Obesity Surgery

, Volume 29, Issue 1, pp 99–108 | Cite as

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

  • Geraldine J. OoiEmail author
  • Paul R. Burton
  • Jacqueline Bayliss
  • Arthe Raajendiran
  • Arul Earnest
  • Cheryl Laurie
  • William W. Kemp
  • Catriona A. McLean
  • Stuart K. Roberts
  • Matthew J. Watt
  • Wendy A. Brown
Original Contributions



Non-alcoholic fatty liver disease (NAFLD), driven by the obesity epidemic, has become the most common form of liver disease. Despite this, there is controversy regarding the prevalence and severity of NAFLD in obesity. Obesity-related factors, such as increasing adiposity, metabolic disease and inflammation, may influence prevalence. We therefore prospectively measured NAFLD prevalence in obesity and studied factors associated with NAFLD.

Materials and methods

We recruited consecutive bariatric patients. Intraoperative liver biopsies were taken. The liver, adipose tissue and serum were collected to measure inflammation. Adipocyte cell size was measured. NAFLD severity was correlated to body mass index (BMI), metabolic health and adipose characteristics.


There were 216 participants; BMI 45.9 ± 8.9 kg/m2, age 44.4 ± 12.1 years, 75.5% female. Overall NAFLD prevalence was 74.1%, with 17.1% having non-alcoholic steatohepatitis (NASH) and/or steatofibrosis. Odds of NASH/steatofibrosis increased independently with BMI category (odds ratio (OR) 2.28–3.46, all p < 0.05) and metabolic disease (OR 3.79, p = 0.003). These odds markedly increased when both super obesity (BMI > 50) and metabolic disease were present (OR 9.71, p < 0.001). NASH/steatofibrosis prevalence was significantly greater with diabetes, hypertension and dyslipidemia. Although greater visceral adipocyte hypertrophy was evident in NASH/steatofibrosis, there was no significant association between adipose inflammation and NASH/steatofibrosis.


NAFLD remains endemic in obesity; however, NASH/steatofibrosis are less common than previously reported. Worsening obesity and metabolic disease increase odds of NAFLD independently, with substantially compounded effect with both. These observations may help with risk stratification in obese populations. We were unable to delineate clear associations between adipose inflammation and NASH/steatofibrosis in this obese population.

Trial Registration

Australian Clinical Trials Registry (ACTRN12615000875505).


Bariatric surgery Obesity Non-alcoholic fatty liver disease Metabolic syndrome Inflammation 


Compliance with Ethical Standards

Ethics approval was obtained (Alfred (195/15), Avenue (190) and Cabrini (09-31-08-15) Human Research Ethics Committees).

Conflict of Interest

GJO, PRB, CL and WAB report being affiliated with the Centre for Obesity Research and Education. The Centre has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand™. The grant is not tied to any specific research project, and neither Allergan nor Apollo Endosurgery have control of the protocol, analysis and reporting of any studies. The Centre also receives a grant from Applied Medical towards educational programs.

WB reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore and Applied Medical. Since initial submission of this paper, she has also received a speaker’s honorarium from Merck Sharpe and Dohme and a speaker’s honorarium and fees from participation in a scientific advisory board from Novo Nordisk. The Bariatric Registry and the honorariums are outside of the submitted work.

GJO reports scholarships from the NHMRC and the Royal Australasian College of Surgeons.

MJW is supported by a Senior Research Fellowship from the NHMRC (APP1077703).

The remaining authors have no other disclosures or conflict of interest.

Ethical Approval Statement

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.

Supplementary material

11695_2018_3479_MOESM1_ESM.docx (896 kb)
ESM 1 (DOCX 896 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Geraldine J. Ooi
    • 1
    • 2
    Email author return OK on get
  • Paul R. Burton
    • 1
    • 2
  • Jacqueline Bayliss
    • 3
    • 4
  • Arthe Raajendiran
    • 3
    • 4
  • Arul Earnest
    • 5
  • Cheryl Laurie
    • 1
    • 2
  • William W. Kemp
    • 6
  • Catriona A. McLean
    • 7
  • Stuart K. Roberts
    • 6
  • Matthew J. Watt
    • 3
    • 4
  • Wendy A. Brown
    • 1
    • 2
  1. 1.Centre for Obesity Research and Education, Central Clinical SchoolMonash UniversityMelbourneAustralia
  2. 2.Department of General SurgeryThe Alfred HospitalMelbourneAustralia
  3. 3.Department of Physiology, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonAustralia
  4. 4.Department of Physiology, School of Biomedical SciencesMelbourne UniversityParkvilleAustralia
  5. 5.Biostatistics, School of Public Health and Preventative MedicineMonash UniversityMelbourneAustralia
  6. 6.Department of GastroenterologyThe Alfred HospitalMelbourneAustralia
  7. 7.Department of Anatomical PathologyThe Alfred HospitalMelbourneAustralia

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