Hepatic steatosis following Bariatric-metabolic surgery linked to type 2 diabetes remission

Following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), low-grade liver steatosis is linked to type 2 diabetes (T2D) remission, says an article published in Obesity Surgery.

Individuals with extreme obesity and non-alcoholic fatty liver disease (NAFLD) benefit from bariatric-metabolic surgery (BS), which lowers the degree of steatosis, hepatic inflammation, and fibrosis in these patients. In individuals with type 2 diabetes mellitus, non-alcoholic fatty liver disease is present 55.5% of the time. Significant weight reduction and concomitant impacts on glucose homeostasis are the mechanisms. In order to better understand the relationship between NAFLD and type 2 diabetes remission up to 8 years after various forms of BS, Anne Lautenbach and colleagues undertook this study.

The link between biopsy-proven NAFLD, defined as steatosis in > 5% of hepatocytes at the time of surgery, and T2D remission up to 8 years after various surgical procedures was examined in a retrospective cohort study involving 107 individuals with obesity and T2D at baseline. The relationship between NAFLD and the remission of T2D was investigated using univariate regression analysis.

The key findings of this study were:

1. 56% of patients (n = 60) had long-term remission of T2D. Remission of T2D was linked to the existence of grade 1 low-grade liver steatosis.

2. Patients who had baseline greater HbA1c levels had liver steatosis scores below ≥ 2.

3. Between patients who obtained T2D remission and those who did not, there were no appreciable changes in the presence of lobular inflammation, hepatocyte ballooning, or fibrosis at the time of surgery.

4. The kind of surgery had no impact on the T2D remission.

In conclusion, Patients with T2D should consider metabolic surgery, regardless of the kind of surgery, at an early stage of NAFLD. Furthermore, mechanistic research that clarifies the reciprocal link between T2D remission and NAFLD is required.

Reference:

Lautenbach, A., Wernecke, M., Mann, O., Wagner, J., Wolter, S., Stoll, F., & Aberle, J. (2022). Low-grade hepatic steatosis is associated with long-term remission of type 2 diabetes independent of type of bariatric-metabolic surgery. Obesity Surgery. https://doi.org/10.1007/s11695-022-06406-0