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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 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]
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“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]
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“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]
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“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].”
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“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].”
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“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]
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“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]
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In the citing paper
“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]
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Understanding the Role of Metabolic Syndrome as a Risk Factor for Hepatocellular Carcinoma
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“Multiple studies, including the Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk trial, demonstrated a significant decrease in adverse liver outcomes in patients who underwent MBS to reduce their BMI prior to transplant [19].”
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“Bariatric surgery emerges as a viable therapeutic choice for individuals meeting specific criteria for metabolic weight loss procedures, and it effectively resolves MASLD/MASH in most non-cirrhotic patients, reducing risk for CVD and malignancy [200].”
Zargar, A. H., Bhansali, A. K., Majumder, A., Maheshwari, A., Bhattacharyya, A., Dasgupta, A., Saboo, B., Sethi, B. K., Sanyal, D., Seshadri, K., et al. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16496 · Cited by 25
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“Metabolic surgery, compared with the usual care, is associated with lower risk of incident myocardial infarction, heart failure, stroke, atrial fi brillation, 24 obesity-associated cancer, 25 progression of MASH to cirrhosis, 26 and death.”
Self-citationSarcopenia in MASLD—Eat to Beat Steatosis, Move to Prove Strength
Crișan, D., Avram, L., Morariu-Barb, A. M., Grapa, C. M., Hirişcău, E. I., Crăciun, R., Donca, V., & Nemeș, A. (2025) · Nutrients · doi:10.3390/nu17010178 · Cited by 21
“In MASLD patients, studies have shown that BS leads to an important reduction in major adverse liver-related outcomes [104], long-term resolution of MASH, and fibrosis regression [105,106], regardless of the surgical technique [107], being significantly more effective compared to other therapeutic…”
The Basics of Metabolic Dysfunction–Associated Steatotic Liver Disease for Cardiologists
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SGLT-2 Inhibitors for Non-Alcoholic Fatty Liver Disease: A Review
Xu, R., Lian, D., Xie, Y., Chen, Z., Wang, Y., Mu, L., Wang, Y., & Zhang, B. (2023) · Frontiers in Bioscience-Landmark · doi:10.31083/j.fbl2807134 · Cited by 22
“In addition, in patients with NASH and obesity, bariatric surgery is associated with a significantly lower risk of major adverse liver outcomes and major adverse cardiovascular events than did non-surgical treatment [89].”
BackgroundTherapeutic Targets and Approaches to Manage Inflammation of NAFLD
Geng, W., Liao, W., Cao, X., & Yang, Y. (2025) · Biomedicines · doi:10.3390/biomedicines13020393 · Cited by 20
“In addition, bariatric surgery can also reduce the progression of NAFLD to cirrhosis [76], as well as lower the risk of cancer [77] and adverse cardiovascular events in NAFLD patients with severe obesity [78].”
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Nonalcoholic fatty liver disease and diabetes
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“…literature supporting bariatric-metabolic surgery, when compared with current best-practice approaches, in reducing all-cause mortality from major adverse cardiovascular events (MACE) and liver-related outcomes, 26 27 as a result of a substantial weight loss of ~14%–25% that is sustained long-term.”
ResultBilleter, A. T., Scheurlen, K. M., Israel, B., Straub, B. K., Schirmacher, P., Kopf, S., Nawroth, P. P., & Müller-Stich, B. P. (2022) · Annals of Surgery · doi:10.1097/sla.0000000000005631 · Cited by 15
Approach to the Patient With Nonalcoholic Fatty Liver Disease
Belfort‐DeAguiar, R., Lomonaco, R., & Cusi, K. J. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac624 · Cited by 16
S2k-Leitlinie Klinische Ernährung in der Hepatologie
Plauth, M., Bechmann, L. P., Grajecki, D., Gundling, F., Kramer, L., Kremer, A. E., Rau, M., Schneider, A., Tacke, F., & van Thiel, I. (2024) · Aktuelle Ernährungsmedizin · doi:10.1055/a-2338-1144 · Cited by 14
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“On top of that, MBS has been demonstrated as having a notable protective in fl uence on CVD [4,10,13,23,24] .”
