Insulin Resistance Predicts Steatosis and Fibrosis in Morbidly Obese Patients Undergoing Bariatric Surgery

Background: Influence of adipokines and insulin resistance on liver histology is an unclear area in morbidly obese patients. Objective: The aim of our study was to study the influence of insulin resistance and adipokines in the grade of liver steatosis and fibrosis in morbidly obese patients undergoing bariatric surgery. Setting: Tertiary hospital. Materials and Methods: A sample of 36 morbidly obese patients undergoing bariatric surgery was analyzed in a cross-sectional study. A liver biopsy was performed. Weights, basal glucose, insulin, insulin resistance (homeostasis model assessment for insulin resistance [HOMA-IR]), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and adipokine blood levels were measured. Results: Seventeen patients (47.2%) had low-grade steatosis, and 19 patients (52.8%) had high-grade steatosis. Sixteen patients (44.4%) did not have liver fibrosis, and 20 patients (56.6%) had liver fibrosis. Only insulin levels, HOMA-IR, and aspartate aminotransferase activity were higher in the patients with high-grade steatosis. Insulin levels and HOMA-IR were higher in patients with fibrosis. In the logistic regression analysis with a dependent dichotomous variable (grades of steatosis: low vs high), the HOMA-IR remained in the model, with an odds ratio to develop high-grade steatosis of 1.33 (95% confidence interval, 1.09-1.86). In the second logistic regression analysis with a dependent dichotomy variable (grades of fibrosis: present vs absent), the HOMA-IR remained in the model, with an odds ratio to develop fibrosis of 1.53 (95% confidence interval, 1.13-2.51). Conclusion: Insulin resistance determined with HOMA-IR model is associated with high-grade steatosis and liver fibrosis in obese patients before bariatric surgery.