Abstract
Purpose
Obesity is a modern pandemic with continuous expansion and represents an independent
risk factor for non-alcoholic fatty liver disease (NAFLD), the most common liver disease
in westernized countries. The crosstalk between adipose tissue and the liver is key
to the development of NAFLD.
Procedures
Therefore, in an observational study blood, visceral adipose tissue and liver tissue
were obtained from 93 severely obese patients with a mean age of 43 years and mean BMI of 52 kg/m2 at the time of weight loss surgery. In a subset of patients a follow-up blood sample
was obtained 6 weeks after surgery to assess acute effects of weight loss. In addition to routine
parameters of liver injury, serum samples were analyzed for leptin, adiponectin, free
fatty acids (FFAs), and several apolipoproteins.
Main findings
The diameter of visceral adipocytes correlated to liver injury, serum markers of inflammation
and serum adipokine levels. Liver injury assessed by serology (ALT, AST) and histology
(NAFLD activity score, NAS) was independent of the BMI. However, serum levels of triglycerides
and Apolipoprotein CIII (ApoCIII) were associated with NAS. Serum levels and composition
of FFAs, especially long chain FFAs, also correlated with NAS. Analysis of serum samples
six weeks after surgery revealed beneficial changes in serum triglycerides, levels
of ApoCIII and several FFAs.
Conclusions
In severely obese patients beneficial effects on liver injury can been observed as
early as six weeks after bariatric surgery. These effects may be explained by the
observed changes in adipose tissue and lipid metabolism. Collectively, these findings
underline the importance of the link between adipose tissue and the liver.
Abbreviations:
ALT (alanine aminotransferase), ApoAI (apolipoprotein AI resp. ApoAII, ApoCII, ApoCIII), AST (aspartate aminotransferase), CRP (C-reactive protein), DGLA (dihomo-gamma-linolenic acid), FFA (free fatty acid), GGT (gamma glutamyltransferase), IL-6 (interleukin-6), INR (international normalized ratio), LDH (lactate dehydrogenase), Lp(A) (lipoprotein A), LPL (lipoprotein lipase), NAFLD (non-alcoholic fatty liver disease), NAS (NAFLD activitiy score), NASH (non-alcoholic steatohepatitis), PTT (partial thromboplastin time), VLDL (very low density lipoprotein), WAT (white adipose tissue), vWAT (visceral WAT)Keywords
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Article info
Publication history
Published online: September 06, 2014
Accepted:
September 2,
2014
Received:
June 10,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
