Impacts of bariatric surgery on adverse liver outcomes: a systematic review and meta-analysis
Abstract
Background Bariatric surgery has been reported to improve degeneration, inflammation, and fibrosis in nonalcoholic fatty liver disease, but the effects of bariatric surgery on the associated clinical outcomes is not known. Objectives This work aimed to assess the impacts of bariatric surgery on adverse liver outcomes in people with obesity. Setting An electronic search was performed on EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL). Methods The primary outcome was the incidence of adverse liver outcomes following bariatric surgery. Liver cancer, cirrhosis, liver transplantation, liver failure, and liver-related mortality were defined as adverse hepatic outcomes. Results We analyzed data from 18 studies comprising 16,800,287 post bariatric surgical patients and 10,595,752 control patients. We found that bariatric surgery reduced the risk of adverse liver outcomes in people with obesity (hazard ratio [HR] = .33, 95% confidence interval [CI] = .31-.34; I 2 = 98.1%). The subgroup analysis showed that bariatric surgery reduced the risk of nonalcoholic cirrhosis (HR = .07, 95% CI = .06-.08; I 2 = 99.3%) and liver cancer (HR = .37, 95% CI = .35-.39; I 2 = 97.8%), although bariatric surgery may also increase the risk of postoperative alcoholic cirrhosis (HR = 1.32, 95% CI = 1.35-1.59). Conclusions This systematic review and meta-analysis revealed that bariatric surgery lowered the incidence of adverse hepatic outcomes. However, bariatric surgery may also increase the risk of alcoholic cirrhosis after surgery. Future randomized controlled trials are required to further investigate the effects of bariatric surgery on liver of people with obesity.
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During a 12-week RCT in people with MASLD, ACC inhibitor firsocostat led to moderate reduction in steatosis without changes in body weight or glycemia, but adversely caused increase in plasma triglyceride levels via augmented VLDL export.
“During a 12-week RCT in people with MASLD, the ACC inhibitor firsocostat led to a moderate reduction in steatosis without changes in body weight or glycemia, but adversely also caused an increase in plasma triglyceride levels via augmented VLDL export [222].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [222]
Combinational treatments with semaglutide and firsocostat or cilofexor or both were more effective in reducing steatosis compared to semaglutide alone (8 vs 10-11% absolute reduction in liver fat) despite similar weight loss and reductions in HbA1c (1.0% to 1.2%).
“Further, combinational treatments with semaglutide and firsocostat or cilofexor or both were more effective in reducing steatosis compared to semaglutide alone (8 vs 10-11 % absolute reduction in liver fat determined by magnetic resonance imaging) despite similar weight loss (except from combined semaglutide/cilofexor treatment resulting in greater weight loss (Table 1)) and reductions in HbA1c (1”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [232]
In patients with NASH, 24 weeks of semaglutide alone reduced body weight by 7.6% from baseline.
“S only: -7.6 %;”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [232]
In patients with NASH, 24 weeks of semaglutide alone reduced PDFF by 8% from baseline.
“S only: -8 %;”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [232]
In patients with NASH, 24 weeks of semaglutide alone did not change liver stiffness.
“Stiffness ↔”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [232]
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Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis
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Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort
Schauer, D. P., Feigelson, H. S., Koebnick, C., Caan, B., Weinmann, S., Leonard, A. C., Powers, J. D., Yenumula, P. R., & Arterburn, D. E. (2019) · Annals of Surgery · doi:10.1097/sla.0000000000002525 · Cited by 373 · see citing works
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Changes in alcohol use after metabolic and bariatric surgery: predictors and mechanisms.
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Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease?
Huttasch, M., Roden, M., & Kahl, S. (2024) · Metabolism · doi:10.1016/j.metabol.2024.155937 · Cited by 169 · see citing works
- Authors
- Wang, G., Huang, Y., Yang, H., Lin, H., Zhou, S., & Qian, J.
- Affiliations
- Dalian Medical University (CN)
- Changzhou No.2 People's Hospital (CN)
- Corresponding author
- Qian, Jun
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2023-07
- Volume
- 19
- Issue
- 7
- Pages
- 717-726
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W4313214627
- Cited by
- 29
- References
- 6
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 12 · 2023: 3
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81700537)
- 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, obesity
- MeSH terms
- Humans, Liver Cirrhosis, Liver Cirrhosis, Alcoholic, Liver Neoplasms, Obesity, Bariatric Surgery, Non-alcoholic Fatty Liver Disease
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