BackgroundA Pragmatic Management Approach for Metabolic Dysfunction-Associated Steatosis and Steatohepatitis
Shah, N., & Sanyal, A. J. (2024) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003215 · Cited by 15
Christensen, S. M., & Nelson, C. (2025) · Obesity Pillars · doi:10.1016/j.obpill.2025.100175 · Cited by 16
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Therapeutic developments in metabolic dysfunction-associated fatty liver disease
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“For MAFLD patients, bariatric surgery also had the superiority of maintaining major adverse cardiovascular events.([38])”
BackgroundNonalcoholic Fatty Liver Disease
Yip, T. C., Wong, G. L., Wong, V. W., Goh, G. B., & Chan, W. (2023) · Medical Clinics of North America · doi:10.1016/j.mcna.2022.12.003 · Cited by 15
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A review on the beneficial effects of bariatric surgery in the management of obesity
Wahab, R. A., & le Roux, C. W. (2022) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2022.2110865 · Cited by 19
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“72).(153) These findings strongly demonstrate that bariatric surgery in particular sleeve gastrectomy and Roux-en-Y gastric bypass can immensely”
BackgroundResultLa Estoria de España de Alfonso X: creación y evolución
Catalán, D. (1992) · Cited by 13
Tasabehji, D., Saleh, S., & Mokadem, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124012 · Cited by 14
Adams, L. A., Kemp, W. W., Muller, K., Powell, E. E., Roberts, S. K., Bertot, L. C., Best, S., Deed, G., Emery, J. D., HOCKING, S. L., et al. (2025) · The Medical Journal of Australia · doi:10.5694/mja2.70008 · Cited by 12
“104 Conversely, weight gain is associated with a lower odds of improvement in MASH and fibrosis.”
Sabench, F., Rusu, E. C., Clavero-Mestres, H., Arredondo-Prats, V., Veciana-Molins, M., Muñiz-Piera, S., Vives, M., Aguilar, C., Bartra, È., París, M., et al. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07585-8 · Cited by 12
“Furthermore, BS is also associated with a substantial reduction in the risk of progression from MASH to cirrhosis (88% according to recently published data [7]).”
Suppressing MASH fibrotic progression by blocking succinate-GPR91 signaling in HSCs
Xie, L., Chen, H., Zhang, L., Yang, Y., Zhou, Y., Ma, Y., Liu, C., Wang, Y.-L., Zhu, Q., Yan, Y.-J., et al. (2025) · Hepatology · doi:10.1097/hep.0000000000001405 · Cited by 11
Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Facts and Hopes
Adinolfi, L. E., Marrone, A., Izzi, A., & Craxì, A. (2025) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2025.103411 · Cited by 11
Jatana, S., Verhoeff, K. K., Mocanu, V., Jogiat, U., Birch, D. W., Karmali, S., & Switzer, N. J. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10017-w · Cited by 11
“Selecting the optimal intervention for patients, especially those with severe obesity-related metabolic [2], cardiac [3, 4], hepatic [5, 6] complications, who experience the greatest risk of complications yet stand to benefit the most from surgery is an ever-growing challenge.”
BackgroundA Mechanistic Rationale for Incretin-Based Therapeutics in the Management of Obesity
Samms, R. J., & Kusminski, C. M. (2024) · Annual Review of Physiology · doi:10.1146/annurev-physiol-022724-105443 · Cited by 11
The Liver in Diabetes and Metabolic Syndrome
Mahmoud, M. C., & Abdelmalek, M. F. (2025) · Clinics in Liver Disease · doi:10.1016/j.cld.2025.04.003 · Cited by 14
Tincopa, M. A., Patel, N., Shahab, A., Asefa, H., & Lok, A. S.-F. (2024) · Scientific Reports · doi:10.1038/s41598-024-57722-7 · Cited by 9
“Obesity pharmacotherapy and bariatric procedures have been shown to decrease NASH activity and fibrosis but not all patients are eligible for these therapies and not all patients achieve or maintain weight loss with these therapies 3,21,22 .”
