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