Improvements in nonalcoholic fatty liver disease (NAFLD) after metabolic surgery is linked to an increased hepatic fatty acid oxidation-a case report.

Metabolic surgeries are regularly performed as a treatment for morbid obesity and have been shown to improve nonalcoholic fatty liver disease (NAFLD). The present case study aimed to evaluate the changes in hepatic fatty acid oxidation (FAO) before and 12-months after metabolic surgery in a patient who exhibited characteristics of NAFLD. A 34 year-old female with a body mass of 68.0 kg/m underwent metabolic surgery (sleeve gastrectomy) and a blood sample and liver biopsy were obtained at the time of surgery. All procedures occurred without incident. Liver tissue was scored histologically to determine the extent of NAFLD using the NAFLD Activity Score (NAS) and fibrosis staging (NAS =5; Fibrosis =1). A follow-up liver biopsy and a blood sample were obtained at 12 months when she had roux-en-Y gastric bypass (RYBG). Hepatic FAO in whole liver lysate and isolated mitochondria was measured ex vivo at baseline and at 12-month. At 12-month post-metabolic surgery, the patient had lost 19% of her body weight (BMI 68.0 to 55.2 kg/m), and she exhibited lower concentrations of fasting plasma glucose (-16%), triglycerides (TG) (-17%), HbA1c (-4%), aspartate transaminase (AST) (-39%), and alanine aminotransferase (ALT) (-42%). Liver fat was reduced by 18% as measured via FibroScan. FAO in whole liver samples and in isolated hepatic mitochondria increased 1.6- and 4.2-fold, respectively. Histologically, NAS and fibrosis scores were markedly improved at 12-month (NAS =0; Fibrosis =0). This case highlights the significant improvements in liver histology that can occur following metabolic surgery in conjunction with an increased capacity for hepatic FAO. Thus, metabolic surgery-induced weight loss may be an effective therapy to treat NAFLD, in part due to improvements in hepatic mitochondrial function. ClinicalTrials.gov Identifier: NCT03151798.