Predictors of Nonalcoholic Steatohepatitis Severity in Obese Patients Undergoing Bariatric Surgery: A Cross-Sectional Study

Gabriel De La Cruz-Ku, Alba Zevallos, César Ramón Rázuri-Bustamante, Sasank Kalipatnapu, Fortunato S. Príncipe-Meneses, Paola Dongo, Diego Chambergo-Michilot, Gustavo Salinas-Sedo, Bryan Valcarcel

Research output: Contribution to journalArticlepeer-review


Background: Nonalcoholic steatohepatitis (NASH) currently affects 3-5% of the general population and 10-50% of patients with obesity. Our aim was to determine the predictors of severity of NASH in patients with obesity undergoing sleeve gastrectomy. Methods: We conducted a retrospective study in patients with obesity who underwent sleeve gastrectomy from 2013 to 2016. Liver biopsy at the time of the surgery showed a histological grade of NASH in all the patients. Patients were stratified into two groups, mild and moderate-severe (MS) NASH. Predictors were evaluated with multivariate logistic regression. Results: We included 193 patients. Of these, 139 had mild, 22 moderate, and 36 severe NASH. Majority of patients were female (54.8%) and the mean body mass index was 40.30±2.19kg/m2. In the adjusted regression model, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (prevalence ratios [PR]: 1.06, confidence interval [95% CI]: 1.02-1.10) and alanine aminotransferase (ALT) (PR: 1.01, 95% CI: 1.00-1.01) were factors associated with MS NASH. Conclusions: Despite the high prevalence of NASH in the obese population, most patients presented mild severity. A higher severity of NASH among patients with obesity can be predicted by clinical abnormalities such as higher HOMA-IR and ALT levels. Higher HOMA-IR levels are potential predictors of MS NASH regardless of insulin resistance status and in patients without metabolic syndrome.

Original languageEnglish
Pages (from-to)218-224
Number of pages7
JournalBariatric Surgical Practice and Patient Care
Issue number4
StatePublished - 1 Dec 2023


  • bariatric surgery
  • obesity
  • sleeve gastrectomy
  • steatohepatitis


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