In nonalcoholic fatty liver disease, Roux-en-Y gastric bypass improves liver histology while persistent disease is associated with lower improvements in waist circumference and glycemic control
Abstract
Background In obese individuals undergoing Roux-en-Y gastric bypass (RYGB), nonalcoholic fatty liver disease (NAFLD) is seen in 75% to 100% of cases. This improves postsurgery, but some patients continue to have persistent NAFLD. Objective The purpose of this study was to determine the factors associated with persistent NAFLD at 12 months post-RYGB. Setting University Hospital, Canada, bariatric clinic. Methods This is a prospective cohort study of 42 patients who underwent RYGB. Liver biopsy, biochemical and clinical parameters were collected pre- and 12 months post-RYGB. Based on histology at 12 months, patients were separated in 2 groups, normal liver (NL) and persistent NAFLD. Results At baseline, NAFLD was diagnosed in 85.7% of patients and at 12 months post-RYGB, NAFLD was present in 19.1% of patients. Patients who had an NL at baseline remained with NL. RYGB resulted in significant decreases in body mass index, waist circumference, blood pressure, aspartate aminotransferase, alanine aminotransferase, fasting glucose and insulin, glycated hemoglobin, and triglycerides and significant increases in high-density lipoprotein cholesterol. Changes were similar in both groups except for waist circumference, which showed lower changes in those with persistent NAFLD. These patients also had significantly higher (P < .05) fasting glucose and insulin with a higher proportion of patients having insulin resistance compared with those with NL. Conclusions RYGB resulted in significant improvements in liver histology, biochemical, and clinical parameters. However, despite similar weight loss, persistent NAFLD was associated with less improvement in waist circumference and worse glycemic control.
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RYGB achieves steatosis remission in 89-95% of patients, especially in those with moderate-to-severe baseline steatosis (grades 2 and 3).
“RYGB achieved steatosis remission in 89–95% of patients, especially in those with moderate-to-severe baseline steatosis (grades 2 and 3) [114,115,116,117].”
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 [114]
38% of RYGB patients achieve full MASH remission.
“RYGB also reduced MASH severity by 75–88.9%, with 38% of patients achieving full remission [114,116], while VSG achieved 100% resolution [118].”
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 [114]
RYGB reduces MASH severity by 75-88.9%.
“RYGB also reduced MASH severity by 75–88.9%, with 38% of patients achieving full remission [114,116], while VSG achieved 100% resolution [118].”
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 [114]
Cites
Matthews, D. R., Hosker, J. P., Rudenski, A. S., Naylor, B. A., Treacher, D. F., & Turner, R. C. (1985) · Diabetologia · doi:10.1007/bf00280883 · Cited by 31,502 · see citing works
Nonalcoholic Steatohepatitis: A Proposal for Grading and Staging The Histological Lesions
Brunt, E. M., Janney, C. G., Di Bisceglie, A. M., Neuschwander-Tetri, B. A., & Bacon, B. R. (1999) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.1999.01377.x · Cited by 3,907 · see citing works
Chalasani, N., Younossi, Z. M., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K. J., Charlton, M., & Sanyal, A. J. (2012) · Hepatology · doi:10.1002/hep.25762 · Cited by 3,798 · see citing works
Nonalcoholic Fatty Liver, Steatohepatitis, and the Metabolic Syndrome
Marchesini, G., Bugianesi, E., Forlani, G., Cerrelli, F., Lenzi, M., Manini, R., Natale, S., Vanni, E., Villanova, N., Melchionda, N., et al. (2003) · Hepatology · doi:10.1053/jhep.2003.50161 · Cited by 2,676 · see citing works
