Bariatric surgery may reduce the risk of serious liver disease, a new study finds


One in four American adults has fatty liver disease caused by obesity, not drinking, and there is no medical treatment for it. Doctors say the only way to keep it in check is to lose weight and eat a healthier diet.

Now a new study reports that bariatric surgery, in addition to helping with weight loss, can protect the liver. The results were astonishing: of a group of more than 1,100 patients with an aggressive form of fatty liver disease, those who underwent weight loss surgery reduced the risk of advanced liver disease, liver cancer, or related death by nearly. 90% in the next decade.

Only five of the 650 patients who underwent bariatric surgery subsequently developed any of these severe liver outcomes, compared with 40 of 508 patients who did not have the procedure.

Patients undergoing weight loss surgery were also at significantly lower risk for cardiovascular disease, a finding that is consistent with previous research. They were 70% less likely to suffer a heart event, stroke, or heart failure, or to die from heart disease, according to the study published Thursday in JAMA.

Dr. Ali Aminian, director of the Cleveland Clinic’s Bariatric and Metabolic Institute and lead author of the study, said weight loss in all likelihood stopped the disease in its infancy.

“Obesity is the main driver of fatty liver – it all starts with obesity,” says Dr. Aminian said. “When we have excess fat accumulating in the liver, it causes fatty liver; Then the inflammation comes and gets worse and then scar tissue forms which leads to cirrhosis.

“When a patient loses weight, the fat disappears everywhere, including the liver; the inflammation subsides and some of the scar tissue can reverse and improve, “said Dr. Aminian continued.” Weight loss is the main factor here.

The results have been remarkable, said Dr. Steven Nissen, academic director of the Heart and Vascular Institute at the Cleveland Clinic and senior author of the study.

The outcome of post-surgical disease “was the lowest I’ve seen in 30 years of studies, an 88% reduction in progression to advanced liver disease,” he said.

The observational study that looked at cases at the Cleveland Clinic for over 12 years did not establish a causal link with reducing the risks of serious liver or heart conditions resulting from weight-loss procedures, but the findings add to the growing evidence that bariatric surgery can provide health benefits beyond weight loss. . About 100 million American adults are dangerously obese; approximately 250,000 undergo bariatric operations each year.

However, the intervention involves serious risks. Sixty-two of the 650 patients undergoing weight loss surgery in the study group developed severe complications after the operation, and four of them died within a year of the operation.

The most commonly performed procedure is called a sleeve gastrectomy. Only one fifth of the patients studied in this report had that procedure. The vast majority have undergone Roux-en-Y gastric bypass surgery.

More than 40% of American adults struggle with obesity. About 75% have nonalcoholic fatty liver disease, which is often a silent condition with no obvious symptoms. But one in four or five will develop an aggressive form of the disease called nonalcoholic steatohepatitis, or NASH, which causes liver fibrosis, and one in five of those individuals will develop cirrhosis, or scarring of the liver, for which the only cure it’s a liver transplant.

There are no approved medications or therapies available for nonalcoholic fatty liver disease. Doctors generally advise patients to lose weight and switch to a healthier diet in an effort to reduce fat, inflammation and fibrosis in the liver, a vital organ that turns food and drink into nutrients and filters harmful substances from the liver. blood.

Obese patients who undergo bariatric surgery generally lose up to 25% of their body weight, much more than patients who follow a weight loss diet. After surgery, they often require fewer medications to control conditions such as type 2 diabetes, high blood pressure, and high cholesterol.

The new study, however, is not definitive. It was a retrospective observational study that compared the long-term outcomes of 650 patients undergoing bariatric surgery with 508 closely matched patients who did not undergo surgery. As such, it was not a randomized controlled trial of the kind considered the gold standard in medicine, which randomly assigns patients with similar characteristics to an intervention arm or a placebo.

Many of the paper’s 16 authors consult or receive research funding from companies that make devices used in weight loss surgery. Both Dr. Aminiano and Dr. Nissen receives funding from Medtronic, the largest medical device company in the world, and Dr. Nissen also gets funding from Ethicon, a manufacturer of medical devices and surgical instruments. However, they did not receive external funding for this study.

One concern in studies like these is that patients who choose weight loss surgery may be inherently different from those who don’t. They can be more motivated; have the health coverage or the means to cover the procedures; and they are healthy enough that surgeons don’t reject them.

In this case, however, Dr. Nissen said the benefit was so surprising that “even if it’s twice as wrong, it still means the risk is drastically reduced.”

The study looked at Cleveland Clinic cases of 1,158 obese patients whose liver biopsies from 2004 to 2016 were shown to have advanced nonalcoholic fatty liver disease with fibrosis. Women accounted for more than 60 percent of patients; the average age was just under 50; and the median BMI was 44, which is considered dangerously overweight. Heart disease was also reduced after weight loss surgery, as previous studies have shown: About 8.5 percent of those who underwent bariatric surgery had a heart event, compared with 15, 7 percent of those who did not have surgery.

“Fatty liver disease is really the most important disease that most Americans know practically nothing about,” said Dr. Nissen said. “It is now a more important cause of liver failure than alcohol. And with the obesity epidemic, this disease is really increasing at a frightening rate. “


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