Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy

Abstract

Considerable attention has been focused on nonalcoholic fatty liver disease (NAFLD) which occasionally develops after pancreatoduodenectomy (PD). The present study aimed to clarify the prevalence, sequential change in properties and risk factors for NAFLD development after PD. We enrolled 196 patients who underwent PD and a computed tomography (CT) scan 1 month, 6 months and 1 year after surgery. NAFLD was defined as a liver-to-spleen attenuation ratio on plain CT of <0.9. We compared various clinical factors between the NAFLD group and the control group. Individual prevalence of NAFLD at 1 month, 6 months and 1 year after surgery was 12%, 21% and 15%. Significantly different factors by univariate analysis were as follows: 1 month: age, sex, total protein (TP), total cholesterol (TC) and copper (Cu); 6 months: sex, disease, surgical method, portal vein resection (PVR), frequency of defecation, TC and Cu; 1 year: age, sex, disease, surgical method, PVR, frequency of defecation, TP and Cu. Risk factors by multivariate analysis were as follows: 1 month: not elderly age, female sex and a decrease in Cu; 6 months: female sex and a decrease in Cu; 1 year: a decrease in Cu. NAFLD after PD frequently developed in women with a decrease in serum Cu and was influenced by various factors related to poor digestion and absorption associated with pancreatic exocrine insufficiency.

Keywords: nonalcoholic fatty liver disease; pancreatoduodenectomy; risk factor.

Figure 1

We measured the average computed tomography (CT) attenuation values in four sectors of the liver and the median value from all sections of the spleen on unenhanced CT scans. Nonalcoholic fatty liver disease was defined as a liver‐to‐spleen attenuation ratio of <0.9 or a hepatic attenuation value at least 10 Hounsfield units lower than the spleen attenuation value.

Figure 2

Patients with or without nonalcoholic fatty liver disease (NAFLD) were plotted as filled or open circles, respectively. NAFLD development was improved sequentially from 1 month to 6 months or 1 year after surgery in several patients. In contrast, NAFLD developed 6 months after surgery in others and was improved at 1 year after pancreatoduodenectomy in some patients.