Gastrointestinal Surgery for Severe Obesity
Panel, C. D. C. (1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-115-12-956 · Cited by 2,163 · see citing works
Human gut microbiota in obesity and after gastric bypass
Zhang, H., DiBaise, J. K., Zuccolo, A., Kudrna, D., Braidotti, M., Yu, Y., Parameswaran, P., Crowell, M. D., Wing, R., Rittmann, B. E., et al. (2009) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0812600106 · Cited by 1,880 · see citing works
Chang, S.-H., Stoll, C. R. T., Song, J., Varela, J. E., Eagon, C. J., & Colditz, G. A. (2014) · JAMA Surgery · doi:10.1001/jamasurg.2013.3654 · Cited by 1,688 · see citing works
Fain, J. N., Madan, A. K., Hiler, M. L., Cheema, P. S., & Bahouth, S. W. (2004) · Endocrinology · doi:10.1210/en.2003-1336 · Cited by 1,571 · see citing works
Brunt, E. M., Kleiner, D. E., Wilson, L. A., Belt, P., & Neuschwander-Tetri, B. A. (2011) · Hepatology · doi:10.1002/hep.24127 · Cited by 1,251 · see citing works
The gut microbiota and obesity: from correlation to causality
Zhao, L. (2013) · Nature Reviews Microbiology · doi:10.1038/nrmicro3089 · Cited by 847 · see citing works
Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients
Lassailly, G., Caiazzo, R., Buob, D., Pigeyre, M., Verkindt, H., Labreuche, J., Raverdy, V., Leteurtre, E., Dharancy, S., Louvet, A., et al. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.04.014 · Cited by 762 · see citing works
(1992) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/55.2.615s · Cited by 748 · see citing works
Hepatic histology in obese patients undergoing bariatric surgery
Machado, M. V., Marques-Vidal, P. M., & Cortez‐Pinto, H. (2006) · Journal of Hepatology · doi:10.1016/j.jhep.2006.06.013 · Cited by 577 · see citing works
World Gastroenterology Organisation Global Guidelines
LaBrecque, D. R., Abbas, Z., Anania, F. A., Ferenci, P., Khan, A. G., Goh, K., Hamid, S. S., Va, I., Lizarzábal, M., Peñaranda, M. M., et al. (2014) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000116 · Cited by 520 · see citing works
Mathurin, P., Hollebecque, A., Arnalsteen, L., Buob, D., Leteurtre, E., Caiazzo, R. J., Pigeyre, M., Verkindt, H., Dharancy, S., Louvet, A., et al. (2009) · Gastroenterology · doi:10.1053/j.gastro.2009.04.052 · Cited by 483 · see citing works
WAJCHENBERG, B. L., Giannella‐Neto, D., Silva, M., & Santos, R. F. (2002) · Hormone and Metabolic Research · doi:10.1055/s-2002-38256 · Cited by 394 · see citing works
The role of adipokines in chronic inflammation
Mancuso, P. (2016) · ImmunoTargets and Therapy · doi:10.2147/itt.s73223 · Cited by 391 · see citing works
Dowman, J. K., Tomlinson, J., & Newsome, P. N. (2010) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2010.04556.x · Cited by 312 · see citing works
The Role of Gut Microbiota on Insulin Resistance
Caricilli, A. M., & Saad, M. A. (2013) · Nutrients · doi:10.3390/nu5030829 · Cited by 273 · see citing works
Moschen, A. R., Molnar, C., Geiger, S., Graziadei, I., Ebenbichler, C. F., Weiss, H., Kaser, S., Kaser, A., & Tilg, H. (2010) · Gut · doi:10.1136/gut.2010.214577 · Cited by 263 · see citing works
Bower, G., Toma, T., Harling, L., Jiao, L. R., Efthimiou, E., Darzi, A. W., Athanasiou, T., & Ashrafian, H. (2015) · Obesity Surgery · doi:10.1007/s11695-015-1691-x · Cited by 255 · see citing works
Roux‐en‐Y Gastric Bypass Improves Liver Histology in Patients with Non‐Alcoholic Fatty Liver Disease
Clark, J. M., Al-Khuraishi, A., Solga, S. F., Alli, P. M., Diehl, A. M., & Magnuson, T. H. (2005) · Obesity Research · doi:10.1038/oby.2005.140 · Cited by 184 · see citing works