BackgroundZhang, Z., Binbin, S., Liu, H., Huang, B., Gao, X., Qiu, J., & Wang, C. (2024) · Journal of Inflammation Research · doi:10.2147/jir.s464489 · Cited by 12
Glucagon-Like Peptide 1 (GLP-1) Action on Hypothalamic Feeding Circuits
Hwang, E., Portillo, B., & Williams, K. W. (2025) · Endocrinology · doi:10.1210/endocr/bqaf125 · Cited by 10
Targeting obesity for therapeutic intervention in heart failure patients
Sato, R., & von Haehling, S. (2024) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2024.2363395 · Cited by 10
“Although several cohort studies have shown improved cardiovascular outcomes with BS, no randomized controlled trials have ever been conducted [183–185].”
BackgroundImprovement in nonalcoholic fatty liver disease through bariatric surgery
Truong, E., & Noureddin, M. (2022) · Clinical Liver Disease · doi:10.1002/cld.1229 · Cited by 10
Lupoli, R., Calcaterra, I. L., Annunziata, G., Tenore, G. C., Rainone, C., Schiavo, L., Capaldo, B., & Minno, M. N. D. D. (2022) · Biomedicines · doi:10.3390/biomedicines10040916 · Cited by 9
“In actuality, the present data do not question the benefits of bariatric surgery for cardiovascular risk, which is consistently confirmed in recent long-term clinical studies [40,41]; rather, they indicate that the occurrence of hypoglycemia, a common complication of bariatric surgery [42], could hinder these benefici…”
ResultImpact of Nonalcoholic Fatty Liver Disease (NAFLD) on Weight Loss After Bariatric Surgery
Abu-Rumaileh, M. A., Haddad, R. A., Yosef, M., Esfandiari, N. H., Kraftson, A. T., Khairi, S., Lager, C. J., Bushman, J., Khalatbari, S., Tincopa, M. A., et al. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06865-z · Cited by 9
“Bariatric surgery has shown great promise in the treat-ment of NAFLD [16].”
BackgroundJuárez-Hernández, E., Velázquez-Alemán, A. P., Castro‐Narro, G., Uribe, M., & López-Méndez, I. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1026444 · Cited by 9
“Regarding liver disease, BS has demonstrated resolution of NASH and progressive reduction of fibrosis in long term follow-up (15); moreover, and compared with non-surgical treatments, BS has been associated with lower cardiovascular risk, which is the most common cause of death in NAFLD patients (6, 16).”
BackgroundPoljo, A., Kopf, S., Sulaj, A., Roessler, S., Albrecht, T., Goeppert, B., Bojko, S., Müller-Stich, B., & Billeter, A. (2023) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2023.07.005 · Cited by 9
Rouhi, A. D., Castle, R., Hoeltzel, G. D., Williams, N. N., Dumon, K. R., Baimas‐George, M. R., Wachs, M. E., Nydam, T. L., & Choudhury, R. A. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07102-x · Cited by 8
“In particular, bariatric surgery (BS) offers considerable benefit for weight loss and has been associated with reversal of early-stage fibrosis and long-term resolution of NASH [8–10].”
Leng, Y., Yang, Y., Liu, J., Jiang, J., & Zhou, C. (2025) · Obesity Surgery · doi:10.1007/s11695-024-07666-8 · Cited by 10
Management of patients with type 2 diabetes and MASLD: An overview and joint statement
Chouik, Y., Canivet, C. M., Julla, J., Mouillot, T., Parlati, L., Rouland, A., Smati, S., Tramunt, B., Anty, R., Boursier, J., et al. (2025) · Diabetes & Metabolism · doi:10.1016/j.diabet.2025.101709 · Cited by 9
Wang, W., Gong, Z., Zhao, M., Zhang, Z., Qiu, Y., Jiang, Q., & Wu, J. (2023) · Frontiers in Surgery · doi:10.3389/fsurg.2023.1090233 · Cited by 8
Axelrod, C. L., Langohr, I. M., Dantas, W. S., Heintz, E. C., Vandanmagsar, B., Yang, S., Zunica, E. R. M., Townsend, R. L., Albaugh, V. L., Berthoud, H., et al. (2023) · Obesity · doi:10.1002/oby.23876 · Cited by 8
“Similarly, metabolic surgery (MBS) procedures, such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), decrease adverse liver outcomes by (cid:1) 80% and are associated with NAFLD remission in patients with obesity [6].”
