Association of Bariatric Surgery with Major Adverse Liver and Cardiovascular Outcomes in Patients with Biopsy-Proven Nonalcoholic Steatohepatitis
Open accessAbstract
IMPORTANCE: No therapy has been shown to reduce the risk of serious adverse outcomes in patients with nonalcoholic steatohepatitis (NASH). OBJECTIVE: To investigate the long-term relationship between bariatric surgery and incident major adverse liver outcomes and major adverse cardiovascular events (MACE) in patients with obesity and biopsy-proven fibrotic NASH without cirrhosis. DESIGN, SETTING, AND PARTICIPANTS: In the SPLENDOR (Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk) study, of 25 828 liver biopsies performed at a US health system between 2004 and 2016, 1158 adult patients with obesity were identified who fulfilled enrollment criteria, including confirmed histological diagnosis of NASH and presence of liver fibrosis (histological stages 1-3). Baseline clinical characteristics, histological disease activity, and fibrosis stage of patients who underwent simultaneous liver biopsy at the time of bariatric surgery were balanced with a nonsurgical control group using overlap weighting methods. Follow-up ended in March 2021. EXPOSURES: Bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy) vs nonsurgical care. MAIN OUTCOMES AND MEASURES: The primary outcomes were the incidence of major adverse liver outcomes (progression to clinical or histological cirrhosis, development of hepatocellular carcinoma, liver transplantation, or liver-related mortality) and MACE (a composite of coronary artery events, cerebrovascular events, heart failure, or cardiovascular death), estimated using the Firth penalized method in a multivariable-adjusted Cox regression analysis framework. RESULTS: A total of 1158 patients (740 [63.9%] women; median age, 49.8 years [IQR, 40.9-57.9 years], median body mass index, 44.1 [IQR, 39.4-51.4]), including 650 patients who underwent bariatric surgery and 508 patients in the nonsurgical control group, with a median follow-up of 7 years (IQR, 4-10 years) were analyzed. Distribution of baseline covariates, including histological severity of liver injury, was well-balanced after overlap weighting. At the end of the study period in the unweighted data set, 5 patients in the bariatric surgery group and 40 patients in the nonsurgical control group experienced major adverse liver outcomes, and 39 patients in the bariatric surgery group and 60 patients in the nonsurgical group experienced MACE. Among the patients analyzed with overlap weighting methods, the cumulative incidence of major adverse liver outcomes at 10 years was 2.3% (95% CI, 0%-4.6%) in the bariatric surgery group and 9.6% (95% CI, 6.1%-12.9%) in the nonsurgical group (adjusted absolute risk difference, 12.4% [95% CI, 5.7%-19.7%]; adjusted hazard ratio, 0.12 [95% CI, 0.02-0.63]; P = .01). The cumulative incidence of MACE at 10 years was 8.5% (95% CI, 5.5%-11.4%) in the bariatric surgery group and 15.7% (95% CI, 11.3%-19.8%) in the nonsurgical group (adjusted absolute risk difference, 13.9% [95% CI, 5.9%-21.9%]; adjusted hazard ratio, 0.30 [95% CI, 0.12-0.72]; P = .007). Within the first year after bariatric surgery, 4 patients (0.6%) died from surgical complications, including gastrointestinal leak (n = 2) and respiratory failure (n = 2). CONCLUSIONS AND RELEVANCE: Among patients with NASH and obesity, bariatric surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident major adverse liver outcomes and MACE.
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Long-term results of metabolic and bariatric surgery consistently demonstrate safety and efficacy.
“Long-term results of MBS consistently demonstrate safety and efficacy.”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [18]
The Discussion reports lower long-term liver and cardiovascular risks after bariatric surgery in patients with obesity and biopsy-proven NASH, supporting efficacy in that population. But the Major Adverse Events After Bariatric Surgery section reports serious postoperative complications and surgery-attributable deaths; this study does not establish that MBS is consistently safe across patients generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMBS is associated with an 88% risk reduction of progression of nonalcoholic steatohepatitis to cirrhosis.