Universal equation for estimating ideal body weight and body weight at any BMI
Peterson, C. M., Thomas, D. M., Blackburn, G. L., & Heymsfield, S. B. (2016) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.115.121178 · Cited by 175 · see citing works
Santos, A. C., Lopes, C. M. M., Guimarães, J. T., & Barros, H. (2005) · International Journal of Obesity · doi:10.1038/sj.ijo.0803035 · Cited by 171 · see citing works
Seppala-Lindroos, A. (2002) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.87.7.3023 · Cited by 168 · see citing works
Campos, G. M., Rabl, C., Peeva, S., Ciovica, R., Rao, M. N., Schwarz, J., Havel, P. J., Schambelan, M., & Mulligan, K. M. (2009) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-009-1060-y · Cited by 160 · see citing works
Clinical approaches to non-alcoholic fatty liver disease
Schwenger, K. J. P. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i7.1712 · Cited by 133 · see citing works
Self-citationNon-invasive diagnosis of nonalcoholic fatty liver and nonalcoholic steatohepatitis
Adams, L. A., & Feldstein, A. E. (2010) · Journal of Digestive Diseases · doi:10.1111/j.1751-2980.2010.00471.x · Cited by 99 · see citing works
Froylich, D., Corcelles, R., Daigle, C. R., Boules, M., Brethauer, S. A., & Schauer, P. R. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2015.04.004 · Cited by 83 · see citing works
Histological Findings in the Liver Before and After Gastric Bypass
Csendes, A., Smok, G., & Burgos, A. (2006) · Obesity Surgery · doi:10.1381/096089206776944904 · Cited by 78 · see citing works
Genetics of insulin resistance
Pedersen, O. B. (2009) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-0029-1212085 · Cited by 68 · see citing works
Ahmed, M. H., & Byrne, C. D. (2010) · Drug Discovery Today · doi:10.1016/j.drudis.2010.06.007 · Cited by 14 · see citing works
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Cited by
Sorted by citations
Lee, Y., Doumouras, A. G., Yu, J., Brar, K., Banfield, L., Gmora, S., Anvari, M., & Hong, D. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2018.10.017 · Cited by 371 · see citing works
Bariatric surgery improves nonalcoholic fatty liver disease: systematic review and meta-analysis
Zhou, H., Luo, P., Li, P., wang, G., Yi, X., Fu, Z., Sun, X., Cui, B., Zhu, L., & Zhu, S. (2022) · Obesity Surgery · doi:10.1007/s11695-022-06011-1 · Cited by 79 · see citing works
de Brito e Silva, M. B., Tustumi, F., de Miranda Neto, A. A., Dantas, A. C. B., Santo, M. A., & Cecconello, I. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05412-y · Cited by 66 · see citing works
Yadav, J., Liang, T., Qin, T., Nathan, N., Schwenger, K. J. P., Pickel, L., Xie, L., Lei, H., Winer, D. A., Maughan, H., et al. (2023) · Cell Reports Medicine · doi:10.1016/j.xcrm.2023.101051 · Cited by 47 · see citing works
Self-citationPedersen, J. S., Rygg, M. O., Serizawa, R., Kristiansen, V. B., Albrechtsen, N. J. W., Gluud, L. L., Madsbad, S., & Bendtsen, F. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10173783 · Cited by 42 · see citing works
Kvitne, K. E., Krogstad, V., Wegler, C., Johnson, L. K., Kringen, M. K., Hovd, M. H., Hertel, J. K., Heijer, M., Sandbu, R., Skovlund, E., et al. (2022) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.15349 · Cited by 40 · see citing works
Kvitne, K. E., Robertsen, I., Skovlund, E., Christensen, H., Krogstad, V., Wegler, C., Angeles, P. C., Wollmann, B. M., Hole, K., Johnson, L. K., et al. (2021) · Clinical and Translational Science · doi:10.1111/cts.13142 · Cited by 34 · see citing works
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Feng, G., Han, Y., Yang, W., Shikora, S. A., Mahawar, K. K., Cheung, T. T., Targher, G., Byrne, C. D., Hernández–Gea, V., Tilg, H., et al. (2024) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2024.05.009 · Cited by 31 · see citing works
