Elastic Fibers Density: a New Parameter of Improvement of NAFLD in Bariatric Surgery Patients
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ORIGINAL CONTRIBUTIONS
Elastic Fibers Density: a New Parameter of Improvement of NAFLD in Bariatric Surgery Patients Carine Leite 1 & Rodrigo Tzovenos Starosta 2 & Eduardo Neubarth Trindade 3 & Eduardo de Melo Monteiro 4 & Pedro Funari Pereira 5 & Manoel Roberto Maciel Trindade 1,3 & Mário Reis Álvares-da-Silva 1,6 & Carlos Thadeu Schmidt Cerski 1,7
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Obesity is a major risk factor for nonalcoholic fatty liver disease (NAFLD), affecting 25% of the worldwide population. Weight loss through bariatric surgery can improve much of the liver steatosis, inflammation, and fibrosis. However, it is not known whether there is reversal of the elastic fiber deposition process, triggered by hepatic damage and related to worse prognosis. Materials and Methods Individuals submitted to bariatric surgery at our institution, from March 2016 to June 2017, with intraoperative liver biopsy confirming NAFLD were approached. Those who consented were submitted to a second liver biopsy 1 year later and were included. Specimens were sliced and stained with hematoxylin-eosin and Sirius red for histological assessment according to Brunt’s criteria and with orcein for digital analysis morphometrics using ImageJ®. Quantification of elastic fibers was accomplished by corrected integrated density. Results Thirty-seven patients were included. Body mass index, metabolic markers, NAFLD activity score, and fibrosis improved 1 year after the procedure. The elastic fiber density showed a significant decrease: 239.3 × 103 absorbance micrometer2 (141.08– 645.32) to 74.62 × 103 absorbance micrometer2 (57.42–145.17), p = 0.007. Conclusion Liver elastic fiber density decreases with the reversal of NAFLD through weight loss. Keywords Obesity . Nonalcoholic fatty liver disease . Elastic fibers
Introduction * Carine Leite [email protected] 1
Graduate Program on Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
2
Graduate Program on Genetics and Molecular Biology, UFRGS, Porto Alegre, RS, Brazil
3
Department of Surgery, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil
4
School of Medicine, UFRGS, Porto Alegre, RS, Brazil
5
Department of Surgery, Hospital São Francisco de Paula, Pelotas, RS, Brazil
6
Division of Gastroenterology, HCPA, UFRGS, Porto Alegre, RS, Brazil
7
Department of Surgical Pathology, HCPA, UFRGS, Porto Alegre, RS, Brazil
NAFLD is a frequent disorder that affects approximately 25% of the worldwide population [1]. Half of the patients have obesity, which is the main risk factor [2]. Approximately 20% of patients with liver steatosis develop steatohepatitis, of which 15–20% will develop fibrosis, which increases the chance of cirrhosis and hepatocellular carcinoma [3]. The mainstay therapy for NAFLD is weight loss. Bariatric surgery has a great impact on this scope in obese subjects. A recent meta-analysis including differe
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