Patients with MASLD lost less weight after bariatric surgery, study finds
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Key takeaways:
- Patients with MASLD who underwent bariatric surgery lost less weight over 5 years than those without MASLD.
- Roux-en-Y gastric bypass surgery had better outcomes than sleeve gastrectomy.
BOSTON — Patients with metabolic dysfunction-associated steatotic liver disease who underwent bariatric surgery lost less weight over 5 years than those without MASLD, according to research presented at The Liver Meeting.
“Individuals with MASLD at baseline lost less total weight,” Monica Tincopa, MD, MS, a gastroenterologist, transplant hepatologist and assistant professor of medicine at UC San Diego Health, told Healio. “Overall, 33% of patients had evidence of persistent or recurrent MASLD, with baseline hyperlipidemia associated with persistent or recurrent MASLD.”
Tincopa and colleagues sought to assess the long-term effects of bariatric surgery on weight, metabolic parameters and persistence of chronic liver disease in patients with MASLD.
They enrolled 714 adults who underwent sleeve gastronomy or Roux-en-Y gastric bypass between 2008 and 2013, of whom 79% were women and 36% had diabetes. The median age of the cohort was 45 years and median BMI was 47.4 kg/m2.
Among participants, 221 had confirmed MASLD at baseline, 93 of whom underwent sleeve gastronomy and 128 underwent gastric bypass.
Tincopa and colleagues determined that the gastric bypass group had significantly higher A1c, triglycerides and cholesterol than the sleeve gastronomy group, which had significantly higher weight.
At all timepoints during the 5-year follow up period, median weight loss was highest among those who underwent gastric bypass, researchers reported.
Further, patients with MASLD lost less total weight than their counterparts without MASLD, an impact that was more pronounced among patients who underwent gastric bypass. This group also had greater improvement in NAFLD Fibrosis Score.
Among 83 patients with MASLD who underwent follow-up imaging, 33.7% had evidence of persistent or recurrent MASLD, according to researchers.
A multivariable model also showed that only baseline hyperlipidemia was independently associated with persistent MASLD.
The researchers noted that these findings suggest that bariatric surgery may have a weight-independent effect on MASLD.
“Prospective, longitudinal studies of patients using noninvasive testing to assess for presence and severity of MASLD at baseline and at standardized intervals post-op are needed to better understand which surgical procedures are most effective to achieve weight loss and improvement in metabolic and hepatic parameters, and if specific interventions, such as medications or structured lifestyle interventions, can optimize outcomes,” Tincopa said.
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Tincopa M, et al. Impact of nonalcoholic fatty liver disease on weight loss after bariatric surgery:5-Year postoperative analysis of 714 patients enrolled in a bariatric surgery cohort. Presented at: The Liver Meeting; Nov. 10-14, 2023; Boston (hybrid meeting).
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