We evaluated patients from public and privative health care before and after bariatric surgery (pdf paper below). The presence or absence of advanced hepatic fibrosis was evaluated by NAFLD Fibrosis Score, a non-invasive method that uses age, BMI, AST/ALT ratio, albumin, platelet count and the presence or absence of hyperglycemia or diabetes. The characteristics of the two groups were compared.
Were analyzed 40 patients with a mean age of 34.6±9.5 years for private network and 40.6± 10.2 years for public. The study sample, 35% were treated at private health system and 65% in the public ones, 38% male and 62% female. Preoperatively in the private network one (7.1%) patient had advanced liver fibrosis and developed to the absence of liver fibrosis after surgery. In the public eight (30.8%) patients had advanced liver fibrosis preoperatively, and at one year after the proportion fell to six (23%).
The non-alcoholic fatty liver disease in its advanced form is more prevalent in obese patients treated in the public network than in the treated at the private network and bariatric surgery may be important therapeutic option in both populations.
Hi Ghanim Al-Khaledi. I as asking what you think about bariatric surgery as a therapeutic option to non-alcoholic fatty liver disease considering the paper attached.
Hi, Marco,
Thank You for sharing your paper with us.
Challenging the dogma of yesterday is the "Axioms" of today's medical "surgical" practice. in modern Evidence-Based Surgery, critical appraisal tools and criteria are in place to evaluate such evidence. " multiple sound clinical reports published correlates the favorable outcome of such strategy. https://www.ncbi.nlm.nih.gov/pmc/?term=Bariatric-Surgery+and+Non-Alcoholic+Fatty-Liver+Disease
Having said that, the question remains "what is the evidence?" and how to critically appraise such data to produce practical guidelines?
May I suggest first to start with the methodologies and metadata format,. A good start would be this guideline:
https://www.springer.com/gp/book/9783030051198
All best wishes.
Ghanim.
not only for advance fatty liver diseases but should bone for any patient have nonalcoholic fatty liver diseases and has BMI >40 with minim feature of NASH or F1-F2
Mohmmed Faris
I agree with you. No doubt the indications are broader than just non-alcoholic fatty liver disease.
Hi.
Great question.
If you would allow me, consider, hypothetically, perhaps another way to phrase the question : "If your mother was suffering from NAFLD, would you recommend bariatric surgery to her?"
From that perspective, it might be natural to simultaneously ask:
+ Is her alcohol consumption actually zero?
+ Is her soda consumption actually zero?
+ Have her attempts at time restricted feeding -- i.e, regularly going 14 hours or more with zero calories -- been rigorously verified?
+ Was she in compliance with the Prolong protocol (5 day fast mimicking diet {1000 cal/day w/o insulin triggering, once a month, x3 months in a row).
+ Does she feel safe and on track in the gym with the person training her to advance with resistance training (building type II fibers to fatigue)?
+ Is her diet very rich in polyphenols that act as pancreatic amylase inhibitors and fiber that binds sugar?
+ Is her omega3 to omega6 ratio high? (More salmon, less canola).
+ Is her diet devoid of all vegetable oil? , and rich in anti-inflammatory tumeric, clove, sulphorafane, ECGC, amla, ginseng, etc..
+ While not fasting, has she had experience with consuming zero processed carbs?
It could be the case that the mere process of answering the above could cause improvement, and the process of maximizing "Yes" responses could cause frank reversion (of NAFLD, and diabetes, and hypertension, and CVD and renal dysfunction, etc) to sub-clinical status.
No melodrama intended, but I would say yes, bariatric surgery should be considered, but so should my above.
P.S. Re "in its advanced form"... Depending on how advanced it is, high volume centers in the US sometimes have protocols of exclusion -- to reduce required surgical effort and to keep postoperative mortality statistics low, which might work out for the best with patients at greatest preoperative risk receiving treatment at better equipped centers.
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Marco Antonio Prado Nunes
Federal University of Sergipe
Hi Eric Klein. I loved your teasing.
I completely agree with you that lifestyle habits and simple clinical interventions, including an efficient approach to anxiety and minor mental disorders, would control much of our chronic illnesses.
What would require an approach carried out by a team of qualified professionals and working in a team in an interdisciplinary way would probably be much cheaper and more efficient.
I totally agree.
Would you have experience with this type of approach?
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Eric Klein
Obesityhelp Foundation
In Brazil the Fobi-Capella method (I knew both of them) really took off in the 1990s. With weight loss surgery it becomes apparent pretty quickly that aftercare followup is important. Dietitians, psychologists, etc. So, centers became interdisciplinary.
Two challenges to this included (1) patients seeking surgery as a magic bullet method of avoiding lifestyle change effort, and (2) clinical understanding of exercise and diet being flawed, leading to poor results even when successfully implemented. (For example, the war on fat caused (and still causes) significant worldwide death, while exercise protocols chronically underestimate the metabolic benefits of resistance training and high intensity intervals).
Here's a random presentation on bariatric team setup:
https://jnjinstitute.com/en-latam/online-profed-resources/resources/multidisciplinary-approach-bariatric-surgery-robin-blackstone-md
Glancing at
Article Ten-years of bariatric surgery in Brazil: in-hospital mortal...
I suspect one could look at correlations between RD and PhD visits -- if available in insurance databases -- on one hand and post-operative complication rates. Lifestyle interventions could easily render a majority of surgeries unnecessary, but they might -- depending on the intervention! -- also increase the success of surgeries and reduce the incidence of people having revision surgeries.
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