Short-term preoperative diet modification reduces steatosis and blood loss in patients undergoing liver resection

Background: Steatosis and steatohepatitis have been associated with increased morbidity and mortality after liver resection. Our objective was to determine the effect of a preoperative calorie-restricted diet on steatosis and steatohepatitis in patients undergoing liver resection.

Methods: We studied 111 consecutive patients who had major elective hepatic resections. More than 90% of the patients had cancer resections. The mean body mass index was 27.2; 32% had a body mass index ≥30. A week-long calorie- and fat-restricted diet was instituted in the most recent patient group (n = 51). We retrospectively evaluated steatosis and steatohepatitis in the diet and no-diet control groups. Clinical outcomes of the 2 groups, including complications and blood loss, were compared.

Results: The preoperative diet patients had less steatosis (15.7% vs 25.5% of hepatocytes containing fat, P = .05) than the nondiet controls. A lower percentage of patients in the diet group had steatohepatitis than in the nondiet group (15% vs 27%, P =.02). Preoperative diet patients had less mean intraoperative blood loss than nondiet patients (600 mL vs 906 mL, P = .002). There was no difference in overall or infectious complications between the groups.

Conclusion: We have shown for the first time that short-term calorie restriction before liver resection significantly reduces both hepatic steatosis and steatohepatitis. Dietary modification also was associated with decreased intraoperative blood loss. This intervention is easily instituted; therefore, it is clinically feasible.