Endocrine Abstracts

Background: Patients undergoing bariatric surgery have a higher prevalence of non alcoholic liver fatty disease (NAFLD) than the general population; however, its assessment and the accurate staging of fibrosis are often complicated because noninvasive tests are not very accurate in patients with morbid obesity, and liver biopsy cannot be performed as a routine exam.

Aim: The aim of this study was to determine the prevalence of non alcoholic fatty liver disease and fibrosis in patients undergoing bariatric surgery.

Methods: This is a monocentric prospective descriptive study including 40 morbidly obese patients before bariatric surgery. NAFLD was diagnosed by ultrasound and alterations in liver enzyme levels (aspartate aminotransferase (ASAT), alanine aminotransferase(ALAT) and yGlutamylTransferase (yGT)). Fibrosis score used was the fibrosis-4 (FIB-4) index.

Results: The mean age was 38.18 ± 10.03 years, 35 (87.5%) were females, mean body mass index (BMI) was 47.13 ±7.73 kg/m^² and mean waist circumference was 134.64 ± 20.39 cm. Mean triglyceride level was 1.8 ± 1.67 mmol/l [0.41-7.67]. Mean serum levels of liver enzymes ASAT, ALAT and yGT were respectively 25.29 ± 12.11 UI/l [10-54], 26.82 ± 14 UI/l [14-58] and 28.11 ± 15.6UI/l [8-55]. Mean 25 OH vitamin D level was 17.02 ± 13.61 ng/ml [8.1-64.8].Ultrasound was abnormal in 26 patients (65%). NAFLD was associated with triglyceride levels (P = 0.034). However, age (P = 0.5), body mass index (P = 0.44), hypertension (P = 0.7), diabetes (P = 0.4), ASAT levels (P = 0.6), ALAT levels (P = 0.1), ASAT/ALAT(P = 0.053) and yGT levels (P = 0.4) and Vitamin D levels (P = 0.05) were not associated with NAFLD. Mean FIB-4 index was 0.74 [0.19-3.76]. Of the study population, 92.1% of patients had a FIB-4 index <1.3, 5.3% had a FIB-4 index between 1.4 and 2.67 and 2.6% of patients had a FIB-4 index >2.67. FIB-4 index >1.3 was associated with ALAT levels (P = 0.005), vitamin D levels (P = 0.038) and yGT(P = 0.03).However, no association was found with ASAT levels (P = 0.1), yGT (P = 0.3), HOMA2-insulin resistance (P = 0.9), age (P = 0.3), BMI (P = 0.56) and waist circumference (P = 0.4).

Conclusion: Vitamin D status were associated with NAFLD and advanced fibrosis in morbidly obese patients. Therefore, routine screening of 25OH vitamin D deficiency have important therapeutic implications in this population. FIB-4 index ruled out advanced fibrosis in most of our study cases.