Fatty Liver (cont.)
Bhupinder Anand, MD
In this Article
Bariatric surgery is surgery of the gastrointestinal tract that results in loss of weight, and there are several different types of bariatric surgery. Since obesity is believed to be an important factor in the causation of NAFLD and loss of weight has been shown to have beneficial effects on NAFLD, it is not surprising that bariatric surgery has been considered as a potential treatment for NAFLD. Only one study has reported the effects of bariatric surgery on NAFLD and has demonstrated that fat and inflammation decrease, and progression from mild fibrosis to more severe fibrosis is arrested. (Patients with more severe fibrosis were not studied and, therefore it is not known if the progression from more severe fibrosis also is arrested.) Nevertheless, because appropriate studies to determine both the benefits and risks of bariatric surgery have not been done, it is recommended that bariatric surgery should not be used as a treatment for NASH. Instead, patients should be selected for surgery irrespective of the presence or absence of NASH.
Once a liver has become cirrhotic and complications have developed, the options for treatment are either treating the complications as they arise or to replace the diseased liver with a transplanted liver. In fact, NASH has become the third most common cause of transplanting livers, only surpassed by alcoholic liver disease and hepatitis C, but it is expected to climb to the number one position due to the epidemic of obesity and diabetes that is occurring in the U.S.. Unfortunately, NASH recurs frequently in the transplanted liver and then progresses to cirrhosis, presumably because the underlying causes - obesity and diabetes--continue.
What is the relationship between nonalcoholic fatty liver disease and cardiovascular disease?
As mentioned previously, cardiovascular disease, especially heart attacks and strokes, is commonly seen in patients with fatty liver. In fact, cardiovascular causes of death occur more frequently than liver-related deaths. Whereas the components of the metabolic syndrome are risk factors for cardiovascular disease, NAFLD has been found to be a risk factor that is independent of the metabolic syndrome, increasing the risk two-fold. Since the means of treating NAFLD are limited, it is important that the manifestations of the metabolic syndrome - obesity, diabetes, high blood pressure, dyslipidemia (abnormalities of fats or lipids in the blood) - should be aggressively treated.
Medically Reviewed by a Doctor on 7/9/2014
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