Purpose: In obesity, a cluster of metabolic alterations (Metabolic Syndrome, MS) is often associated with Fatty Liver (FL). The bright liver at abdominal ultrasonography (US) and, in most cases, increased levels of hepatic enzymes, alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT), are considered the hallmarks of Nonalcoholic Fatty Liver Disease (NAFLD) in obese patients. Insulin resistance (IR) is the main link among obesity, FL and MS. Bioenterics Intragastric Balloon (BIB, Inamed Health, Santa Barbara, Ca., USA) is considered a safe procedure to prepare patients to the bariatric surgery. The aim was to evaluate if the weight loss induced by BIB can improve both IR and liver enzymes. Methods: From March 2003 through April 2007 in our digestive endoscopy service, 100 patients (F 65; age 20-63 yrs) with obesity and severe obesity (BMI 32-62) underwent BIB insertion. The BIB was placed under endoscopic control and removed 6 months later. US, clinical and routine laboratory investigations were performed before and after BIB. IR was calculated by the Homeostasis Model Assessment (HOMA-IR), as fasting serum insulin ( U/ml) x fasting plasma glucose (mmol/l)/22.5; values >2.5 indicate a state of IR. Exclusion criteria: HBV(+), HCV(+), alcohol consumption >20g/day, known drugs in the history. Results: BMI decreased significantly after BIB (42.7 5.6 vs. 38.4 5.3; p<.001). BMI reduction higher than 10% ( BMI>10%) was observed in 50 patients (pts.). US showed FL in the majority (70%). In FL pts. ALT U/L (48.8 46.5 vs. 31.1 26.9) and GGT U/L (41.5 38.9 vs. 29.5 20.9) significantly decreased after treatment (p<.01). In 30% pts. without FL at US (noFL), both ALT and GGT ranged normally before and after BIB. HOMA-IR basal values >2.5 were recorded in 86% FL and in 74% noFL pts. Values significantly decreased after treatment both in FL (6.03 4.47 vs. 4.21 3.35; p<0.05), and in noFL pts. (4.71 2.62 vs 2.89 1.39; p<.001). FL and noFL pts. with BMI<10%, HOMA-IR, ALT, GGT values did not significantly change after BIB. Before BIB in FL pts. a weak correlation (r=0.37) was found between GGT and HOMA-IR values. Hypertriglyceridemia in 42.3%, HDL cholesterol levels <40mg/dL in 32.4% did not significantly change after BIB. Conclusion: Weight loss induced by intragrastric balloon reduces IR. The ALT and GGT decrease suggests an improvement of hepatic lobular inflammation. The benefit depends on a decrease of BMI higher than 10%. We confirm the pivotal role of IR in FL.
Can metabolic and hepatic abnormalities be improved by intragastric balloon treatment for obesity?
RICCI, Giorgio;
2007
Abstract
Purpose: In obesity, a cluster of metabolic alterations (Metabolic Syndrome, MS) is often associated with Fatty Liver (FL). The bright liver at abdominal ultrasonography (US) and, in most cases, increased levels of hepatic enzymes, alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT), are considered the hallmarks of Nonalcoholic Fatty Liver Disease (NAFLD) in obese patients. Insulin resistance (IR) is the main link among obesity, FL and MS. Bioenterics Intragastric Balloon (BIB, Inamed Health, Santa Barbara, Ca., USA) is considered a safe procedure to prepare patients to the bariatric surgery. The aim was to evaluate if the weight loss induced by BIB can improve both IR and liver enzymes. Methods: From March 2003 through April 2007 in our digestive endoscopy service, 100 patients (F 65; age 20-63 yrs) with obesity and severe obesity (BMI 32-62) underwent BIB insertion. The BIB was placed under endoscopic control and removed 6 months later. US, clinical and routine laboratory investigations were performed before and after BIB. IR was calculated by the Homeostasis Model Assessment (HOMA-IR), as fasting serum insulin ( U/ml) x fasting plasma glucose (mmol/l)/22.5; values >2.5 indicate a state of IR. Exclusion criteria: HBV(+), HCV(+), alcohol consumption >20g/day, known drugs in the history. Results: BMI decreased significantly after BIB (42.7 5.6 vs. 38.4 5.3; p<.001). BMI reduction higher than 10% ( BMI>10%) was observed in 50 patients (pts.). US showed FL in the majority (70%). In FL pts. ALT U/L (48.8 46.5 vs. 31.1 26.9) and GGT U/L (41.5 38.9 vs. 29.5 20.9) significantly decreased after treatment (p<.01). In 30% pts. without FL at US (noFL), both ALT and GGT ranged normally before and after BIB. HOMA-IR basal values >2.5 were recorded in 86% FL and in 74% noFL pts. Values significantly decreased after treatment both in FL (6.03 4.47 vs. 4.21 3.35; p<0.05), and in noFL pts. (4.71 2.62 vs 2.89 1.39; p<.001). FL and noFL pts. with BMI<10%, HOMA-IR, ALT, GGT values did not significantly change after BIB. Before BIB in FL pts. a weak correlation (r=0.37) was found between GGT and HOMA-IR values. Hypertriglyceridemia in 42.3%, HDL cholesterol levels <40mg/dL in 32.4% did not significantly change after BIB. Conclusion: Weight loss induced by intragrastric balloon reduces IR. The ALT and GGT decrease suggests an improvement of hepatic lobular inflammation. The benefit depends on a decrease of BMI higher than 10%. We confirm the pivotal role of IR in FL.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