Schwenger, K. J. P., Ghorbani, Y., Bharatselvam, S., Chen, L., Chomiak, K. M., Tyler, A. C., Eddingsaas, N. C., Fischer, S. E., Jackson, T. D., Okrainec, A., et al. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.176153 · Cited by 30 · see citing works
Self-citationWolf, R. M., Oshima, K., Canner, J. K., & Steele, K. E. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.08.013 · Cited by 20 · see citing works
Mazzini, G. S., Augustin, T., Noria, S. F., Romero‐Marrero, C., Li, N., Hameed, B., Eisenberg, D., Azagury, D. E., & Ikramuddin, S. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.11.015 · Cited by 20 · see citing works
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Perysinakis, I., Pappis, H. C., & Margaris, E. (2019) · Obesity Surgery · doi:10.1007/s11695-019-03705-x · Cited by 15 · see citing works
Tsamos, G., Vasdeki, D., Koufakis, T., Michou, V., Makedou, K., & Tzimagiorgis, G. (2023) · Metabolites · doi:10.3390/metabo13040517 · Cited by 16 · see citing works
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Tasabehji, D., Saleh, S., & Mokadem, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124012 · Cited by 14 · see citing works
Jamialahmadi, T., Jangjoo, A., Rezvani, R., Goshayeshi, L., Tasbandi, A., Nooghabi, M. J., Rajabzadeh, F., Ghaffarzadegan, K., Mishamandani, Z. J., & Nematy, M. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04452-0 · Cited by 12 · see citing works
Aktary, M. L., Eller, L. K., Nicolucci, A. C., & Reimer, R. A. (2020) · Food & Nutrition Research · doi:10.29219/fnr.v64.4548 · Cited by 12 · see citing works
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Khalifa, O., & Arredouani, A. (2026) · Pharmaceuticals · doi:10.3390/ph19030408 · Cited by 5 · see citing works
Bharatselvam, S., Schwenger, K. J. P., Ghorbani, Y., Fischer, S. E., Jackson, T. D., Okrainec, A., & Allard, J. P. (2024) · Nutrition · doi:10.1016/j.nut.2024.112530 · Cited by 3 · see citing works
Self-citationCourcoulas, A. P., Stefater, M. A., Shirley, E., GOURASH, W. F., & Stylopoulos, N. (2018) · JMIR Research Protocols · doi:10.2196/12459 · Cited by 3 · see citing works
Bertasso, I. M., Pietrobon, C. B., Ribeiro, R. A., Soares, G. M., de Oliveira, J. C., Alegre-Maller, A. C. P., Boschero, A. C., Araújo, A. C. F., Guimarães, A. T. B., Bonfleur, M. L., et al. (2021) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174421000271 · Cited by 3 · see citing works
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Reichert, M., Strowitzki, M. J., Tuffs, C., Amati, A., Amin, D., Raj, S., Sprenger, T., Hecker, A., & Schneider, M. (2026) · Zeitschrift für Gastroenterologie · doi:10.1055/a-2927-4771
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Self-citation
- Authors
- Schwenger, K. J. P., Fischer, S. E., Jackson, T., Okrainec, A., & Allard, J. P.
- Affiliations
- University Health Network (CA)
- University of Toronto (CA)
- Corresponding author
- Allard, Johane P.
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 14
- Issue
- 9
- Pages
- 1233-1239
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W2807852621
- Cited by
- 36
- References
- 32
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 9 · 2020: 6 · 2019: 3 · 2018: 2
- FWCI
- 5.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- non-alcoholic fatty liver disease, Roux-en-Y gastric bypass
- MeSH terms
- Adult, Blood Glucose, Female, Humans, Liver, Male, Middle Aged, Obesity, Prospective Studies, Gastric Bypass, Waist Circumference, Non-alcoholic Fatty Liver Disease
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