Liver problems among people with obesity and cirrhosis reduced by bariatric surgery

Weight loss surgery can prevent people with obesity and fatty liver-related cirrhosis from developing major complications of liver disease, a new study has demonstrated.

Researchers from Cleveland Clinic have suggested that bariatric surgery is a good treatment option for both cirrhosis and obesity. Senior author Dr Ali Aminian said: “Bariatric surgery was associated with a 72 per cent lower risk of developing serious complications of liver disease and an 80 per cent lower risk of progression to decompensated stage among patients with compensated cirrhosis and obesity.”  

Metabolic dysfunction-associated steatohepatitis (MASH) is the most common form of chronic liver disease in the United States and is triggered by type 2 diabetes and obesity.

Roughly 20 per cent of individuals living with MASH end up developing cirrhosis – late-stage liver scarring. The two stages of cirrhosis are compensated and decompensated. The liver maintains sufficient residual function to support the body's needs in the compensated stage.

Meanwhile, life-threatening complications occur in the decompensated stage, reflecting the liver's inability to sustain vital functions and liver transplantation becomes essential for survival. Corresponding author Dr Sobia Laique said: “Patients with MASH-related cirrhosis have extremely limited treatment options.

“Currently, no therapeutic interventions have demonstrated efficacy in mitigating the risk of severe liver complications within this patient population.”

 Dr Laique added: “This underscores a critical unmet need for the development of effective therapies specifically targeting patients with compensated MASH-related cirrhosis.”

During the study, the team of researchers analysed the health outcomes of 62 people with compensated MASH-related cirrhosis and obesity who had bariatric surgery. In addition, they looked at the health outcomes of 106 nonsurgical people.

 A total of 20.9 per cent of the surgical group and 46.4 per cent of the non-surgical group went on to develop one major complication of liver disease, the study has reported. In addition, the results have shown that 15.6 per cent of the surgical group and 30.7% of the non-surgical group progressed from compensated cirrhosis to the decompensated stage.

Co-author Dr Steven Nissen said: “Currently, lifestyle intervention is the only therapeutic recommendation for compensated MASH-related cirrhosis.

“However, lifestyle changes alone rarely provide the weight loss and metabolic changes needed to reduce the risk of liver complications in this patient population.”

He added: “The study shows that bariatric surgery is an effective treatment that can influence the trajectory of cirrhosis progression in select patients.”

Read more in Nature Medicine.