Perspective from Johanna DiStefano, PhD
Perspective from Sangeeta Kashyap, MD
Source:

Seeberg KA, et al. Ann Intern Med. 2021;doi:10.7326/M21-1962.

Disclosures: The authors report no relevant financial disclosures.
December 01, 2021
2 min read
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Gastric bypass, sleeve gastrectomy ‘substantially’ reduce liver fat in type 2 diabetes

Perspective from Johanna DiStefano, PhD
Perspective from Sangeeta Kashyap, MD
Source:

Seeberg KA, et al. Ann Intern Med. 2021;doi:10.7326/M21-1962.

Disclosures: The authors report no relevant financial disclosures.
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Roux-en-Y gastric bypass and sleeve gastrectomy are equally effective at reducing hepatic steatosis, with an almost complete clearance of liver fat 1 year after the surgical procedures, according to data from a single-center study.

“With an almost complete clearance of liver fat 1 year after surgery, our study provides new high-quality evidence that the two most common weight loss surgeries, Roux-en-Y gastric bypass and sleeve gastrectomy, appear to be highly effective in reducing liver fat content in patients with type 2 diabetes and obesity,” Jens Kristoffer Hertel, PhD, head of research at the Morbid Obesity Centre at Vestfold Hospital Trust in Tønsberg, Norway, told Healio. “However, the effect of these weight loss surgery approaches on liver scarring is more unclear.”

Percentage of patients with no or low-grade steatosis at 1-year follow-up 94 percent Sleeve gastrectomy 100 percent Roux-en-Y gastric bypass

In a randomized controlled trial, Hertel and colleagues analyzed data from 100 patients with type 2 diabetes from a tertiary care obesity center in Norway (65% women; mean age, 48 years; mean BMI, 42 kg/m2). From January 2013 to February 2018, researchers randomly assigned patients to sleeve gastrectomy or Roux-en-Y gastric bypass. The study’s primary outcome of remission of type 2 diabetes was previously published; predefined secondary outcomes for the new analysis were hepatic steatosis and fibrosis assessed by MRI (liver fat fraction), enhanced liver fibrosis (ELF) test, noninvasive indices and liver enzymes.

Jens Kristoffer Hertel

The findings were published in Annals of Internal Medicine.

From surgery to 1-year follow-up, researchers found liver fat fraction declined similarly after sleeve gastrectomy (mean, –19.7%; 95% CI, –22.5 to –16.9) and Roux-en-Y gastric bypass (mean, –21.5%; 95% CI, –24.3 to –18.6). Almost all patients — 94% who underwent sleeve gastrectomy and 100% who underwent gastric bypass — had no or low-grade steatosis at 1 year.

The ELF score category remained stable for 77% of patients; however, 18% experienced worsening of fibrosis at 1 year, with no between-group difference.

“Both Roux-en-Y gastric bypass and sleeve gastrectomy appear to be effective in reducing liver fat content,” Hertel told Healio. “Our study also shows that the liver fat content was reduced dramatically during the first 5 weeks after surgery, indicating that the first 10% of weight loss achieved is the most important regarding fatty liver disease. Together, this might have clinical implications for the treatment of fatty liver disease.”

The researchers noted the study recruited mostly white patients and had short follow-up; however, the study is ongoing, with follow-up planned to 5 years.

“Both procedures stand out as appropriate treatment options to reduce the burden of nonalcoholic fatty liver disease,” the researchers wrote. “The ELF test results might suggest a slight worsening in liver fibrosis after bariatric surgery, but further research is warranted on long-term progression or regression of fibrosis.”

For more information:

Jens Kristoffer Hertel, PhD, can be reached at jehert@siv.no.