The Absence of Obstructive Sleep Apnea May Protect against Non-Alcoholic Fatty Liver in Patients Undergoing Bariatric Surgery

被引:14
作者
Corey, Kathleen E. [1 ,4 ]
Misdraji, Joseph [2 ]
Zheng, Hui [3 ,4 ]
Malecki, Kyle M. [1 ]
Kneeman, Jacob [1 ]
Gelrud, Louis [4 ,5 ]
Chung, Raymond T. [1 ,4 ]
机构
[1] Massachusetts Gen Hosp, Gastrointestinal Unit, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, MGH Biostat Ctr, Boston, MA 02114 USA
[4] Harvard Univ, Sch Med, Boston, MA USA
[5] Bon Secours Richmond Hlth Syst, Dept Internal Med, Richmond, VA USA
关键词
CHRONIC INTERMITTENT HYPOXIA; DISEASE; OBESE; STEATOHEPATITIS; RISK;
D O I
10.1371/journal.pone.0062504
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide and its progressive form, steatohepatitis, will be the leading indication for liver transplant by 2020. While risk factors for steatohepatitis have been identified, little work has been performed to identify factors protective against NAFLD development. Aim: This study sought to identify factors predictive of normal liver histology in a bariatric cohort. Methods: Patients undergoing weight loss surgery with liver biopsies at the time of surgery were included. Patients with other causes of chronic liver disease were excluded. Results: One hundred fifty-nine patients were included. Forty-nine patients had normal liver histology and 110 patients had NAFLD. Several previously identified factors associated with normal liver histology were found. Black race was the strongest predictor of the absence of NAFLD with an odds ratio (OR) of 6.8, 95% confidence interval (CI) 2.4-18.9. Low HOMA-IR was also associated with normal histology (OR 1.4, 95% CI 1.03-1.9). In contrast, low HDL was associated with a decreased chance of normal histology (OR 0.38, 95% CI 0.05-0.83). Interestingly, a novel protective factor, the absence of obstructive sleep apnea (OSA) was strongly associated with normal histology (OR 5.6, 95% CI 2.0-16.1). In multivariate regression controlling for BMI, black race, absence of OSA, low HOMA-IR and low ALT independently predicted normal liver histology with an area under the ROC curve of 0.85. Conclusions: Our study confirmed several factors associated with normal liver histology, including black race and identified a novel factor, absence of OSA. Further evaluation of these factors will allow for improved understanding of the pathogenesis of NAFLD.
引用
收藏
页数:5
相关论文
共 13 条
[1]   Chronic intermittent hypoxia is a major trigger for non-alcoholic fatty liver disease in morbid obese [J].
Aron-Wisnewsky, Judith ;
Minville, Caroline ;
Tordjman, Joan ;
Levy, Patrick ;
Bouillot, Jean-Luc ;
Basdevant, Arnaud ;
Bedossa, Pierre ;
Clement, Karine ;
Pepin, Jean-Louis .
JOURNAL OF HEPATOLOGY, 2012, 56 (01) :225-233
[2]   Cirrhosis and liver failure in nonalcoholic fatty liver disease: Molehill or mountain? [J].
Charlton, Michael .
HEPATOLOGY, 2008, 47 (05) :1431-1433
[3]  
Corey KE, 2012, CLIN GASTROENTEROL H
[4]   Suspected Nonalcoholic Fatty Liver Disease and Mortality Risk in a Population-Based Cohort Study [J].
Dunn, Winston ;
Xu, Ronghui ;
Wingard, Deborah L. ;
Rogers, Christopher ;
Angulo, Paul ;
Younossi, Zobair M. ;
Schwimmer, Jeffrey B. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2008, 103 (09) :2263-2271
[5]   Nonalcoholic fatty liver disease in severely obese subjects [J].
Gholam, Pierre M. ;
Flancbaum, Louis ;
Machan, Jason T. ;
Charney, Douglas A. ;
Kotler, Donald P. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2007, 102 (02) :399-408
[6]   Recent advances in nonalcholic fatty liver disease [J].
Greenfield, Victoria ;
Cheung, Onpan ;
Sanyal, Arun J. .
CURRENT OPINION IN GASTROENTEROLOGY, 2008, 24 (03) :320-327
[7]   Non-alcoholic steatohepatitis in type 2 diabetes mellitus [J].
Gupte, P ;
Amarapurkar, D ;
Agal, S ;
Baijal, R ;
Kulshrestha, P ;
Pramanik, S ;
Patel, N ;
Madan, A ;
Amarapurkar, A ;
Hafeezunnisa .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2004, 19 (08) :854-858
[8]   Design and validation of a histological scoring system for nonalcoholic fatty liver disease [J].
Kleiner, DE ;
Brunt, EM ;
Van Natta, M ;
Behling, C ;
Contos, MJ ;
Cummings, OW ;
Ferrell, LD ;
Liu, YC ;
Torbenson, MS ;
Unalp-Arida, A ;
Yeh, M ;
McCullough, AJ ;
Sanyal, AJ .
HEPATOLOGY, 2005, 41 (06) :1313-1321
[9]   Hepatic histology in obese patients undergoing bariatric surgery [J].
Machado, Mariana ;
Marques-Vidal, Pedro ;
Cortez-Pinto, Helena .
JOURNAL OF HEPATOLOGY, 2006, 45 (04) :600-606
[10]   Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea [J].
Norman, Daniel ;
Bardwell, Wayne A. ;
Arosemena, Farah ;
Nelesen, Richard ;
Mills, Paul J. ;
Loredo, Jose S. ;
Lavine, Joel E. ;
Dimsdale, Joel E. .
SLEEP, 2008, 31 (01) :121-126