4):711-725.e6.

Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology. 2010;51(2):679-89.

McCullough AJ. Pathophysiology of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40 Suppl 1:S17-29.

Adams LA, Waters OR, Knuiman MW, Elliott RR, Olynyk JK. NAFLD as a risk factor for the development of diabetes and the metabolic syndrome: an eleven-year follow-up study. Am J Gastroenterol. 2009;104(4):861-7.

Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330-44.

Lattuada G, Ragogna F, Perseghin G. Why does NAFLD predict type 2 diabetes? Curr Diab Rep. 2011;11(3):167-72.

Ortiz-Lopez C, Lomonaco R, Orsak B, et al. Prevalence of prediabetes and diabetes and metabolic profile of patients with nonalcoholic fatty liver disease (NAFLD). Diabetes Care. 2012;35(4):873-8.

Boza C, Riquelme A, Ibañez L, et al. Predictors of nonalcoholic steatohepatitis (NASH) in obese patients undergoing gastric bypass. Obes Surg. 2005;15(8):1148-53.

Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25(10):1822-32.

Liu X, Lazenby AJ, Clements RH, Jhala N, Abrams GA. Resolution of nonalcoholic steatohepatitis after gastric bypass surgery. Obes Surg. 2007;17(4):486-92.

Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101(2):368-73.

Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg. 2012;22(7):1016-21.

Vargas V, Allende H, Lecube A, et al. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol. 2012;4(12):382-8.

Moretto M, Kupski C, da Silva VD, Padoin AV, Mottin CC. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22(7):1044-9.

Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396-402.

Cazzo E, Jimenez LS, Pareja JC, Chaim EA. Effect of Roux-en-Y gastric bypass on nonalcoholic fatty liver disease evaluated through NAFLD fibrosis score: a prospective study. Obes Surg. 2015;25(6):982-5.

Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S-619S.

International Diabetes Federation. Clinical Guidelines Task Force. Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2012. Available from: https://www.idf.org/sites/default/files/IDF%20T2DM%20Guideline.pdf. Accessed in 2015 (Oct 15).

Shalhub S, Parsee A, Gallagher SF, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54-9.

Simo KA, McKillop IH, McMillan MT, et al. Does a calculated “NAFLD fibrosis score” reliably negate the need for liver biopsy in patients undergoing bariatric surgery? Obes Surg. 2014;24(1):15-21.

Cazzo E, de Felice Gallo F, Pareja JC, Chaim EA. Nonalcoholic fatty liver disease in morbidly obese subjects: correlation among histopathologic findings, biochemical features, and ultrasound evaluation. Obes Surg. 2014;24(4):666-8.

Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846-54.

McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59(9):1265-9.

Qureshi K, Clements RH, Abrams GA. The utility of the “NAFLD fibrosis score” in morbidly obese subjects with NAFLD. Obes Surg. 2008;18(3):264-70.

Pimentel SK, Strobel R, Gonçalves CG, et al. Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery. Arq Gastroenterol. 2010;47(2):170-3.

Bhatt HB, Smith RJ. Fatty liver disease in diabetes mellitus. Hepatobiliary Surg Nutr. 2015;4(2):101-8.

Stefan N, Häring HU. The metabolically benign and malignant fatty liver. Diabetes. 2011;60(8):2011-7.

Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221-31.

Fukuda T, Hamaguchi M, Kojima T, et al. The impact of non-alcoholic fatty liver disease on incident type 2 diabetes mellitus in non- overweight individuals. Liver Int. 2015. [Epub ahead of print]

Yamazaki H, Tsuboya T, Tsuji K, Dohke M, Maguchi H. Independent Association Between Improvement of Nonalcoholic Fatty Liver Disease and Reduced Incidence of Type 2 Diabetes. Diabetes Care. 2015;38(9):1673-9.

Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia. 2008;51(11):1947-53.

Mantovani A, Pernigo M, Bergamini C, et al. Nonalcoholic Fatty Liver Disease Is Independently Associated with Early Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes. PLoS One. 2015;10(8):e0135329.

Clark JM, Alkhuraishi AR, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13(7):1180-6.

Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22(3):222-6.

Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137(2):532-40.

Shaker M, Tabbaa A, Albeldawi M, Alkhouri N. Liver transplantation for nonalcoholic fatty liver disease: new challenges and new opportunities. World J Gastroenterol. 2014;20(18):5320-30.

Santos LF, Hernandez G, Puerta AV, et al. Non alcoholic fatty liver disease. The new millennium Pandemia. Rev Col Gastroenterol. 2010;25:373-91.

Downloads

Published

2016-02-04

How to Cite

1.
Cazzo E, Jimenez LS, Gallo F de F, Pareja JC, Chaim EA. Influence of type 2 diabetes mellitus on liver histology among morbidly obese individuals. A cross-sectional study. Sao Paulo Med J [Internet]. 2016 Feb. 4 [cited 2025 Mar. 9];134(1):79-83. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/947

Issue

Vol. 134 No. 1 (2016)

Section

Short Communication

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.