BackgroundSelf-citationJacobsen, A. P., Whelton, S. P., Blumenthal, R. S., & McEvoy, J. W. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-88369-6.00042-6 · Cited by 13
Lupoli, R., Lembo, E., Giosuè, A., Schiavo, L., & Capaldo, B. (2022) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2022.02.019 · Cited by 9
Yue, T., Xiong, S., Zheng, D., Wang, Y., Long, P., Yang, J., Danzeng, D., Gao, H. J., Wen, X., Li, X., et al. (2022) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2022.988683 · Cited by 8
Remission with an Intervention
Hanipah, Z. N., Rubino, F., & Schauer, P. R. (2023) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.09.002 · Cited by 8
Self-citationChen, S., Zeng, Q., Cai, X., Xue, J., Yin, G., Song, P., Tang, L., Klein, C., Tacke, F., Guillot, A., et al. (2024) · International Journal of Biological Sciences · doi:10.7150/ijbs.98362 · Cited by 8
Impact of Weight Loss on Metabolic Dysfunction Associated Steatohepatitis and Hepatic Fibrosis
Takawy, M., & Abdelmalek, M. F. (2025) · Current Diabetes Reports · doi:10.1007/s11892-025-01579-1 · Cited by 11
“…surgery resolves the metabolic risk factors of MASLD/MASH (i.e., obesity, metabolic syndrome, diabetes, hypertension, dyslipidemia), resolves MASH, improves hepatic fibrosis in patients with MASLD/MASH and decreases cardiovascular, liver-related and all-cause morbidity and mortality [145–152].”
Bariatric Surgery and Incident Development of Obesity-Related Comorbidities
Bader, A. L., Hsu, J. Y., Altieri, M. S., Vollmer, C. M., Lewis, J. D., Kaplan, D. E., & Mahmud, N. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.30787 · Cited by 7
The Burden of Nonalcoholic Steatohepatitis: A Systematic Review of Epidemiology Studies
Tapper, E. B., Fleming, C., Rendon, A., Fernandes, J. D. D. R., Johansen, P., Augusto, M., & Nair, S. (2022) · Gastro Hep Advances · doi:10.1016/j.gastha.2022.06.016 · Cited by 7
Eisenberg, D., Arnow, K. D., Barreto, N. B., Davis‐Lopez, K. M., LaVela, S. L., Frayne, S. M., Nevedal, A., Wu, J. C., & Harris, A. H. S. (2022) · Obesity Science & Practice · doi:10.1002/osp4.643 · Cited by 6
“There is a growing recognition of nonalcoholic fatty liver disease (NAFLD) as a global health concern, with increasing prevalence and potential implications for liver adverse outcomes.(1,2) Nonalcoholic fatty liver disease is now a leading cause of liver disease worldwide affecting up to 25% of the world adult populat…”
BackgroundAbdalla, T. S. A., Giannou, A. D., Abdalla, A. S. A., Izbicki, J. R., Duprée, A., Mann, O., & Wolter, S. (2023) · World Journal of Surgery · doi:10.1007/s00268-023-07153-8 · Cited by 7
“…that patients undergoing bariatric surgery had, compared with nonsurgical management, a signifi-cantly lower risk of incident major adverse liver outcomes and major adverse cardiovascular events [27], In our cohort, biochemical analyses showed a general improvement in all NAFLD groups at follow-up.”
