A UCSF Fresno hepatology fellow’s retrospective chart review of a large cohort of bariatric surgery patients shows obstructive sleep apnea warrants attention as a potential risk factor for fatty liver disease, and bariatric surgery for severe obesity confers long-term benefits for liver health, among other findings.
Significant reductions over time in steatosis (accumulation of excess fat in the liver) and fibrosis (scar tissue) were documented in patients undergoing bariatric surgery with severe obesity, as reported in an abstract presented by UCSF Fresno Hepatology Fellow Kazi Haque, MD, at the Northern California Society of Clinical Gastroenterology earlier this spring.
The abstract on the long-term impact of metabolic and bariatric surgery on fatty liver disease was selected as the top abstract at the conference and has been accepted for presentation at Digestive Disease Week, a global meeting of hepatologists and gastroenterologists, to be held this May in Chicago.
The study involved a retrospective chart review of 632 patients who underwent surgery for severe obesity from January 2020 to August 2021 and confirmed that the procedure has a significant impact on reducing scarring and loss of fat in the liver.
Three additional abstracts were presented by Haque at the Northern California conference and will be submitted to the American College of Gastroenterology later this year.
One of the abstracts shows obstructive sleep apnea as a possible underlying risk factor for the development of fatty liver disease. The known risk factors for the disease include diabetes, high blood pressure, high cholesterol levels, and obesity. “We’re not saying it (obstructive sleep apnea) is causative, but it could be a potential link to developing fatty liver disease if you have other risk factors as well,” Haque said.
For another abstract, he looked at the cumulative effect of multiple risk factors, including diabetes, high blood pressure, high cholesterol levels, and obesity, for developing fatty liver disease and steatosis. The results show that the more risk factors you have, the greater your risk of developing steatosis and scarring.
A surprising result from the study was that diabetes was the predominant predictor of fibrosis, and Haque said more focus should be paid to educating patients about the effects of diabetes. “It’s important for us to contribute to the care of our patients,” he said.
The fourth abstract presented shows results from an assessment of the limitations of vibration-controlled transient elastography (VCTE) for measuring fibrosis and fat. The non-invasive procedure has been studied widely, but not in the severely obese population.
Haque and Morgan McGrath, MAS, an analyst and statistician at Fresno Heart & Surgical Hospital, created a logistic regression model to evaluate the accuracy of VCTE in heavier individuals. The results suggest that higher steatosis and Body Mass Index levels may contribute to inaccurate VCTE results. There is a need for caution in interpreting VCTE liver stiffness measurements in patients with severe obesity, Haque said. “We need to look at the whole picture and determine whether a patient has liver disease.”
Haque’s research findings presented in the abstracts are important for clinicians, said Marina Roytman, MD, FACP, UCSF clinical professor at UCSF Fresno, interim chief for Gastroenterology and Hepatology, director of the Liver Program, and Inspire Health hepatologist.
“Knowing these results will certainly help us take better care of our patients,” Roytman said. “Doing research like this and presenting it at national conferences and eventually publishing it in full papers, which Kazi is working on, will also make an impact not only on our population but on the population at large.”
