1293 FACTORS AFFECTING SEVERITY OF FATTY LIVER DISEASE IN PATIENTS UNDERGOING LAPAROSCOPIC GASTRIC BANDING (LAGB) SURGERY FOR OBESITY

POSTERS Results: 61.5% of OSA patients exhibited advanced steatosis as defined by a Steatotest® ≥S2. By multivariate analysis, triglycerides (p < 0.0001), insulin resistance (HOMA >3 (p = 0.0004)) and intermittent hypoxia as measured by cumulative time spent <90% of SaO2 (CT90) (p = 0.01) were independent factors for liver steatosis. 38% of OSA displayed possible or probable NASH (N1 or N2 with NASHtest® ). In univariate analysis, CT90 was significantly associated with NASH (p = 0.035) but this became non significant in multivariate analysis. Endothelial function was more impaired in OSA patients with advanced steatosis (p = 0.04) and possible or probable NASH (p = 0.013). Office systolic blood pressure was also significantly more elevated in those with advanced steatosis and possible or probable NASH (p = 0.01 and p = 0.004, respectively). Discussion and Conclusion: In a large unselected population of OSA patients, the severity of intermittent hypoxia was independently associated with steatosis. Endothelial dysfunction was more severely impaired in OSA patients demonstrating NAFLD. This is the first demonstration of the involvement of this mechanism in cardiovascular consequences of OSA. The interest of a systematic evaluation by non invasive biomarkers of NAFLD in severe OSA patients deserves further studies. 1292 GILBERT’S SYNDROME AND NASH: A PROTECTIVE EFFECT OF UNCONJUGATED HYPERBILIRUBINEMIA M. Hjelkrem1 , A. Morales2 , C. Williams1 , S.A. Harrison1 . 1 Gastroenterology and Hepatology, 2 Internal Medicine, Brooke Army Medical Center, San Antonio, TX, USA E-mail: [email protected] Background and Aims: It has been recognized that unconjugated bilirubin contains hepatic anti-fibrogenic and anti-inflammatory properties and is a potent physiologic antioxidant cytoprotectant. We believe that unconjugated hyperbilirubinemia may protect against progression of non-alcoholic fatty liver disease (NAFLD) from simple steatosis to non-alcoholic steatohepatitis (NASH). This study was conducted to assess the association of serum unconjugated bilirubin levels and histological liver damage in NAFLD. Methods: This was a retrospective analysis involving adult patients from a tertiary medical center undergoing liver biopsy to evaluate suspected NAFLD or NASH and a control group without NAFLD based on normal liver ultrasound, labs, and history. Identification of unconjugated hyperbilirubinemia was based on the presence of predominantly unconjugated bilirubin ≥1.0 mg/dL (17.1 mmol/L) while fasting, in the absence of hemolytic disease or other hepatic function alteration. Results: Six-hundred and forty-one patients were included. Of the patients without NAFLD (133 patients), 13 (9.8%) had unconjugated hyperbilirubinemia (range 1.0–1.8, average 1.3). Of the patients with simple steatosis (285 patients), 32 (11.2%) had unconjugated hyperbilirubinemia (range 1.0–2.0, average 1.2). Of the patients with NASH (223 patients), 3 (1.3%) had unconjugated hyperbilirubinemia (1.0, 1.1 and 1.4) (p < 0.001). Conclusion: This study shows significantly lower prevalence of unconjugated hyperbilirubinemia in patients with histopathologic evidence of steatohepatitis (NASH) compared to simple steatosis and a normal control group. It is possible that sustained unconjugated hyperbilirubinemia inhibits oxidative stress, inflammation, and hepatic fibrogenesis, preventing NASH. This may have significant therapeutic implications for patients at high risk of developing NASH with medications which elevate unconjugated bilirubin such as probenecid, rifampin, phycobilins, and algal biliverdin metabolites.

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1293 FACTORS AFFECTING SEVERITY OF FATTY LIVER DISEASE IN PATIENTS UNDERGOING LAPAROSCOPIC GASTRIC BANDING (LAGB) SURGERY FOR OBESITY B.E. Jones1 , H. Berry1 , G. Smith2 , S. Leibman2 , R. CliftonBligh3 , R. Eckstein4 . 1 Hepatology Unit, 2 Department of Surgery, 3 Endocrinology Department, 4 Department of Pathology, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia E-mail: [email protected] Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity and insulin resistance and its effects range from simple steatosis to cirrhosis and hepatocellular carcinoma. The aims of our study are to determine the factors associated with hepatic steatosis, inflammation and fibrosis in obese patients undergoing bariatric surgery. Methods: Clinical and biochemical data (including baseline liver biopsy) was collected prospectively from patients (n = 173) who underwent LAGB at Royal North Shore/North Shore Private Hospitals. Univariate and multivariate analysis was used to identify factors associated with hepatic steatosis, fibrosis and insulin resistance (HOMA-IR) in patients. Results: Mean age was 46 yrs, 69% were female, baseline BMI was 45.9 and weight 132.7 kg. Co-morbidities included diabetes (26%); dyslipidaemias (37%); hypertension (39%) and sleep apnoea (39%). Of 165 patients biopsied 3.6% had advanced liver fibrosis and a further 26% had mild to moderate fibrosis. Inflammation was observed in 68% of patients with 92% of these being graded as mild. Steatosis was present in 90% of patients with 47% of these being moderate to severe. Steatohepatitis was present in 22% of patients. Multivariate analysis confirmed that steatosis was significantly associated with elevated Chol:HDl ratio, AST, gamma-GT levels and BMI (p < 0.05). Steatohepatitis was significantly associated with elevated BSL, HOMA-IR, triglycerides, AST, ALT and gamma-GT levels (p < 0.05). Inflammation, ballooning degeneration and Mallorys hyaline on liver biopsy and AST were significantly associated with liver fibrosis (p < 0.05). Mean weight loss post-gastric banding was 19, 24.6 and 26.3 kg at 6, 12 and 24 months respectively. Statistically significant improvement in insulin, glucose, HbA1c, lipids and liver function tests were observed and correlated with weight loss. Conclusions: In an obese population undergoing gastric banding AST and liver biopsy markers of inflammation and hepatocyte injury were associated with liver fibrosis. Metabolic parameters were not associated with progressive fibrosis but were associated with the occurrence and severity of steatosis. LAGB results in sustained weight loss and improvement in biochemical and metabolic parameters at 12 and 24 months. 1294 CROSS-SECTIONAL RELATIONSHIP BETWEEN DIETARY CARBOHYDRATE AND AMINOTRANSFERASE ACTIVITY IN A KOREAN POPULATION D.W. Jun1 , D.C. Kim1 , W. Sohn1 , D.H. Koh2 , T.Y. Kim1 , J.H. Sohn1 , K.N. Lee1 , H.L. Lee1 . 1 Internal Medicine, Hanyang University Hospital, 2 Hallym University School of Medicine, Seoul, Republic of Korea E-mail: [email protected] Background: There are some recent research that low-carbohydrate diet (carbohydrate proportion to total calories <40%) is effective in obesity and metabolic syndrome. However, there is little data about the influence of low-carbohydrate diet on aminotransferase level. The purpose of this research is to investigate the effect of carbohydrate diet on aminotransferase level in Korea, where carbohydrate contents is extremely high in usual meal. Method: It used the data of 2005 and 2007 Korean National Health and Nutrition Examinations (KNHANES). Total of 19,749 people were included. Exclusion criteria were people who is positive hepatitis B antigen, had a history of liver disease and excessive

Journal of Hepatology 2012 vol. 56 | S389–S548