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2010 Annual Meeting Abstracts

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Short term preoperative diet modification decreases steatosis and steatohepatitis in patients undergoing hepatic resections
*Justin Reeves, *David Ng, *Arief Suriawinata, *Jiang Gui, *Jeannine Mills, *Richard J Barth, Jr.
Dartmouth, Lebanon, NH

Objective: Steatosis and steatohepatitis have been associated with increased morbidity and mortality after liver resection. Our objective was to determine the effect of a low fat/low carbohydrate preoperative diet on steatosis and steatohepatitis in patients undergoing liver resection.
Design: Retrospective cohort study.
Setting: Academic tertiary medical center.
Patients: 82 consecutive elective hepatic resections by a single surgeon.
Intervention: A preoperative low fat/low carbohydrate diet was instituted in the most recent patient cohort. The diet provided 800-1000 calories, 80-100 g carbohydrate, 20-30 g fat and 60-70 g protein daily. Self-reported dietary compliance was 100%.
Main Outcome Measures: Steatosis (measured as a continuous variable as the percentage of hepatocytes containing fat inclusions), steatohepatitis (measured by the Kleiner score) and intraoperative blood loss.
Results: The diet cohort had less steatosis (11.4% vs 25.5%, p=0.009) than the non-diet cohort. The dietary intervention also resulted in lower steatohepatitis scores (0.67 vs 2.17, p=0.0003). There was no difference between the cohorts when patient factors which might influence steatosis or steatohepatitis (eg. body mass index, diabetes, chemotherapy) were considered. Dietary intervention resulted in lower steatosis and steatohepatitis in patients with high (>30) BMIs (14 vs 38.7, p=0.026 and 0.6 vs 3.1, p=0.003) and in patients with low (<25) BMIs (1.4 vs 14.2, p=0.004) and 0.14 vs 1.43, p=0.0007). Diet cohort patients had less mean intraoperative blood loss than non-diet patients (550 ml vs 906 ml, p=0.026).
Conclusions: A preoperative low fat/low carbohydrate diet initiated one week prior to hepatic resection significantly reduces both steatosis and steatohepatitis. This dietary modification is also associated with decreased intraoperative blood loss.

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