| Autor: |
Schmitz SM; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany., Storms S; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany., Koch A; Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany., Stier C; Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, 97080 Wuerzburg, Germany.; Department of General-, Visceral-, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, 97080 Wuerzburg, Germany.; Department of Surgical Endoscopy, Sana Hospital Huerth, 50354 Huerth, Germany., Kroh A; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany., Rheinwalt KP; Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825 Cologne, Germany., Schipper S; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany., Hamesch K; Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany., Ulmer TF; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany.; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands., Neumann UP; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany.; Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825 Cologne, Germany., Alizai PH; Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany.; Gemeinschaftskrankenhaus Bonn, Klinik für Allgemein- und Viszeralchirurgie, 53113 Bonn, Germany. |
| Abstrakt: |
(1) Background: Metabolically healthy obesity (MHO) is a concept that applies to obese patients without any elements of metabolic syndrome (metS). In turn, metabolically unhealthy obesity (MUO) defines the presence of elements of metS in obese patients. The components of MUO can be divided into subgroups regarding the elements of inflammation, lipid and glucose metabolism and cardiovascular disease. MUO patients appear to be at greater risk of developing non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) compared to MHO patients. The aim of this study was to evaluate the influence of different MUO components on NAFLD and NASH in patients with morbid obesity undergoing bariatric surgery. (2) Methods: 141 patients undergoing bariatric surgery from September 2015 and October 2021 at RWTH Aachen university hospital (Germany) were included. Patients were evaluated pre-operatively for characteristics of metS and MUO (HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension). Intraoperatively, a liver biopsy was taken from the left liver lobe and evaluated for the presence of NAFLD or NASH. In ordinal regression analyses, different factors were evaluated for their influence on NAFLD and NASH. (3) Results: Mean BMI of the patients was 52.3 kg/m 2 (36-74.8, SD 8.4). Together, the parameters HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension accounted for a significant amount of variance in the outcome, with a likelihood ratio of χ 2 (9) = 41.547, p < 0.001, for predicting the presence of NASH. Only HOMA was an independent predictor of NASH (B = 0.102, SE = 0.0373, p = 0.007). Evaluation of steatosis showed a similar trend (likelihood ratio χ 2 (9) = 40.272, p < 0.001). Independent predictors of steatosis were HbA1c (B = 0.833, SE = 0.343, p = 0.015) and HOMA (B = 0.136, SE = 0.039, p < 0.001). (4) Conclusions: The above-mentioned model, including components of MUO, was significant for diagnosing NASH in patients with morbid obesity undergoing bariatric surgery. Out of the different subitems, HOMA independently predicted the presence of NASH and steatosis, while HbA1c independently predicted steatosis and fibrosis. Taken together, the parameter of glucose metabolism appears to be more accurate for the prediction of NASH than the parameters of lipid metabolism, inflammation or the presence of cardiovascular disease. |
