Suneel_Bariatric. final after correction
- 1. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease that runs from simple steatosis to nonalcoholic steatohepatitis (NASH) and fibrosis. It is mostly asymptomatic and is linked with morbid obesity. Currently bariatric surgery is the most rapid and effective treatment option for morbid obesity and its associated metabolic co-morbidities. Prevalence of nonalcoholic fatty liver disease in African-Americans undergoing bariatric surgery 1 Suneel Arwani, 3 Zaki A. Sherif, 1 Ali Afsari, 4 Terrence Fullum, 4 Gezzer Ortega, 5 Charu Gandotra, 4 Denia Tapscott, 1 Hassan Brim, 2 Hassan Ashktorab 1 Department of Pathology, 2 Department of Medicine, 3 Department of Biochemistry, 4 Department of Surgery, 5 Department of Cardiology, Cancer Center Howard University Hospital, Washington, DC. Data were collected from Electronic Medical Records of 477 adult African-American obese patients who had undergone bariatric surgery at Howard University Hospital from April 2004 through September 2015. Sixty two patients diagnosed with liver condition at the pre-operative stage underwent an anthropometric assessment. Confirmatory scanning liver images were also sought when necessary. BACKGROUND METHODS CONCLUSION RESULTS Sixty one cases (13%) of liver condition were identified out of the 477 bariatric patients, and of these only 6 cases (10%) of NAFLD were reported. The total NAFLD cases in bariatric patients were (1.3%). The associated comorbidities with NAFLD were: Hypertension (100%), diabetes mellitus (72%), dyslipidemia (86%), obstructive sleep apnea (72%) and gastroesophageal reflux disease (43%). All bariatric patients including NAFLD cases exhibited BMI of 40 and above. AIM To determine the frequency of NAFLD cases in African-American obese patients seeking bariatric surgery at Howard University Hospital. Table 2. Variables of different blood metabolites in 61 patients undergoing bariatric surgery RESULTS (continued) Liver condition N (%) normal range 61 (13) Mean Age 49 Mean body mass index (BMI) 45 (18-24) Female 54 (89) DM 25 (41) HTN 51 (84) Dyslipidemia 26 (42) OSA 47 (77) GERD 32 (51) Table 1. Anthropomorphic and clinical data of patients with liver disorder Metabolites (Mean) Amount Laboratory reference range Unit Glucose level 120 70-105 mg/dl Aspartate aminotransferase (AST) 22 16-40 IU/L Alanine aminotransferase (ALT) 23 10-41 IU/L Alkaline phosphatase (ALP) 77 38-126 IU/L HTN DM OSA GERD Dyslipidemia HTN + DM 100% (6/6) 67% (4/6) 67% (4/6) 50% (3/6) 84% (5/6) 67% (4/6) Table 3. Analysis of NAFLD associated conditions in (n=6) patients undergoing bariatric surgery This longitudinal study demonstrated that obese African- American bariatric surgery patients are not strongly associated with NAFLD although they manifest characteristics of metabolic syndrome similar to the general patient population. This also confirms the low prevalence of NAFLD reported in the African- American population, which may be partially due to genetics and other as yet undetermined factors. Fig 1. Patient's liver biopsies pre- and post bariatric surgery Fig. 2 Roux-en-y Gastric bypass