Obesity Surgery

, Volume 29, Issue 3, pp 1012–1014 | Cite as

Crashing NASH in Patients Listed for Bariatric Surgery

  • T. J. I. De Munck
  • P. L. M. Verhaegh
  • J. Verbeek
  • J. Verheij
  • J. W. Greve
  • D. M. A. E. Jonkers
  • A. A. M. Masclee
  • G. H. KoekEmail author
Letter to the Editor
We read with great interest the publication of Ooi et al. describing the prevalence of NAFLD and NASH in a bariatric population [ 1]. They discussed the fact that there is a large variation in NASH prevalence in bariatric studies ranging from 7.3 to 56%. In their cohort, they found a NASH prevalence of 17.1%, which was lower than expected based on previous literature. This lower than expected NASH prevalence was in line with our observation. We intraoperatively collected liver needle and wedge biopsies from 20 obese patients undergoing bariatric surgery (Table 1). Patients with significant alcohol use (> 14 standard beverages a week for men and > 7 for women), secondary causes of hepatic fat accumulation, and chronic inflammatory diseases other than NASH were excluded. Strikingly, NASH, defined as the combined presence of steatosis, lobular inflammation, and hepatocyte ballooning, was not present in any of our obese patients, and the maximal NAFLD activity score was only 3 (Table 2).


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ooi GJ, Burton PR, Bayliss J, et al. Effect of body mass index, metabolic health and adipose tissue inflammation on the severity of non-alcoholic fatty liver disease in bariatric surgical patients: a prospective study. Obes Surg. 2018;
  2. 2.
    Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21(3):345–50.CrossRefGoogle Scholar
  3. 3.
    Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–78.e5. quiz e14–5CrossRefGoogle Scholar
  4. 4.
    Brunt EM. Nonalcoholic fatty liver disease: pros and cons of histologic systems of evaluation. Int J Mol Sci. 2016;17(1):97.CrossRefGoogle Scholar
  5. 5.
    Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065–83.CrossRefGoogle Scholar
  6. 6.
    Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis. 2011;7(6):760–7.CrossRefGoogle Scholar
  7. 7.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(0 1):S1–27.CrossRefGoogle Scholar
  8. 8.
    Bourne R, Tweedie J, Pelly F. Preoperative nutritional management of bariatric patients in Australia: the current practice of dietitians. Nutr Diet. 2018;75(3):316–23.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Division of Gastroenterology and HepatologyMaastricht University Medical CentreMaastrichtThe Netherlands
  2. 2.School of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
  3. 3.Department of PathologyAmsterdam University Medical CenterAmsterdamThe Netherlands
  4. 4.Department of SurgeryHeerlenThe Netherlands
  5. 5.Department of Visceral and Transplantation SurgeryKlinikum RWTHAachenGermany

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