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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Bertrand HANSLIK
Coup de coeur :
 
 
Gut
  2017/09  
 
  2017 Sep;66(9):1688-1696  
  doi: 10.1136/gutjnl-2016-312238  
 
  Systematic review of bariatric surgery liver biopsies clarifies the natural history of liver disease in patients with severe obesity.  
 
  Bedossa P, Tordjman J, Aron-Wisnewsky J, Poitou C, Oppert JM, Torcivia A, Bouillot JL, Paradis V, Ratziu V, Clément K  
  http://gut.bmj.com/content/early/2016/11/24/gutjnl-2016-312238  
 
 
Abstract
Objective Non-alcoholic fatty liver disease (NAFLD) is a frequent complication of morbid obesity, but its severity varies greatly and thus there is a strong need to better define its natural history in these patients.
Design Liver biopsies were systematically performed in 798 consecutive patients with severe obesity undergoing bariatric surgery. Histology was compared with clinical, biological, anthropometrical and body composition characteristics.
Results Patients with presumably normal liver (n=179, 22%) were significantly younger at bariatric surgery than patients with NAFLD (37.0 vs 44.4 years, p<0.0001). However, both groups showed quite similar obesity duration, since patients with presumably normal liver reported the onset of obesity at a significantly younger age than those with NAFLD (14.8 vs 20.0 year, p<0.0001). The trunk/limb fat mass ratio increased according to liver disease severity (presumably normal liver: 1.00, steatosis: 1.21, non-alcoholic steatohepatitis (NASH): 1.34, p<0.0001), although the total body fat mass decreased (presumably normal liver: 50%, steatosis: 49.1%, NASH: 47.4%, p<0.0001). The volume of subcutaneous adipocytes increased according to severity of liver disease but only in female patients (presumably normal liver: 8543 picolitres, steatosis: 9156 picolitres, NASH: 9996 picolitres).
Conclusions These results suggest that young adults are more prone to store fat in subcutaneous tissue and reach the threshold of bariatric surgery indication before their liver is damaged. A shift of fat storage from subcutaneous to visceral adipose tissue compartment is associated with liver damages. Liver might also be targeted by subcutaneous hypertrophic adipocytes in females since hypertrophic adipocytes are more exposed to lipolysis and to the production of inflammatory mediators.
 
Question posée
 
Apprécier l’histoire naturelle de la stéatopathie métabolique chez le patient obèse sévère.
 
Question posée
 
Le jeune stocke la graisse plus souvent en sous-cutané et a moins de lésions hépatiques, qui augmentent avec le ratio tronc/membres de la masse grasse. L’hypertrophie adipocytaire sous cutanée est associée à des lésions hépatiques plus fréquentes chez la femme.
 
Commentaires

Une raison supplémentaire de lutter dès le plus jeune âge contre l’obésité et ses causes.

 
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