Abstract
BACKGROUND:
Bariatric surgery is a viable treatment for obesity (a risk factor for nonalcoholic steatohepatitis [NASH]). Studies have related weight reduction with changes in NASH, however, few have used imaging to investigate effects on liver health. We evaluated differences in response to intervention using disease activity (corrected T1 [cT1]), and liver fat (proton density fat fraction [PDFF]).
METHODS:
34 morbidly obese patients were included; 13 underwent laparoscopic sleeve gastrectomy (LSG) alongside intraoperative liver biopsy, and N=21 underwent a lifestyle-modification program (LMP). All patients had multi-parametric MRI at baseline and 4-months follow-up. Diagnostic accuracy to identify NASH was assessed using area under the curve (AUC).
RESULTS:
31% of patients in the LSG group had NASH (NAS≥4) on liver biopsy and had significantly higher cT1 (p=0.031), but not PDFF, compared to those without NASH. PDFF and cT1 correlated with the NAS score (r=0.81, 0.70, p<0.05, respectively). There was good AUC for cT1 (0.89) and PDFF (0.83) to identify NASH. At follow-up, weight reduction -22.8%, (p=0.013) vs. -1.3%, (p=0.262) resulted in cT1 reduction of -8.04% (p=0.025) vs. -3.87%, (p=0.083) in the LSG vs. LMP group, respectively. Significant differences between interventions were observed for %PDFF decrease (p=0.001). Both biomarkers were significantly reduced in the LSG group (p<0.05), while only PDFF (p=0.012) was significantly reduced in the LMP group.
CONCLUSIONS
MRI biomarkers have utility to monitor NASH following intervention in patients with morbid obesity allowing objective comparison between intervention strategies. Compared to lifestyle modification, bariatric surgery was more effective in improving liver health (especially fat).
Bariatric surgery is a viable treatment for obesity (a risk factor for nonalcoholic steatohepatitis [NASH]). Studies have related weight reduction with changes in NASH, however, few have used imaging to investigate effects on liver health. We evaluated differences in response to intervention using disease activity (corrected T1 [cT1]), and liver fat (proton density fat fraction [PDFF]).
METHODS:
34 morbidly obese patients were included; 13 underwent laparoscopic sleeve gastrectomy (LSG) alongside intraoperative liver biopsy, and N=21 underwent a lifestyle-modification program (LMP). All patients had multi-parametric MRI at baseline and 4-months follow-up. Diagnostic accuracy to identify NASH was assessed using area under the curve (AUC).
RESULTS:
31% of patients in the LSG group had NASH (NAS≥4) on liver biopsy and had significantly higher cT1 (p=0.031), but not PDFF, compared to those without NASH. PDFF and cT1 correlated with the NAS score (r=0.81, 0.70, p<0.05, respectively). There was good AUC for cT1 (0.89) and PDFF (0.83) to identify NASH. At follow-up, weight reduction -22.8%, (p=0.013) vs. -1.3%, (p=0.262) resulted in cT1 reduction of -8.04% (p=0.025) vs. -3.87%, (p=0.083) in the LSG vs. LMP group, respectively. Significant differences between interventions were observed for %PDFF decrease (p=0.001). Both biomarkers were significantly reduced in the LSG group (p<0.05), while only PDFF (p=0.012) was significantly reduced in the LMP group.
CONCLUSIONS
MRI biomarkers have utility to monitor NASH following intervention in patients with morbid obesity allowing objective comparison between intervention strategies. Compared to lifestyle modification, bariatric surgery was more effective in improving liver health (especially fat).
Original language | English |
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Article number | O-0705 |
Pages (from-to) | S303 |
Number of pages | 822 |
Journal | Hepatology International |
Volume | 18 |
Issue number | 1 supplement |
Publication status | Published - 20 Mar 2024 |