“Furthermore, MBS is associated with an 88% risk reduction of progression of NASH to cirrhosis [18].”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [18]
The Discussion reports an 88% lower risk of major adverse liver outcomes after bariatric surgery, not an 88% lower risk of progression to cirrhosis specifically. The Primary End Points section defines that composite to include cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related mortality. (LLM, conf=0.91)
Experimental — accuracy not yet measuredProcedures such as RYGB and VSG are associated with significant metabolic improvements and reductions in NAFLD severity, including reductions in liver fat, liver enzymes, and fibrosis.
“Procedures like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are associated with significant metabolic improvements and reductions in NAFLD severity [13,14,15], including reductions in liver fat, liver enzymes, and fibrosis [16,17,18].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [17]
The Abstract and Discussion say bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy, is associated with metabolic improvement and better liver outcomes in patients with obesity and NASH. The Discussion also reports fibrosis regression from another study. This paper does not report postoperative reductions in liver fat or liver enzymes, so it does not support those specific parts of the claim. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn SURMOUNT-1, the 15 mg tirzepatide group exhibited an average weight decrease of 20.9%, and 36.2% of participants achieved the ≥25% weight-loss goal.
“Notably, the 15 mg tirzepatide group in this trial exhibited an average weight decrease of 20.9%, and an impressive 36.2% of participants successfully achieved the≥25% weight-loss goal, approaching the effects observed with bariatric surgery [32, 33].”
After MBS, there is significant improvement of metabolic disease.
“After surgery, the significant improvement of metabolic disease, as well as the decrease in overall mortality, has been reported in multiple studies further supporting the importance of this treatment modality [15–19].”
Surgical, compared to non-surgical treatment, was related to reduce risk of major liver-related and cardiac events in patients with MASH and obesity.
“Surgical, compared to non-surgical treatment, was related to reduce risk of major liver-related and cardiac events in patients with MASH and obesity [88].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [88]
The large retrospective SPLENDOR study found significantly lower rates of adverse liver-related outcomes and major adverse cardiovascular events in individuals who underwent metabolic surgery compared to non-surgical controls.
“In line with data from prospective studies, the large retrospective SPLENDOR study found signi fi cantly lower rates of adverse liver-related outcomes and major adverse cardiovascular events in individuals who underwent metabolic surgery compared to non-surgical controls.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [439]
After MBS, there is a decrease in overall mortality.
“After surgery, the significant improvement of metabolic disease, as well as the decrease in overall mortality, has been reported in multiple studies further supporting the importance of this treatment modality [15–19].”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [18]
The Primary End Points and Abstract report lower risks of composite liver and cardiovascular outcomes after bariatric surgery; those composites include cause-specific deaths, but they are not measures of overall mortality. A search for all-cause mortality, survival, and deaths found no comparison showing a decrease in overall mortality. (LLM, conf=0.76)
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Long term outcomes of metabolic/bariatric surgery in adults
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Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease?
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Healthcare and socioeconomic costs of NAFLD: A global framework to navigate the uncertainties
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Friend or foe? The elusive role of hepatic stellate cells in liver cancer
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“…liver diseases (for example, through treatment of hepatitis B 185–187 , cure of hepatitis C 188,189 , bariatric surgery in patients with NASH 190,191 or abstinence from alcohol 192 ) can yield substantial fibrosis regression, which is associated with improved outcomes and, for HBV and HCV…”
BackgroundElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Cusi, K. J., Ekhlaspour, L., Fleming, T. K., Hilliard, M. E., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc24-s004 · Cited by 167 · see citing works
Transforming obesity: The advancement of multi-receptor drugs
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Persistence of severe liver fibrosis despite substantial weight loss with bariatric surgery
Pais, R., Aron‐Wisnewsky, J., Bedossa, P., Ponnaiah, M., Oppert, J., Siksik, J., Genser, L., Charlotte, F., Thabut, D., Clement, K., et al. (2022) · Hepatology · doi:10.1002/hep.32358 · Cited by 95 · see citing works
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“that have shown benefits in T2DM [6], nonalcoholic fatty liver disease [7], and cardiovascular outcomes [8], as well as cancer occurrence [9] and mortality [10].”
