Identification of Novel Clinical Factors Associated with Hepatic Fat Accumulation in Extreme Obesity

Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity. Methods. We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation. Results. A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea. The accuracy of a multiple logistic regression model for presence of liver fat was 81% and for severity of liver fat accumulation was 77%. Conclusions. A limited set of clinical factors can be used to model hepatic fat accumulation with moderate accuracy and may provide potential mechanistic insights in the setting of extreme obesity

Identification of Novel Clinical Factors Associated with Hepatic Fat Accumulation in Extreme Obesity

Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity. Methods. We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation. Results. A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea. The accuracy of a multiple logistic regression model for presence of liver fat was 81% and for severity of liver fat accumulation was 77%. Conclusions. A limited set of clinical factors can be used to model hepatic fat accumulation with moderate accuracy and may provide potential mechanistic insights in the setting of extreme obesity

215 Weight Stigma as an Ongoing Challenge for Mental Health Post-Bariatric Surgery

OBJECTIVES/GOALS: The objective for this study was to evaluate the associations between weight stigma and symptoms of depression, anxiety, and binge eating following bariatric surgery. METHODS/STUDY POPULATION: Bariatric surgery is the leading evidence-based treatment for severe obesity; however, mental health challenges can compromise long-term improvements in quality of life. Weight stigma is a major contributor to mental health challenges for individuals with obesity generally; however, the role of weight stigma post-operatively after significant weight loss is poorly understood.148 patients underwent pre-bariatric surgery psychological evaluation and completed a follow-up study approximately 2 years after. Measures included the Stigmatizing Situations Inventory-Brief, Patient Health Questionnaire, Generalized Anxiety Questionnaire, and Binge Eating Scale. RESULTS/ANTICIPATED RESULTS: In regression models controlling for demographic covariates (sex, age, education, race), body mass index, and baseline measure of each outcome (e.g., depressive symptoms pre-surgery in models predicting depression post-surgery), weight stigma was independently associated with depression (p=.023), anxiety (p <.001), and binge eating (p=.008) symptoms post-surgery.Above and beyond weight, demographics, and pre-surgery measurements of mental health, weight stigma continues to influence mental health outcomes in the years following bariatric surgery. Despite weight loss after bariatric surgery, this data suggests the cumulative experiences of stigma and discrimination continue to negatively impact mental health. DISCUSSION/SIGNIFICANCE: Interventions for bariatric surgery patients must consider the effects of weight stigma, at both the societal and individual levels. Interventions countering stigma could optimize long-term quality of life and associated outcomes