Hepatic histology in obese patients undergoing bariatric surgery

J Hepatol. 2006 Oct;45(4):600-6. doi: 10.1016/j.jhep.2006.06.013. Epub 2006 Jul 25.


Background/aims: Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis (NASH). Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population.

Methods: Review of available studies on prevalence of NAFLD/NASH in severely obese patients submitted to bariatric surgery.

Results: Twelve observational and transversal studies were included, with consecutive recruitment, and prospective evaluation of data, summing 1620 patients with severe obesity. Prevalence of steatosis and NASH was 91% (range: 85-98%) and 37% (24-98%), respectively, with unexpected cirrhosis in 1.7% (1-7%). NASH was not related with age or body mass index, but there was an association between male sex and NASH/hepatic fibrosis. Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH, and hypertension with advanced hepatic fibrosis.

Conclusions: There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients, more than one-third presenting histological criteria for NASH. This review underscores the large variations in prevalence of NASH between studies, calling for the need for a better agreement in the use of the histological criteria.

MeSH terms

  • Adult
  • Age Distribution
  • Bariatric Surgery*
  • Body Mass Index
  • Dyslipidemias / epidemiology
  • Fatty Liver / epidemiology
  • Fatty Liver / pathology*
  • Female
  • Humans
  • Hypertension / epidemiology
  • Liver / pathology*
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / pathology
  • Male
  • Middle Aged
  • Obesity, Morbid / epidemiology
  • Obesity, Morbid / pathology*
  • Obesity, Morbid / surgery*
  • Prevalence
  • Severity of Illness Index
  • Sex Distribution
  • Transaminases / blood


  • Transaminases