Bariatric Surgery Reduces Risk of NAFLD

West Virginia University researchers have discovered vital data demonstrating that bariatric surgery as a therapeutic approach for patients with nonalcoholic fatty liver disease has a significant impact on improving clinical outcomes. The study, conducted by Dr. Shailendra Singh, involved thousands of individuals with NAFLD, a disorder that is on the rise and relates to a variety of other ailments.
While bariatric surgery has long been linked to a reduction in cardiovascular disease and death in patients with obesity, the researchers wanted to see if the same was true for patients with NAFLD. Their findings were published in the journal JAMA Network Open.

“NAFLD is one of the most common causes of liver disease in the United States,” said Singh, associate professor and director of bariatric endoscopy in the WVU School of Medicine. “The global prevalence of NAFLD has reached 25% and is projected to be more than 33% by 2030. NAFLD is closely associated with obesity and metabolic syndrome, and it can lead to various complications, such as liver cirrhosis, cancer, and cardiovascular diseases.

“Our study provides critical data about the impact of bariatric surgery on patients with NAFLD and supports its use as a therapeutic modality to improve clinical outcomes.”

NAFLD, as the name implies, is a fat deposit in the liver that is not caused by excessive alcohol consumption. While the cause is unknown, researchers believe it is more common in people who are obese, have type 2 diabetes, high blood pressure, or have high levels of fats in their blood, such as cholesterol and triglycerides. People in their forties and fifties are at a higher risk, while youngsters can contract the disease.

Currently, no specific drugs are allowed to treat NAFLD, and weight loss through lifestyle changes is the primary treatment. According to Singh’s latest research, bariatric operations are a viable choice.

“Obesity is a significant risk factor for cardiovascular disease, one of the leading worldwide mortality causes,” Singh said. “Bariatric surgery is an effective weight-loss intervention in patients with obesity.”

There are various types of minimally invasive procedures in use, all of which change the stomach and intestines so that the patient has a greater sense of fullness and thus consumes less food.
Patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were included in the study. Patients who had previously undergone gastric banding or other less common bariatric procedures were excluded. Roux-en-Y, also known as gastric bypass, is the most frequent treatment, which entails separating the stomach into two sections: a smaller, egg-sized piece for food storage and a larger portion that is bypassed and no longer stores or digests food. The small intestine is also divided and linked to each new segment of the stomach.

Approximately 80% of the stomach is removed during a sleeve gastrectomy, reducing the amount of food, liquid, and calories consumed.

The study comprised 9,374 adult patients with NAFLD and obesity, defined as having a BMI of 35 or higher. The patients were separated into two groups of 4,687 each: those who had bariatric surgery and those who did not. Patients in the surgery group were matched to those in the control group based on age, demographics, medication, and comorbidities (the presence of two or more chronic or long-term diseases at the same time).

“We then studied the risk of major cardiovascular events such as heart failure, myocardial infarction, stroke or need for cardiac surgeries and death in both groups,” Singh said.

According to the findings of the study, bariatric surgery is associated with significantly lower chances of major adverse cardiovascular events and death. Patients in the surgical group, in particular, had lower chances of new-onset heart failure, adverse cardiovascular events, stroke, and treatment for coronary artery blockages than those in the non-surgical group. These findings held true after one, three, five, and seven years of follow-up.

“The multifaceted nature of NAFLD with varying coexisting complications makes its treatment complex,” Singh said. “We hope that our study findings will lead to increased awareness of the benefits of bariatric surgery and its role in the management of patients with NAFLD and obesity.”

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