Diabetes and cirrhosis: Current concepts on diagnosis and management
Castéra, L., & Cusi, K. J. (2023) · Hepatology · doi:10.1097/hep.0000000000000263 · Cited by 87 · see citing works
“Of note, some studies have shown improved outcomes of patients with NASH.”
BackgroundInfluentialRomeo, S., Vidal‐Puig, A., Husain, M., Ahima, R. S., Arca, M., Bhatt, D. L., Diehl, A. M., Fontana, L., Foo, R., Frühbeck, G., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf314 · Cited by 91 · see citing works
NASH drug treatment development: challenges and lessons
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Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population
Mentias, A., Aminian, A., Youssef, D., Pandey, A., Menon, V., Cho, L., Nissen, S. E., & Desai, M. Y. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.01.047 · Cited by 81 · see citing works
Self-citationUnderstanding the Burden of Nonalcoholic Fatty Liver Disease: Time for Action
Younossi, Z. M., & Henry, L. L. (2024) · Diabetes Spectrum · doi:10.2337/dsi23-0010 · Cited by 83 · see citing works
“However, to date, there are no guidelines for the use of bariatric surgery This lack of guidelines is most likely due to the inconsistency of results reported from cross-sectional or retrospective studies, despite the positive outcomes noted (99 – 102).”
BackgroundResultSteatotic Liver Disease: Pathophysiology and Emerging Pharmacotherapies
Kokkorakis, M., Muzurović, E. M., Volčanšek, Š., Chakhtoura, M., Hill, M. A., Mikhailidis, D. P., & Mantzoros, C. S. (2024) · Pharmacological Reviews · doi:10.1124/pharmrev.123.001087 · Cited by 77 · see citing works
Antifibrotic therapy in nonalcoholic steatohepatitis: time for a human-centric approach
Brennan, P. N., Elsharkawy, A. M., Kendall, T. J., Loomba, R., Mann, D. A., & Fallowfield, J. A. (2023) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-023-00796-x · Cited by 68 · see citing works
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Prevention of cardiorenal complications in people with type 2 diabetes and obesity
Drucker, D. J. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2023.12.018 · Cited by 68 · see citing works
Metabolic mechanisms for and treatment of NAFLD or NASH occurring after liver transplantation
Lonardo, A., Mantovani, A., Petta, S., Carraro, A., Byrne, C. D., & Targher, G. (2022) · Nature Reviews Endocrinology · doi:10.1038/s41574-022-00711-5 · Cited by 68 · see citing works
Bajaj, M. S., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Early, K. B., ChallaSivaKanaka, S., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc26-s004 · Cited by 86 · see citing works
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Self-citationDíaz, L. A., Arab, J. P., Idalsoaga, F. J., Perelli, J., Vega, J. A., Dirchwolf, M., Carreño, J., Samith, B., Valério, C. M., Moreira, R. O., et al. (2025) · Annals of Hepatology · doi:10.1016/j.aohep.2025.101903 · Cited by 66 · see citing works
“The profound weight loss induced by bariatric surgery leads to signi fi cant reductions in hepatic steatosis, in fl ammation, fi brosis, and cardiovascular events [187,188].”
Elsaid, M. I., Li, Y., Bridges, J. F. P., Brock, G., Minacapelli, C. D., & Rustgi, V. K. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.35003 · Cited by 63 · see citing works
Nonalcoholic Fatty Liver Disease and Omega-3 Fatty Acids: Mechanisms and Clinical Use
Spooner, M. H., & Jump, D. Β. (2023) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-061021-030223 · Cited by 60 · see citing works
“…review of the value of bariatric surgery for the NASH patient had the objective of investigating the long-term relationship between bariatric surgery, major adverse liver outcomes, and major adverse cardiovascular events in obese patients with biopsy-proven fibrotic NASH without cirrhosis (3).”