Clinical Outcomes of Metabolic Surgery on Diuretic Use in Patients With Heart Failure
Kachmar, M., Corpodean, F., LaChute, C., Popiv, I., Cook, M. W., Danos, D., Albaugh, V. L., Moraes, D. L., Tang, W. H. W., & Schauer, P. R. (2024) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2024.07.012 · Cited by 7
Self-citationWilson, R. L., & Aminian, A. (2023) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2023.01.027 · Cited by 7
Self-citationWeight loss maintenance after bariatric surgery
Cho, Y. H., Lee, Y., Choi, J. I., Lee, S. R., & Lee, S. Y. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i18.4241 · Cited by 11
Liver health and the interplay between obesity, alcohol and bariatric surgery
Geerts, A. M., Onghena, L., & Lefere, S. (2023) · Acta gastro-enterologica belgica · doi:10.51821/86.2.11553 · Cited by 7
Bashir, B., Adam, S., Ho, J. H., Linn, Z., Durrington, P. N., & Soran, H. (2023) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000889 · Cited by 7
Geography and equity: expanding access to obesity medicine diplomate care
Townsend, M. J., Reddy, N., & Stanford, F. C. (2022) · International Journal of Obesity · doi:10.1038/s41366-021-01044-5 · Cited by 7
“Longitudinal cohort data such as the recent SPLENDOR study of bariatric surgery in people with obesity and nonalcoholic steatohepatitis enable us to quantify benefits and risks of anti-obesity interventions for specific populations [7].”
BackgroundGuía de práctica clínica multidisciplinar de manejo de la esteatosis hepática metabólica
Romero‐Gómez, M., Escalada, J., Noguerol, M., Pérez, A., Carretero, J., Crespo, J., Mascort, J. J., Aguilar, I., Tinahones, F. J., Cañones, P., et al. (2025) · Gastroenterología y Hepatología · doi:10.1016/j.gastrohep.2025.502442 · Cited by 9
Bariatric Surgery and Risk of End-Stage Liver Disease in a Four-Country Cohort Study
Holmberg, D., Santoni, G., von Euler‐Chelpin, M., Kauppila, J. H., Ness‐Jensen, E., & Lagergren, J. (2025) · Obesity Surgery · doi:10.1007/s11695-025-07857-x · Cited by 6
“Only two studies have examined how bariatric surgery influences the long-term risk of developing end-stage liver disease, one showing a decreased risk and the other an unchanged risk [11, 12].”
InfluentialLin, Y., Kao, C., Hung, K., Yu, T., Liu, M., Lai, C.-C., & Wu, J. (2025) · Obesity Surgery · doi:10.1007/s11695-025-07939-w · Cited by 6
“[23, 25, 26] However, differences exist across studies, particularly in the composition of composite outcomes.”
Mortality After Bariatric Surgery: A Comprehensive Review
Jumaev, N. A., Teshaev, O., Tavasharov, B., & Lekomseva, M. (2025) · Obesity Surgery · doi:10.1007/s11695-025-08212-w · Cited by 10
Bariatric Surgery as a Strategy for Improving Outcomes in Nonalcoholic Steatohepatitis
Corey, K. E., & Memel, Z. N. (2021) · JAMA · doi:10.1001/jama.2021.17451 · Cited by 6
The Impact of Metabolic Health and Obesity on Liver Transplant Candidates and Recipients
Vogel, A. S., Roediger, R., von Ahrens, D., Fortune, B. E., Schwartz, J. M., Frager, S., Chacko, K. R., & Tow, C. (2024) · Life · doi:10.3390/life14060685 · Cited by 6
“Countless studies have now shown that bariatric surgery can improve hepatic fibrosis, decrease the risk of serious liver-related outcomes, and resolve MASH [72,90,91].”
BackgroundPais, R., Chouik, Y., Moga, L., Lebedel, L., Silvain, C., Genser, L., Weill, D., Larrue, H., Malézieux, E., Jézequel, C., et al. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07583-w · Cited by 5
“Bariatric surgery is an attractive therapeutic option in patients with MASLD and is associated with various degree of histological improvement across the severity spectrum of the disease [11, 12], and 88% risk reduction of progression to cirrhosis [13].”
The Values and Perspectives of Organoids in the Field of Metabolic Syndrome
Chen, T., Ding, M., & Zheng, Y. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24098125 · Cited by 5
“Furthermore, in 2021, an observational study also noted that in patients with non-alcoholic steatohepatitis and obesity, bariatric surgery was associated with a significantly lower risk of serious adverse liver outcomes and major adverse cardiovascular events compared to nonsurgical treatment [18].”
