Introduction

Metabolic-dysfunction-associated-steatotic liver disease (MASLD) affects more than half of obese subjects. To date, weight reduction by diet and physical activity is recommended to improve liver injury. Recent studies have shown that bariatric surgery induces stable weight loss and ameliorates metabolic parameters.

Aims & Methods

The aim of this study is to evaluate the effect of bariatric surgery on liver steatosis and fibrosis.
This is a monocentric prospective study including all patients with severe obesity and MASLD candidates for bariatric surgery in a single Italian-center. Other causes of chronic liver disease were an exclusion criteria. Clinical and biochemical data were collected. Liver fibrosis and steatosis were non-invasively assessed with Liver Stiffness Measurements (LSM) and Controlled Attenuation Parameter (CAP) by Fibroscan at three time-points: before surgery, 6- and 12-months after surgery.

Results

A total of 112 patients (63.4% female, mean age 41.5 years) were enrolled. Before bariatric surgery, the BMI was 43.6±6.2kg/m², the LSM was 8±5.8kPa and the CAP was 319.7±57.8dB/m. Ninety-six patients continued follow-up up after surgery. These patients demonstrated a significant reduction in BMI and CAP as early as 6-months post-surgery, while a significant decrease in LSM was observed only after 12-months. Specifically, the mean BMI was 31.9±5.1kg/m² after 6 months and 28.0±3.5kg/m² after 12-months, representing an overall decrease of 35.9% from baseline (p<0.0001). The mean CAP was 264.5±57dB/m after 6-months and 214.8±47.8dB/m after 12-months, reflecting an overall decrease of 32.8% from baseline (p<0.0001). Finally, the mean LSM was 6.3±2.5kPa after 6-months and 5.8±1.9kPa after 12-months, showing an overall decrease of 21.6% from baseline (p=0.02).

Conclusion

This study demonstrated a significant weight loss and liver steatosis decrease already at 6-months after surgery, while liver fibrosis reduction takes longer at 12-months after surgery. Therefore, in adults with MASLD and severe obesity, bariatric surgery should be considered as a valid therapeutic option for improving the liver damage.