Chew, N., Pan, X. H., Chong, B., Chandramouli, C., Muthiah, M. D., & Lam, C. S. P. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111652 · Cited by 57 · see citing works
Qin, W., Yang, J., Ni, Y., Deng, C., Ruan, Q., Ruan, J., Zhou, P., & Duan, K. (2024) · Endocrine · doi:10.1007/s12020-024-03896-z · Cited by 55 · see citing works
“Notably, the 15 mg tirzepatide group in this trial exhibited an average weight decrease of 20.9%, and an impressive 36.2% of participants successfully achieved the ≥ 25% weight-loss goal, approaching the effects observed with bariatric surgery [32, 33].”
ResultInfluentialNdumele, C. E., Rodriguez, F., Dixon, D. L., Khan, S. S., Mukherjee, D., Bajaj, M., Bangalore, S., Bozkurt, B., Breathett, K., Clarke, S. L., et al. (2026) · JACC · doi:10.1016/j.jacc.2026.03.056 · Cited by 90 · see citing works
Krishnan, A., Hadi, Y. B., Alqahtani, S. A., Woreta, T. A., Fang, W., Abunnaja, S., Szoka, N. L., Tabone, L. E., Thakkar, S. J., & Singh, S. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.7188 · Cited by 54 · see citing works
Gries, J. J., Lazarus, J. V., Brennan, P., Siddiqui, M. S., Targher, G., Lang, C. C., Virani, S. S., Lavie, C. J., Isaacs, S. D., Arab, J. P., et al. (2024) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(24)00310-8 · Cited by 55 · see citing works
“…and liver biopsies, bariatric surgery was associated with a lower risk of incident major adverse liver (adjusted HR 0.12, 95% CI 0.02-0.63, P = .01) and cardiovascular outcomes (adjusted HR 0.30, 95% CI 0.12-0.72, P = .007) in patients living with biopsy-proven MASLD compared to controls 148 .”
InfluentialLuca, M. D., Shikora, S. A., Eisenberg, D., Angrisani, L., Parmar, C. D., Alqahtani, A. R., Aminian, A., Aarts, E. O., Brown, W. A., COHEN, R. V., et al. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.05.009 · Cited by 52 · see citing works
Self-citationAssessing the risk of surgery in patients with cirrhosis
Kaltenbach, M. G., & Mahmud, N. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000086 · Cited by 50 · see citing works
“[65] For individuals with compensated cirrhosis and no significant portal hypertension, bariatric surgery is a viable weight loss option and is associated with a decreased risk of liver adverse outcomes.[66] There are small studies that have reported feasibility in performing bariatric surgery in patients with clinica…”
BackgroundMASLD treatment—a shift in the paradigm is imminent
Machado, M. V. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1316284 · Cited by 51 · see citing works
Chew, N., Ng, C. H., Muthiah, M. D., & Sanyal, A. J. (2022) · Current Atherosclerosis Reports · doi:10.1007/s11883-022-01027-5 · Cited by 49 · see citing works
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Nonalcoholic Fatty Liver Disease
Isaacs, S. D. (2022) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.06.007 · Cited by 50 · see citing works
Long‐term all‐cause and cause‐specific mortality for four bariatric surgery procedures
Adams, T. D., Meeks, H., Fraser, A. M., Davidson, L. E., Holmen, J. R., Newman, M. G., Ibele, A. R., Richards, N. G., Hunt, S. C., & Kim, J. (2023) · Obesity · doi:10.1002/oby.23646 · Cited by 44 · see citing works
“After median follow-up of 7 years, bariatric surgery was significantly associated with a lower risk of major adverse liver outcomes, with five surgical and 40 non-surgical patients experiencing the adverse liver outcomes [37].”
BackgroundLam, C. S. P., Rodríguez, Á., Aminian, A., Ferrannini, E., Heerspink, H. J. L., Jastreboff, A. M., Laffin, L. J., Pandey, A., Ray, K. K., Ridker, P. M., et al. (2025) · Obesity · doi:10.1002/oby.24332 · Cited by 49 · see citing works
“The substantial and sustained weight reduction with continued tirzepatide use may offer the potential for outcome benefits similar to those observed in metabolic surgery studies across multiple organ systems impacted by obesity, including cardiovascular event reduction [10, 23].”
