Obesity surgery improves metabolic dysfunction-associated steatotic liver disease and type 2 diabetes – MRI and biochemical analysis of liver and pancreas

TL;DR

Obesity surgery reduces liver fat and improves diabetes and liver disease in patients, with no major difference between two common surgical methods.

Contribution

This study provides MRI and biochemical evidence that obesity surgery significantly improves MASLD and type 2 diabetes.

Findings

Liver volume and fat content decreased significantly at 3 and 12 months post-surgery.

Pancreatic fat also reduced, and NAFLD scores improved significantly after surgery.

No significant difference in outcomes was found between sleeve gastrectomy and gastric bypass.

Abstract

This study evaluated changes in metabolic dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes mellitus, liver volume, liver/pancreas fat in patients after obesity surgery.

Magnetic Resonance Imaging (MRI) measured liver volume/fat and pancreas fat in 31 patients with laparoscopic sleeve gastrectomy (LSG, N = 20) or Roux-en-Y gastric bypass (RYGB, N = 11) preoperatively and at 3- and 12-month follow-up. Clinical data and blood values were taken concomitantly to calculate Non-alcoholic fatty liver disease (NAFLD) score.

The percentage total weight lost (17.5 % ± 5.4 % at 3 months, 28.4 % ± 8.3 % at 12 months) and percentage excess weight lost (40.0 % ± 11.8 % at 3 months, 65.0 % ± 18.8 % at 12 months) were significant. Liver volume decreased from 2378.3 ± 514.5 cm3 to 1928.7 ± 333.5 cm3 at 3 months (p < 0.001) and 1685.0 ± 310.9 cm3 at 12 months (p < 0.001) after surgery. Liver fat percentage decreased from 16.7 % ± 10.3 % to 8.7 % ± 5.4 % at 3 months (p < 0.001) and 5.2 % ± 3.6 % at 12 months (p < 0.001). Pancreatic fat percentage showed a reduction from 14.8 % ± 5.5 % to 10.9 % ± 4.9 % at 3 months (p = 0.007) postoperatively. NAFLD score improved from preoperative measurements to 12 months postoperatively (−0.89 ± 1.54 vs. -1.77 ± 1.25, p < 0.019). Preoperatively, 22 of 31 (71 %) patients had advanced/intermediate scores; 12 months postoperatively only 12 (39 %) remained (p = 0.044). No significant differences between LSG and RYGB were found regarding goal parameters.

Obesity surgery reduced liver volume, type 2 diabetes, fat content of liver and pancreas and improved indicators of MASLD. No significant difference in outcome between operation methods could be established.

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