Context: Non-alcoholic steatohepatitis(NASH)is considered as the hepatic counterpart of the metabolic syndrome. Objective: To investigate the determinants of NASH reversal in patients undergoing biliopancreatic diversion(BPD)in a 5-year follow-up study. Design: Prospective Study, Policlinico Universitario Agostino Gemelli. Participants: 37 patients underwent fine-needle liver biopsy during BPD. Nine of them had a negative liver biopsy for NASH and were excluded. Ultrasonography-guided percutaneous liver biopsy was obtained at 5 years after operation. Intervention: Biliopancreatic Diversion and liver biopsy. Main outcome measures: The primary outcome of our study was histologic NASH reversal, at 5-years follow-up. To better characterize the clinical variables involved in the resolution of NASH, we also compared patients without histologic NASH resolution at 5 years, with those in whom NASH had disappeared. Results: At follow-up, NASH reversed in 56.5% of the patients. NAFLD Activity-Score(NAS)improved from 3.33±1.15 to 1.84±1.10(P<0.0001).Fibrosis reversed in 16% of the patients(P=0.022)and in 32% improved(95% CI, 0.05-0.54).No significant differences in BMI or clinical parameters changes explained the effect of surgery on NASH, apart from the measure insulin sensitivity post-surgery. HOMA-IR decreased from 3.31±1.72 at baseline to 1.73±1.08(P<0.0001)after BPD and Matsuda index improved from 2.66±1.79 to 4.73±3.05(P<0.0001).Lipid profile normalized(total-cholesterol from 4.75±1.18 to 3.32±0.77mmol/l, P<0.0001; LDL-cholesterol from 2.92±0.91 to 1.60±0.51mmol/l, P=0.0001; HDL-cholesterol from 0.97±0.33 to 1.10±0.35mmol/l, P=0.023; triglycerides from 2.52±1.6 to 1.47±0.67 mmol/l, P=0.003).Neural network analysis showed that end-study Matsuda index discriminated between responders and non-responders with high accuracy[receiver operating characteristic curve(ROC)area-under-the curve(AUC)0.98%]. Conclusion: Remission of NASH is driven by reversal of whole-body insulin resistance post-intervention.

Russo, M. F., Lembo, E., Mari, A., Angelini, G., Verrastro, O., Nanni, G., Pompili, M., Raffaelli, M., Vecchio, F. M., Bornstein, S. R., Mingrone, G., Insulin resistance is central to long-term reversal of histologic non-alcoholic steatohepatitis after metabolic surgery, <<THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM>>, 2020; (Nov28): 1-12. [doi:10.1210/clinem/dgaa892] [http://hdl.handle.net/10807/167598]

Insulin resistance is central to long-term reversal of histologic non-alcoholic steatohepatitis after metabolic surgery

Russo, Maria Francesca;Lembo, Erminia;Angelini, Giulia;Verrastro, Ornella;Nanni, Giuseppe;Pompili, Maurizio;Raffaelli, Marco;Vecchio, Fabio Maria;Mingrone, Geltrude
2020

Abstract

Context: Non-alcoholic steatohepatitis(NASH)is considered as the hepatic counterpart of the metabolic syndrome. Objective: To investigate the determinants of NASH reversal in patients undergoing biliopancreatic diversion(BPD)in a 5-year follow-up study. Design: Prospective Study, Policlinico Universitario Agostino Gemelli. Participants: 37 patients underwent fine-needle liver biopsy during BPD. Nine of them had a negative liver biopsy for NASH and were excluded. Ultrasonography-guided percutaneous liver biopsy was obtained at 5 years after operation. Intervention: Biliopancreatic Diversion and liver biopsy. Main outcome measures: The primary outcome of our study was histologic NASH reversal, at 5-years follow-up. To better characterize the clinical variables involved in the resolution of NASH, we also compared patients without histologic NASH resolution at 5 years, with those in whom NASH had disappeared. Results: At follow-up, NASH reversed in 56.5% of the patients. NAFLD Activity-Score(NAS)improved from 3.33±1.15 to 1.84±1.10(P<0.0001).Fibrosis reversed in 16% of the patients(P=0.022)and in 32% improved(95% CI, 0.05-0.54).No significant differences in BMI or clinical parameters changes explained the effect of surgery on NASH, apart from the measure insulin sensitivity post-surgery. HOMA-IR decreased from 3.31±1.72 at baseline to 1.73±1.08(P<0.0001)after BPD and Matsuda index improved from 2.66±1.79 to 4.73±3.05(P<0.0001).Lipid profile normalized(total-cholesterol from 4.75±1.18 to 3.32±0.77mmol/l, P<0.0001; LDL-cholesterol from 2.92±0.91 to 1.60±0.51mmol/l, P=0.0001; HDL-cholesterol from 0.97±0.33 to 1.10±0.35mmol/l, P=0.023; triglycerides from 2.52±1.6 to 1.47±0.67 mmol/l, P=0.003).Neural network analysis showed that end-study Matsuda index discriminated between responders and non-responders with high accuracy[receiver operating characteristic curve(ROC)area-under-the curve(AUC)0.98%]. Conclusion: Remission of NASH is driven by reversal of whole-body insulin resistance post-intervention.
Inglese
Russo, M. F., Lembo, E., Mari, A., Angelini, G., Verrastro, O., Nanni, G., Pompili, M., Raffaelli, M., Vecchio, F. M., Bornstein, S. R., Mingrone, G., Insulin resistance is central to long-term reversal of histologic non-alcoholic steatohepatitis after metabolic surgery, <<THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM>>, 2020; (Nov28): 1-12. [doi:10.1210/clinem/dgaa892] [http://hdl.handle.net/10807/167598]
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