Self-citationHepatocyte nuclear factor 4α in the pathogenesis of non-alcoholic fatty liver disease
Pan, X., & Zhang, Y. (2022) · Chinese Medical Journal · doi:10.1097/cm9.0000000000002092 · Cited by 42 · see citing works
“([74])Nodrugs have been approved for NASHtreatment,althoughsomepharmacological therapies atvariousphasesof clinical trials showpromisingoutcomes.”
BackgroundAminian, A., Aljabri, A., Wang, S. Z., Bena, J., Allende, D. S., Rosen, H., Arnold, E., Wilson, R. L., Milinovich, A., Loomba, R. S., et al. (2025) · Nature Medicine · doi:10.1038/s41591-024-03480-y · Cited by 42 · see citing works
“In a long-term follow-up study of 1,158 patients with biopsy-proven noncirrhotic MASH, metabolic surgery, compared with nonsurgical management, was associated with an 88% lower risk of incident MALO and a 70% lower risk of major adverse cardiovascular events 21 .”
Self-citationHagström, H., Hegmar, H., & Moreno, C. (2024) · United European Gastroenterology Journal · doi:10.1002/ueg2.12524 · Cited by 40 · see citing works
“94 Furthermore, secondary prevention by improved treatment of metabolic risk factors other than obesity in the metabolic syndrome is also important.”
BackgroundThe interplay between nonalcoholic fatty liver disease and atherosclerotic cardiovascular disease
Finney, A. C., Das, S., Kumar, D., McKinney, M. P., Cai, B., Yurdagul, A., & Rom, O. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1116861 · Cited by 40 · see citing works
Incretin-based investigational therapies for the treatment of MASLD/MASH
Brouwers, B., Rao, G., Tang, Y., Rodríguez, Á., Glass, L. C., & Hartman, M. L. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111675 · Cited by 40 · see citing works
MetALD: Clinical aspects, pathophysiology and treatment
Gratacós‐Ginès, J., Ariño, S., Sancho‐Bru, P., Bataller, R. A., & Pose, E. (2024) · JHEP Reports · doi:10.1016/j.jhepr.2024.101250 · Cited by 42 · see citing works
“145,146 However, some studies have also shown an increase in AUD diagnoses after surgery and more frequently when performing bypass procedures compared to sleeve gastrectomy.”
Suresh, M. G., Mohamed, S., Geetha, H. S., Prabhu, S., Trivedi, N., Mehta, P. D., Damodaran, U., Brar, A., Sohal, A., Hatwal, J., et al. (2025) · Korean Circulation Journal · doi:10.4070/kcj.2025.0212 · Cited by 43 · see citing works
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“However, it is contraindicated for patients with established cirrhosis due to elevated perioperative risks 119 .”
Review article: current and emerging therapies for the management of cirrhosis and its complications
Tapper, E. B., Ufere, N. N., Huang, D. Q., & Loomba, R. S. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16831 · Cited by 39 · see citing works
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“Consistently, a significant weight loss achieved either by lifestyle modification, medication, or surgery can vigorously lower the risk of NAFLD and atherosclerotic cardiovascular diseases or alleviate the pre-existing disease [11–13].”
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A multistakeholder approach to innovations in NAFLD care
Schattenberg, J. M., Allen, A. M., Jarvis, H., Zelber‐Sagi, S., Cusi, K., Dillon, J. F., Caussy, C., Francque, S., Younossi, Z. M., Alkhouri, N., et al. (2023) · Communications Medicine · doi:10.1038/s43856-022-00228-y · Cited by 36 · see citing works
Self-citationHepatic Fibrosis and Cancer: The Silent Threats of Metabolic Syndrome
Friedman, S. L. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2023.0240 · Cited by 37 · see citing works
“These patients have reduced fibrosis stage and improved overall outcomes for years after bariatric surgery [72].”
