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Non-Alcoholic Fatty Liver Disease Is Associated with Impairment of Ejection Fraction Among Individuals with Obesity Undergoing Bariatric Surgery: Results of a Cross-Sectional Study

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Abstract

Background

The relationship between non-alcoholic fatty liver disease (NAFLD) and myocardial function seems to be more than just the effect of mutual metabolic risk factors.

Objective

To determine whether there is a significant association between NAFLD assessed by means of liver biopsy and left ventricular function expressed by the estimated ejection fraction among individuals with obesity.

Methods

This is a cross-sectional study which enrolled individuals who consecutively underwent bariatric surgery. NAFLD was assessed by means of liver biopsies which were systematically collected during the procedures. The estimated ejection fraction was obtained by means of transthoracic echocardiograms. The main outcome evaluated was a possible association between NAFLD features and ejection fraction. The results of liver biopsies and the respective degrees of severity of each NAFLD feature were also correlated with the ejection fraction and main anthropometric, biochemical, and clinical variables.

Results

Of 112 individuals, 86.6% were female and the mean age was 38.5 ± 9.3 years. It was observed that the average estimated ejection fraction (EEF) was significantly lower among individuals with liver fibrosis (67.6 ± 5.5% vs. 70.8 ± 4.9%, p = 0.008). After adjustment for confounding variables in a multivariate model, the degree of liver fibrosis was independently associated with the EEF (R = − 0.3, p = 0.02).

Conclusion

Among individuals with morbid obesity, the findings of this study are suggestive that liver fibrosis confirmed by histopathological examination is associated with a slight impairment of left ventricular function. Further studies are needed to confirm this association.

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Authors and Affiliations

  1. Department of Surgery; Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil

    Tiago Bezerra de Freitas Diniz, Rafael Nascimento de Jesus, Laísa Simakawa Jimenez, José Carlos Pareja, Elinton Adami Chaim & Everton Cazzo

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  1. Tiago Bezerra de Freitas Diniz
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  2. Rafael Nascimento de Jesus
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  3. Laísa Simakawa Jimenez
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  4. José Carlos Pareja
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  5. Elinton Adami Chaim
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  6. Everton Cazzo
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Correspondence to Everton Cazzo.

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

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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.

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de Freitas Diniz, T.B., de Jesus, R.N., Jimenez, L.S. et al. Non-Alcoholic Fatty Liver Disease Is Associated with Impairment of Ejection Fraction Among Individuals with Obesity Undergoing Bariatric Surgery: Results of a Cross-Sectional Study. OBES SURG 30, 456–460 (2020). https://doi.org/10.1007/s11695-019-04179-7

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  • DOI: https://doi.org/10.1007/s11695-019-04179-7

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