Obesity and Liver Disease

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Obesity is a multisystem disease that can almost affect any body system with no exception.

The management of obesity (as a disease per say) or its long-term risks and related disorders mandates every specialty within the medical field to be involved directly or indirectly.

The subject of the relation between obe­sity and liver disease is well-reviewed in the literature, with Nonalcoholic fatty liver disease (NAFLD) and its advanced stages of nonalcoholic steatohepatitis (NASH) and fi­brosis as the commonest related problem. NAFLD is more common in obese patients with a prevalence of about 90% in comparison to 3% to 14% in the general population.

In those 90% of the obese patients group, 25% to 55% have NASH, 34% to 47% have fi­brosis, and 2% to 12% have bridging fibrosis or cirrhosis.

NAFLD in obese patients has a faster pro­gression compared to non-obese patients, if the underlying increase in weight persists. On the other hand, substantial weight loss is accompanied by a marked attenuation of insulin resistance and related metabolic syn­dromes including NAFLD.

When we look at the progression of dia­betes management through bariatric Sur­gery and the success it achieves to the point where it becomes one of the strongest indication for bariatric Surgery should raise the questions: should the presence of NAFLD be an indication for bariatric surgery even in the absence of other metabolic disease? And should patients who progress into end stage liver disease that requires liver transplant be subjected to bariatric surgery before they proceed to liver transplant (as there is a high risk of post-transplant recurrence)?

Knowing these devastating outcomes of the advance stage of NAFLD and the limited treat­ments options which include mainly diet and weight reduction, bariatric surgeons should be included earlier as part of the multidisciplinary team caring for those patients.

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