BackgroundA roadmap for clinical trials in MASH-related compensated cirrhosis
Pericàs, J. M., Anstee, Q. M., Augustín, S., Bataller, R. A., Berzigotti, A., Ciudin, A., Francque, S., Abraldeṣ, J. G., Hernández–Gea, V., Pons, M., et al. (2024) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-024-00955-8 · Cited by 37 · see citing works
Key takeaways from the updated multidisciplinary European MASLD guidelines
Horn, P., & Tacke, F. (2025) · eGastroenterology · doi:10.1136/egastro-2025-100196 · Cited by 37 · see citing works
“45 Consequently, the current guidelines recommend considering bariatric surgery in adults with non-cirrhotic MASLD and an approved indication for bariatric surgery.”
Ballestri, S., Mantovani, A., Girolamo, M. D., Baldelli, E., Capitelli, M., & Lonardo, A. (2023) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2022.23 · Cited by 33 · see citing works
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Fecal Metabolome and Bacterial Composition in Severe Obesity: Impact of Diet and Bariatric Surgery
Salazar, N., Alonso, M. P., Garriga, M. J., Sánchez-Carrillo, S., Hernández‐Barranco, A. M., Redruello, B., Fernández, M., Botella-Carretero, J. I., Vega‐Piñero, B., Galeano, J., et al. (2022) · Gut Microbes · doi:10.1080/19490976.2022.2106102 · Cited by 34 · see citing works
The cardiovascular effects of novel weight loss therapies
Usman, M., Davies, M. J., Hall, M. E., Verma, S., Anker, S. D., Rosenstock, J., & Butler, J. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad664 · Cited by 31 · see citing works
Bariatric surgery for non-alcoholic fatty liver disease: Indications and post-operative management
Geerts, A. M., & Lefere, S. (2022) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2022.0373 · Cited by 30 · see citing works
“A recent retrospective cohort study conducted by Aminian et al.32 was the first to demonstrate a significant lower risk for major adverse liver and cardiac outcomes in the bariatric surgery group compared with nonsurgical management in patients with biopsy-proven NASH and obesity.”
BackgroundResultInfluentialRole of steatotic liver disease in prediction and prevention of cardiometabolic diseases
Stefan, N., Lonardo, A., & Targher, G. (2023) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-023-00880-2 · Cited by 30 · see citing works
“In patients with obesity and biopsy-proven MASH, bariatric surgery resulted in a 70% reduction in the relative risk of major adverse cardiovascular events compared with nonsurgical care 7 .”
Obesity Management in the Primary Prevention of Hepatocellular Carcinoma
Zunica, E. R. M., Heintz, E. C., Axelrod, C. L., & Kirwan, J. P. (2022) · Cancers · doi:10.3390/cancers14164051 · Cited by 29 · see citing works
Medical and Surgical Treatment of Obesity
Reid, T. J., & Körner, J. (2022) · Medical Clinics of North America · doi:10.1016/j.mcna.2022.03.002 · Cited by 31 · see citing works
Care of the Patient After Metabolic and Bariatric Surgery
Bramante, C., Wise, E., & Chaudhry, Z. (2022) · Annals of Internal Medicine · doi:10.7326/aitc202205170 · Cited by 28 · see citing works
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Impacts of bariatric surgery on adverse liver outcomes: a systematic review and meta-analysis
Wang, G., Huang, Y., Yang, H., Lin, H., Zhou, S., & Qian, J. (2023) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.12.025 · Cited by 29 · see citing works
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“[ 29 – 49 ] .”
Nixdorf, L., Hartl, L., Ströhl, S., Felsenreich, D. M., Mairinger, M., Jedamzik, J., Richwien, P., Mozayani, B., Semmler, G., Balcar, L., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-67415-w · Cited by 26 · see citing works
“However, in obese patients, weight loss substantially improves liver health by reducing insulin resistance, decreasing hepatic steatosis, and improving liver enzymes 5,6 .”
