Elsevier

Surgery

Volume 154, Issue 5, November 2013, Pages 1031-1037
Surgery

Original Communication
Short-term preoperative diet modification reduces steatosis and blood loss in patients undergoing liver resection

https://doi.org/10.1016/j.surg.2013.04.012Get rights and content

Background

Steatosis and steatohepatitis have been associated with increased morbidity and mortality after liver resection. Our objective was to determine the effect of a preoperative calorie-restricted diet on steatosis and steatohepatitis in patients undergoing liver resection.

Methods

We studied 111 consecutive patients who had major elective hepatic resections. More than 90% of the patients had cancer resections. The mean body mass index was 27.2; 32% had a body mass index ≥30. A week-long calorie- and fat-restricted diet was instituted in the most recent patient group (n = 51). We retrospectively evaluated steatosis and steatohepatitis in the diet and no-diet control groups. Clinical outcomes of the 2 groups, including complications and blood loss, were compared.

Results

The preoperative diet patients had less steatosis (15.7% vs 25.5% of hepatocytes containing fat, P = .05) than the nondiet controls. A lower percentage of patients in the diet group had steatohepatitis than in the nondiet group (15% vs 27%, P =.02). Preoperative diet patients had less mean intraoperative blood loss than nondiet patients (600 mL vs 906 mL, P = .002). There was no difference in overall or infectious complications between the groups.

Conclusion

We have shown for the first time that short-term calorie restriction before liver resection significantly reduces both hepatic steatosis and steatohepatitis. Dietary modification also was associated with decreased intraoperative blood loss. This intervention is easily instituted; therefore, it is clinically feasible.

Section snippets

Methods

This study was approved by the Dartmouth Committee for the Protection of Human Subjects, study 22273. We retrospectively evaluated steatosis and steatohepatitis in all patients who underwent major hepatic resection by a single surgeon (R.J.B.) between June 2005 and March 2012. The most recent group of 51 patients was given explicit written dietary instructions by their surgeon and were requested to follow the diet at home for 1 week before resection; the 60 control patients were not given any

Results

We observed that steatosis and steatohepatitis were common in the control group: mild hepatic steatosis was present in 43% of the patients, moderate or severe hepatic steatosis was present in 33%, and steatohepatitis (NAS ≥ 4) was present in 27% (Table III). Steatosis and steatohepatitis were less common in the 21 control patients with BMI <25: only 19% of patients in this subset had moderate or severe steatosis, and only 10% had steatohepatitis. In contrast, 42% of the subset of patients with

Discussion

To the best of our knowledge, our study is the first to demonstrate histologically that a short-term, low-calorie diet as the sole intervention can result in decreased hepatic steatosis and steatohepatitis. The nonrandomized design of this study may lead one to question whether factors other than the preoperative diet were responsible for these observed differences in steatosis and steatohepatitis. We believe that this is very unlikely. In linear regression analysis, the only factor other than

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