Tuesday, January 29, 2008

Will Weight Loss Surgery Improve Your Liver?


According to this, it will:

Mattar, . (2005). Surgically-Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome. . Annals of Surgery, 242(4), 610-620. Surgically-Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome. Original Articles Annals of Surgery. 242(4):610-620, October 2005. Mattar, Samer G. MD, FACS *; Velcu, Laura M. MD +; Rabinovitz, Mordechai MD ++; Demetris, A J. MD [S]; Krasinskas, A M. MD [S]; Barinas-Mitchell, Emma PhD [//]; Eid, George M. MD *; Ramanathan, Ramesh MD *; Taylor, Debra S. RN *; Schauer, Philip R. MD + Abstract: Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients. Summary Background Data: Nonalcoholic fatty liver disease (NAFLD), a spectrum that extends to liver fibrosis and cirrhosis, is rising at an alarming rate. This increase is occurring in conjunction with the rise of severe obesity and is probably mediated in part by metabolic syndrome (MS). Surgical weight loss operations, probably by reversing MS, have been shown to result in improvement in liver histology. Methods: Patients who underwent laparoscopic surgical weight loss operations from March 1999 through August 2004, and who agreed to have an intraoperative liver biopsy followed by at least one postoperative liver biopsy, were included. Results: There were 70 patients who were eligible. All patients underwent laparoscopic operations, the majority being laparoscopic Roux-en-Y gastric bypass. The mean excess body weight loss at time of second biopsy was 59% +/- 22% and the time interval between biopsies was 15 +/- 9 months. There was a reduction in prevalence of metabolic syndrome, from 70% to 14% (P < 0.001), and a marked improvement in liver steatosis (from 88% to 8%), inflammation (from 23% to 2%), and fibrosis (from 31% to 13%; all P < 0.001). Inflammation and fibrosis resolved in 37% and 20% of patients, respectively, corresponding to improvement of 82% (P < 0.001) in grade and 39% (P < 0.001) in stage of liver disease. Conclusion: Surgical weight loss results in significant improvement of liver morphology in severely obese patients. These beneficial changes may be associated with a significant reduction in the prevalence of the metabolic syndrome. (C) 2005 Lippincott Williams & Wilkins, Inc.

Metabolic Syndrome is a collection of health-related problems and symptoms that link a person's likelihood of developing chronic heart, diabetic, high blood pressure, or other long-term problems. The Cleveland Clinic has a good overall description of Metabolic Syndrome here. In a nut shell Metabolic Syndrome is a combination of high bad cholesterol, low good cholesterol, high triglycerides (usually obtained from animal fats), high liver enzymes (which result from liver cells bursting like balloons and spewing their enzymes into the blood), and insulin resistance (often an onset to diabetes). Nasty yet becoming more prevalent in a world with ever increasing-sized people. In essence, Metabolic Syndrome is no a true medical condition but rather a collection of nasty side effects usually associated with overweight people. True, by itself, any number of the symptoms could be associated to genetics, but collectively they say you are fat. And fat people tend to have fatty livers. Fatty livers work harder and develop “scars” in the form of fibrosis an cirrhosis. They work hard but produce less. The strain on the body increases over time. So, what does this article suggest and why should you care? It says that in a majority of patients followed after having some form of weight loss surgery (the most in this study having a “gastric bypass” surgery which also results in less fats absorbed by the body during digestion) their livers improved. They stuck needles into the people to actually biopsy and test results. There are some interesting features to this study and they do mention it. First off, not all liver conditions they tested for were improved in a majority (>50%) of patients studied. Fibrosis only improved in 20% of the patients tracked. That is still a significant number, though (1 in 5). But did the weight loss surgery “cure” the livers? No, at least not directly. What they saw was a significant drop in Metabolic Syndrome which, again, is not a “single” systemic problem but actually a collection of related problems. 70% of the original patients (before their surgeries) had Metabolic Syndrome. At the conclusion of the study, only 14% of the now-post-surgery patients had Metabolic Syndrome. A look at the numbers in the abstract are a little confusing (I admit I do not have the entire study and wish I had all of the tables to look over...Bobblehead loves statistics!) because you see a wide-range of patients. Some are 5 years out from when the study was published. Others are 1 year or less (and hence probably not at their ideal weight, yet). Some have had a true significant weight loss and appear to be a a reasonable target. Others are still loosing weight and are breaking down fat cells grown over years and years, thus releasing lipids into to the blood and keeping the Metabolic Syndrome going. Likewise, you store glycogen in your liver and many people who have not yet lost a significant amount of weight are still relying on their livers. The fatty livers remain. Again, does weight loss surgery directly fix your liver? No.....but... Indirectly it does and that is good news. The livers are repaired (livers are marvelous organs fully under-appreciated by Western Culture!) fairly well on their own assuming massive chronic damage does not occur. Who cares that the livers get better, not as a direct result of the surgery, but rather as a pleasant side effect of curing excess lipids (fats) in the blood and getting your body to properly respond to insulin? In other words, by fixing the Metabolic Syndrome you end up fixing the liver. And the pancreas. And the heart. And the knees. And the kidneys. And the arteries. And that is very, very good. Now, I have to make a smart-ass remark to this article. Duh! Anyone could have predicted this. I saw this first hand in my tests. Yet, I agree this study should have occurred to at least give evidence to the situation. A similar study comparing two sets of patients, one that loses weight via a malabsorbtion surgery, and one set that loses weight through either non-surgical or restriction methods (Lap-Band) would be interesting. Also, tracking a set of patients with similar starting BMIs over time would have been interesting as well. In any case, the article give credence to the fact that if you have Metabolic Syndrome (and most morbidly obese patients do), losing weight and changing diet will help. If surgery ends up being a tool to accomplish this, your liver will thank you.

[posted by Bobblehead]