Journal of Isfahan Medical School

Journal of Isfahan Medical School

Investigating the Diagnostic Value of Albumin in Predicting the Improvement of Non-Alcoholic Fatty Liver Disease in Patients Undergoing Bariatric Surgery

Document Type : Original Article (s)

Authors
Behrooz Keleidari 1
Mehdi Rabiei 2
1 Associate Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v43.i820.0695
Abstract
Background: Considering the importance of the diagnostic value of albumin in predicting the recovery of non-alcoholic fatty liver disease (NAFLD), this study was conducted with the aim of determining the diagnostic value of serum albumin in the recovery of NAFLD in patients with fatty liver undergoing bariatric surgery.
Methods: In this prospective study, 112 patients undergoing bariatric surgery were subjected to intraoperative liver biopsy to determine the presence of fatty liver disease. Serum albumin levels and fatty liver status were determined by ultrasound before and 1, 3 and 6 months after the operation. The amount of changes in serum albumin level in two groups with and without fatty liver disease and the diagnostic value criteria of albumin for predicting NAFLD were determined using the liver biopsy results as the reference. Data were analyzed using statistical tests.
Findings: Liver biopsy confirmed that 48.2% of the patients had fatty liver. The mean serum albumin level was 4.53 ± 0.77 before the operation and 3.31 ± 0.65 mg/dL six months after the operation and decreased by 25.53 ± 15.5 percent. The percentage decrease in albumin level in patients with fatty liver was 17.67±13% in patients with fatty liver and 33.97 ± 13.6% in the non-affected group (P < 0.001). According to the ROC curve findings, the albumin cut-off point for predicting fatty liver was 3.5 mg/dL, and according to it, the albumin level had a sensitivity of 98.1%, a specificity of 37.9%, a positive predictive value of 59.6%, and a negative predictive value of 95.7%.
Conclusion: Serum albumin levels in obese patients can be used as a preliminary test to determine the grade of fatty liver and also to determine the recovery status of fatty liver after surgery.

Highlights

Behrooz Keleidari: Google Scholar 

Keywords
Bariatric
Albumin
Fatty liver
Non-alcoholic
Subjects
  1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346(16): 1221-31.
  2. Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis. JAMA 2003; 289(22): 3000-4.
  3. Collantes R, Ong JP, Younossi ZM. Nonalcoholic fatty liver disease and the epidemic of obesity. Cleve Clin J Med 2004; 71(8): 657-64.
  4. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology (Baltimore, Md) 2004; 40(6): 1387-95.
  5. Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol 1999; 94(4): 1018-22.
  6. Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991; 43(1): 26-31.
  7. Lakka TA, Laaksonen DE. Physical activity in prevention and treatment of the metabolic syndrome. Appl Physiol Nutr Metab 2007; 32(1): 76-88.
  8. Clark JM, Brancati FL, Diehl AM. The prevalence and

    etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003; 98(5): 960-7.
  9. Garg A, Helderman JH, Koffler M, Ayuso R, Rosenstock J, Raskin P. Relationship between lipoprotein levels and in vivo insulin action in normal young white men. Metabolism 1988; 37(10): 982-7.
  10. Garg A. Insulin resistance in the pathogenesis of dyslipidemia. Diabetes Care 1996; 19(4): 387-9.
  11. Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2008; 6(12): 1396-402.
  12. Mathurin P, Hollebecque A, Arnalsteen L, Buob D, Leteurtre E, Caiazzo R, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology 2009; 137(2): 532-40.
  13. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30(6): 1356-62.
  14. Serra A, Granada M, Romero R, Bayés B, Cantón A, Bonet J, et al. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Clin Nutr 2006; 25(3): 400-8.
  15. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med 2014; 370(21): 2002-13.
  16. Tahrani AA, Bailey CJ, Del Prato S, Barnett AH. Management of type 2 diabetes: new and future developments in treatment. Lancet 2011; 378(9786): 182-97.
  17. Deng Y, Pang Q, Miao R-C, Chen W, Zhou Y-Y, Bi J-B, et al. Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma. Onco Targets Ther 2016; 9: 5317-28.
Journal of Isfahan Medical School
Volume 43, Issue 820
4th Week, August
July and August 2025
Pages 695-702

  • Receive Date 17 June 2025
  • Accept Date 19 July 2025