Metabolic syndrome and non-alcoholic fatty liver disease in liver surgery: The new scourges?

Table 1 Diagnostic criteria of the metabolic syndrome

Criteria	Consensual criteria definition1	Other non-consensual criteria
Central obesity	Abdominal waist2	Different cutoff values of BMI ≥ 28 or ≥ 28.8 or ≥ 30 kg/m2
	> 102 cm (United States) or 94 cm (Europe) in men
	> 88 cm (United States) or 80 cm (Europe) in women
Dyslipidemia	Triglycerides ≥ 150 mg/dL (1.7 mmol/L)	Statin or fenofibrate medication3
	HDL cholesterol
	< 40 mg/dL (1.03 mmol/L) in men
	< 50 mg/dL (1.29 mmol/L) in women
Hypertension	Blood pressure > 135/85 mmHg	Any antihypertensive therapy3
Glucose intolerance	Hyperglycemia	Any diabetes Any antidiabetic therapy (oral or insulin)
	Fasting glucose ≥ 110 mg/dL,
	or type II diabetes

¹Diagnosis of metabolic syndrome (MS) requires at least 3 out of 5 criteria;

²Other cut off values have been established for Asians and Latin Americans;

³These treatments can be taken in account for the diagnosis of MS unless if given in preemptive purpose.

Table 2 Studies focusing on liver resection in a context of metabolic syndrome, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

Ref.	Endpoint	Underlying parenchyma	Assessment of metabolic factors	Morbidity			Mortality
				Overall	Liver related	CV and respiratory
Wakai et al[9]	Influence of the underlying liver on liver resection	NAFLD (n = 17)	BMI	59%	47%	6%	12%
Neal et al[10]	Influence of the underlying liver on right trisectionectomy	NASH (n = 9)	All factors	NA	NA	NA	22%
Reddy et al[11]	Influence of the underlying liver on liver resection	Simple steatosis (n = 72)	All factors	35%	19%	28%	4%
		NASH (n = 102)		57%	28%	13%	4%
Bhayani et al[12]	Influence of the MS on liver resection	NA	MS (n = 256)	29%	NA	22%	6%
			No MS (n = 3.717)	23%		15%	2%
Zarzavadjian Le Bian et al[13]	Influence of the MS on right trisectionectomy	NAFLD (n = 27)	> 2 MS factors (n = 30)	60%	53%	NA	30%
			≥ 3 MS factors (n = 13)	NA	NA	NA	54%
Cauchy et al[8]	Influence of the MS on liver resection	NASH (n = 16)	MS (n = 62)	58%	21%1	17%1	11%

¹Major complications: Clavien III-V. MS: Metabolic syndrome; NAFLD: Non-alcoholic fatty liver disease; NASH: Non-alcoholic steatohepatitis; CV: Cardiovascular; NA: Not applicable.