BackgroundMetabolic bariatric surgery, alcohol misuse and liver cirrhosis: a narrative review
Basa, M. L., Cha, D. S., Mitchell, D. P., & Chan, D. L. (2024) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2024.22 · Cited by 5
Short-term cardiovascular events after bariatric surgery in patients with metabolic syndrome
Chumakova-Orin, M., Ingram, J. L., Que, L. G., Pagidipati, N. J., Gordee, A., Kuchibhatla, M. N., & Seymour, K. A. (2023) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2023.07.009 · Cited by 5
Norouzian Ostad, A., Rajabzadeh, F., Jamialahmadi, T., Goshayeshi, L., Ranjbar, G., Rezvani, R., Nematy, M., & Jangjoo, A. (2023) · Updates in Surgery · doi:10.1007/s13304-022-01421-3 · Cited by 4
“Therefore, bariatric surgery is considered the most effective therapy for obesity that had potentially reversed the histology and elastography of NAFLD and spared the liver from progressive damage in cohort studies [30, 32].”
BackgroundCurrently Approved and Future Regimens for Metabolic Dysfunction-Associated Steatohepatitis
Abreu, E. S., Noureddin, M., Takahashi, H., Schattenberg, J. M., & Abdelmalek, M. F. (2026) · Clinics in Liver Disease · doi:10.1016/j.cld.2026.01.004 · Cited by 4
Impact of medical versus surgical weight loss on cardiovascular outcomes
Ostapenko, A., & Ahmed, B. H. (2025) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2025.03.004 · Cited by 4
Xu, G., Wang, Z., Yu, C., Amin, B., Du, D., Li, T., Chen, G., Wang, L., Li, Z., Chen, W., et al. (2023) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s389346 · Cited by 4
“The age at surgery was between 16 and 65.”
Can Nonalcoholic Steatohepatitis Be Surgically Cured?
Aminian, A., Wilson, R. L., Al‐Kurd, A., Bena, J., Fayazzadeh, H., Alkhouri, N., Nissen, S. E., & Dasarathy, S. (2023) · Annals of Surgery · doi:10.1097/sla.0000000000005914 · Cited by 4
“18,19 1 – 3,20 In patients with obesity and NASH, the current guidelines recommend weight loss.”
BackgroundSelf-citationRacial Disparities in the Outcomes of Bariatric Surgery
Wisniowski, P., & Samakar, K. (2023) · Current Surgery Reports · doi:10.1007/s40137-023-00372-x · Cited by 4
Stefan, N., & Roden, M. (2023) · Diabetologie und Stoffwechsel · doi:10.1055/a-2076-0145 · Cited by 4
Brol, M. J., Drebber, U., Yu, X., Schierwagen, R., Gu, W., Plamper, A., Klein, S., Odenthal, M., Uschner, F. E., Praktiknjo, M., et al. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.02.006 · Cited by 4
Gensthaler, L., Stauffer, M., Jedamzik, J., Bichler, C., Nixdorf, L., Richwien, P., Eichelter, J., Langer, F. B., Prager, G., & Felsenreich, D. M. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07367-2 · Cited by 4
Cardiovascular Profile and Cardiovascular Imaging After Bariatric Surgery: A Narrative Review
Toader, M. P., Gheorghe, L., Chirica, C., Ghicu, I.-A., Chirica, S.-I., Mazga, A. I., Haba, D., Maxim, M., Miler, A. A., Crișu, D., et al. (2025) · Medicina · doi:10.3390/medicina61010073 · Cited by 4
Tangible Resources for Multidisciplinary Treatment of Patients With Nonalcoholic Fatty Liver Disease
Abbas, D., Fix, O. K., Evon, D. M., & Barritt, A. S. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001989 · Cited by 4
Stefan, N., & Roden, M. (2022) · Diabetologie und Stoffwechsel · doi:10.1055/a-1853-9763 · Cited by 4
Metadata
- 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 › Hepatology › 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
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