BackgroundRinella, M. E., & Sookoian, S. C. (2026) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-026-01187-8 · Cited by 29 · see citing works
“Bariat-ric surgery can deliver substantial benefits 40,41 , although its role might narrow as increasingly effective weight-loss drugs become more available.”
Giannakogeorgou, A., & Roden, M. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17848 · Cited by 30 · see citing works
“…surgery has demonstrated effective sustainable weight loss with remission of T2D 16,101 as well as reduction of MASH 102-105 and cardiovascular events, 106 its invasive nature and risk of long-term side effects 107– 109 continued stimulating efforts to develop drugs with comparable weight loss.”
BackgroundDiagnosis and non‐invasive assessment of MASLD in type 2 diabetes and obesity
Chan, W., Petta, S., Noureddin, M., Goh, G. B., & Wong, V. W. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17866 · Cited by 25 · see citing works
HFpEF and MASLD: converging mechanisms and clinical implications
Capone, F., Häseli, S. P., Liu, L., Strocchi, S., Langenberg, C., Lusis, A. J., Pietzner, M., Muoio, D. M., Rider, O. J., Raman, B., et al. (2026) · Nature Reviews Cardiology · doi:10.1038/s41569-026-01257-z · Cited by 32 · see citing works
“SGLT2 inhibitors induce modest but stable weight loss, blood pressure reduction and protection from MACE, including HF 342 .”
InfluentialAdverse Cardiovascular Outcomes in Patients With Obstructive Sleep Apnea and Obesity
Aminian, A., Wang, L., Jabri, A., Wilson, R. L., Bena, J., Milinovich, A., Jin, J., Heinzinger, C. M., Peña-Orbea, C., Foldvary‐Schaefer, N., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.06.008 · Cited by 26 · see citing works
Self-citationLong-term systemic effects of metabolic bariatric surgery: A multidisciplinary perspective
Rajabi, M. R., Rezaei, M., Abdollahi, A., Gholi, Z., Mokhber, S., Farsani, G. M., Abdoli, D., Mousavi, S. D., Amini, H., & Ghandchi, M. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e34339 · Cited by 24 · see citing works
“Research has documented improvements in cardiovascular risk factors, insulin sensitivity, and hormonal balances post-surgery [13 – 15].”
BackgroundInfluentialLassailly, G., Caiazzo, R. J., Goemans, A., Chetboun, M., Gnemmi, V., Labreuche, J., Baud, G., Verkindt, H., Marciniak, C., Daoud, N. O., et al. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.10.025 · Cited by 23 · see citing works
- Authors
- Aminian, A., Al-Kurd, A., Wilson, R., Bena, J., Fayazzadeh, H., Singh, T., Albaugh, V. L., Shariff, F. U., Rodriguez, N. A., Jin, J., Brethauer, S. A., Dasarathy, S., Alkhouri, N., Schauer, P. R., McCullough, A. J., & Nissen, S. E.
- Affiliations
- Cleveland Clinic (US)
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
- Pennington Biomedical Research Center (US)
- Corresponding author
- Nissen, Steven E.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2021-11-23
- Volume
- 326
- Issue
- 20
- Pages
- 2031
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC8587225
- OpenAlex
- W3214171772
- Cited by
- 375
- References
- 36
- Citations by year
- 2026: 66 · 2025: 87 · 2024: 81 · 2023: 77 · 2022: 60 · 2021: 2
- FWCI
- 51.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK061732)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- bariatric surgery, nonalcoholic steatohepatitis, obesity, liver fibrosis, major adverse liver outcomes, major adverse cardiovascular events, Roux-en-Y gastric bypass, sleeve gastrectomy, cirrhosis progression, hepatocellular carcinoma, liver transplantation, cardiovascular mortality, liver-related mortality, long-term outcomes, overlap weighting
- MeSH terms
- Adult, Biopsy, Body Weight, Cardiovascular Diseases, Female, Carcinoma, Hepatocellular, Humans, Liver, Liver Cirrhosis, Liver Neoplasms, Male, Middle Aged, Obesity, Retrospective Studies, Incidence, Bariatric Surgery, Kaplan-Meier Estimate, Propensity Score, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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