Bariatric surgery helps reduce hepatic steatosis in Type 2 Diabetes patients

In a new research, Kathrine Aglen Seeberg and colleagues have found that Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were both extremely successful in decreasing hepatic steatosis, with an almost full clearance of liver fat 1 year after surgery. In the near term, bariatric surgery had less of an effect on the degree of fibrosis, but long-term progression must be assessed.

The findings of this study were published in the Annals of Internal Medicine on 30th November, 2021.

Losing weight helps with fatty liver disease. There has been no randomized investigation comparing the effects of SG and RYGB on liver fat content and fibrosis. Therefore, this study aims to compare the effects of SG and RYGB on hepatic steatosis and fibrosis over a one-year period.

This study was a single Centre, randomized and controlled trial from the tertiary care obesity Centre in Norway. A total of 100 participants with type 2 DM were enrolled. For this study, patients were randomly randomized (1:1) to SG or RYGB from January 2013 to February 2018. The primary outcome was T2DM remission. In the current trial, secondary outcomes included hepatic steatosis and fibrosis as measured by magnetic resonance imaging (liver fat fraction), the enhanced liver fibrosis (ELF) test, noninvasive markers, and liver enzymes.

The results of the study were;

• From surgery to 1-year follow-up, the liver fat fraction decreased equally following SG and RYGB, and practically all patients had no or low-grade steatosis.
• At one year, the ELF score category remained steady in 77% of patients, although 18% had worsened fibrosis, with no significant between-group difference.
• Roux-en-Y gastric bypass and sleeve gastrectomy both appear to be beneficial in lowering liver fat levels.
• The study also found that the liver fat content was significantly reduced within the first 5 weeks following surgery, indicating that the initial 10% of weight reduction accomplished is the most crucial in terms of fatty liver disease.

In conclusion, both techniques stand out as effective ways to minimize the burden of nonalcoholic fatty liver disease. The ELF test results may indicate a little worsening of liver fibrosis following bariatric surgery, but more study on long-term progression or regression of fibrosis is needed.

Reference:

Seeberg, K. A., Borgeraas, H., Hofsø, D., Småstuen, M. C., Kvan, N. P., Grimnes, J. O., Lindberg, M., Fatima, F., Seeberg, L. T., Sandbu, R., Hjelmesæth, J., & Hertel, J. K. (2021). Gastric Bypass Versus Sleeve Gastrectomy in Type 2 Diabetes: Effects on Hepatic Steatosis and Fibrosis. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m21-1962