Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis.

IF 14 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Clinical and Molecular Hepatology Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI:10.3350/cmh.2023.0384

Juchul Hwang, Hyeyoung Hwang, Hyunjae Shin, Bo Hyun Kim, Seong Hee Kang, Jeong-Ju Yoo, Mi Young Choi, Dong Eun Lee, Dae Won Jun, Yuri Cho

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Abstract

Background/aims: Bariatric intervention has been reported to be an effective way to improve metabolic dysfunction-associated steatotic liver disease (MASLD) in obese individuals. The current systemic review aimed to assess the changes in MRI-determined hepatic proton density fat fraction (MRI-PDFF) and nonalcoholic fatty liver disease activity score (NAS) after bariatric surgery or intragastric balloon/gastric banding in MASLD patients with obesity.

Methods: We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH).

Results: Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3-6 months compared to baseline, 40% at 12-24 months, and 50% at 36-60 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3-6 months, 37% at 12-24 months, and 29% at 36-60 months; lobular inflammation by 36% at 12-24 months and 51% at 36-60 months; ballooning degeneration by 38% at 12-24 months; significant fibrosis (≥F2) by 18% at 12-24 months and by 17% at 36-60 months after intervention.

Conclusion: Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.

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减肥干预可改善肥胖症患者的代谢功能障碍相关性脂肪性肝炎：系统回顾和荟萃分析。

背景/目的：据报道，减肥干预是改善肥胖者代谢功能障碍相关性脂肪性肝病（MASLD）的有效方法。本系统综述旨在评估肥胖症相关脂肪性肝病患者在接受减肥手术或胃内气囊/胃束带术后，MRI测定的肝质子密度脂肪分数（MRI-PDFF）和非酒精性脂肪肝活动评分（NAS）的变化情况：我们检索了多个数据库，包括 PubMed、OVID Medline、EMBASE 和 Cochrane Library。主要结果是 MRI-PDFF 上肝内脂肪的变化以及代谢功能障碍相关性脂肪性肝炎（MASH）的组织学特征：共有3134名患者参与了30项研究的荟萃分析。减肥干预能明显降低体重指数（均值比为 0.79），减肥干预后 6 个月，MRI-PDFF 显示肝内脂肪减少 72%（均值比为 0.28）。8 项研究显示，与基线相比，NAS 在 3-6 个月时减少了 60%，在 12-24 个月时减少了 40%，在 36-60 个月时减少了 50%。19项研究显示，干预后，脂肪变性患者的比例在3-6个月时减少了44%，在12-24个月时减少了37%，在36-60个月时减少了29%；小叶炎症在12-24个月时减少了36%，在36-60个月时减少了51%；气球变性在12-24个月时减少了38%；明显纤维化（≥F2）在12-24个月时减少了18%，在36-60个月时减少了17%：减肥干预能明显改善肥胖患者MASH的MRI-PDFF和组织学特征。对于生活方式改变或药物治疗无效的肥胖症患者，减肥干预可能是有效的替代治疗方案。

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来源期刊

Clinical and Molecular Hepatology Medicine-Hepatology

CiteScore

15.60

自引率

9.00%

发文量

审稿时长

10 weeks

期刊介绍： Clinical and Molecular Hepatology is an internationally recognized, peer-reviewed, open-access journal published quarterly in English. Its mission is to disseminate cutting-edge knowledge, trends, and insights into hepatobiliary diseases, fostering an inclusive academic platform for robust debate and discussion among clinical practitioners, translational researchers, and basic scientists. With a multidisciplinary approach, the journal strives to enhance public health, particularly in the resource-limited Asia-Pacific region, which faces significant challenges such as high prevalence of B viral infection and hepatocellular carcinoma. Furthermore, Clinical and Molecular Hepatology prioritizes epidemiological studies of hepatobiliary diseases across diverse regions including East Asia, North Asia, Southeast Asia, Central Asia, South Asia, Southwest Asia, Pacific, Africa, Central Europe, Eastern Europe, Central America, and South America. The journal publishes a wide range of content, including original research papers, meta-analyses, letters to the editor, case reports, reviews, guidelines, editorials, and liver images and pathology, encompassing all facets of hepatology.