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Insulin Resistance Predicts Steatosis and Fibrosis in Morbidly Obese Patients Undergoing Bariatric Surgery
  1. Rocio Aller, MD,
  2. Daniel de Luis, MD,
  3. David Pacheco, MD, PhD,
  4. Maria Concepcion Velasco, MD,
  5. Olatz Izaola, PhD,
  6. Manuel Gonzalez Sagrado, MD
  1. From the Center of Investigation of Endocrinology and Nutrition, School of Medicine, and Unit of Investigation, Hospital Rio Hortega, Gastroenterology Department, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain.
  1. Received October 7, 2011, and in revised form March 26, 2012.
  2. Accepted for publication June 12, 2012.
  3. Reprints: Daniel de Luis, MD, Center of Investigation of Endocrinology and Nutrition, School of Medicine, Valladolid University, C/Los perales 16 Simancas 47130, Valladolid, Spain. E-mail: dadluis{at}yahoo.es.
  4. Author contributions: RA Aller performed clinical evaluation and wrote the article; DA de Luis performed clinical evaluation and wrote the article; D Pacheco performed clinical evaluation; O Izaola coded data in SPSS and performed clinical evaluation; MC Velasco performed liver biopsy; R Conde performed clinical evaluation.
  5. No funding has been received to perform this study.

Abstract

Background Influence of adipokines and insulin resistance on liver histology is an unclear area in morbidly obese patients.

Objective The aim of our study was to study the influence of insulin resistance and adipokines in the grade of liver steatosis and fibrosis in morbidly obese patients undergoing bariatric surgery.

Setting Tertiary hospital.

Materials and Methods A sample of 36 morbidly obese patients undergoing bariatric surgery was analyzed in a cross-sectional study. A liver biopsy was performed. Weights, basal glucose, insulin, insulin resistance (homeostasis model assessment for insulin resistance [HOMA-IR]), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and adipokine blood levels were measured.

Results Seventeen patients (47.2%) had low-grade steatosis, and 19 patients (52.8%) had high-grade steatosis. Sixteen patients (44.4%) did not have liver fibrosis, and 20 patients (56.6%) had liver fibrosis. Only insulin levels, HOMA-IR, and aspartate aminotransferase activity were higher in the patients with high-grade steatosis. Insulin levels and HOMA-IR were higher in patients with fibrosis. In the logistic regression analysis with a dependent dichotomous variable (grades of steatosis: low vs high), the HOMA-IR remained in the model, with an odds ratio to develop high-grade steatosis of 1.33 (95% confidence interval, 1.09–1.86). In the second logistic regression analysis with a dependent dichotomy variable (grades of fibrosis: present vs absent), the HOMA-IR remained in the model, with an odds ratio to develop fibrosis of 1.53 (95% confidence interval, 1.13–2.51).

Conclusion Insulin resistance determined with HOMA-IR model is associated with high-grade steatosis and liver fibrosis in obese patients before bariatric surgery.

Key Words
  • adipokines
  • bariatric surgery
  • insulin resistance
  • nonalcoholic fatty liver disease
  • morbid obesity

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