Serial changes in metabolic dysfunction-associated steatotic liver disease after sleeve gastrectomy and their associations with abdominal adiposity: a prospective cohort study

Chung-Yi Yang; Jian-Han Chen; Chung-Yen Chen; Cheng-Yi Kao; Shiu-Feng Huang; Wen-Yu Chang; Hung-Pin Tu; Jee-Fu Huang; Ming-Lung Yu; Chi-Ming Tai

doi:10.1016/j.soard.2024.11.007

Serial changes in metabolic dysfunction-associated steatotic liver disease after sleeve gastrectomy and their associations with abdominal adiposity: a prospective cohort study

Surg Obes Relat Dis. 2024 Nov 29:S1550-7289(24)00908-0. doi: 10.1016/j.soard.2024.11.007. Online ahead of print.

Authors

Chung-Yi Yang¹, Jian-Han Chen², Chung-Yen Chen², Cheng-Yi Kao³, Shiu-Feng Huang⁴, Wen-Yu Chang⁵, Hung-Pin Tu⁶, Jee-Fu Huang⁷, Ming-Lung Yu⁸, Chi-Ming Tai⁹

Affiliations

¹ Department of Medical imaging, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.
² School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan.
³ Department of Medical imaging, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
⁴ Investigator and Attending Physician, Institute of Molecular and Genomic Medicine, National Health Research Institutes.
⁵ Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; Department of Dermatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁶ Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center of Hepatitis Research, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center of Hepatitis Research, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁹ Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Electronic address: chimingtai@gmail.com.

PMID: 39706718
DOI: 10.1016/j.soard.2024.11.007

Abstract

Background: Little is known about the associations between changes in hepatic steatosis and changes in abdominal adiposity after metabolic bariatric surgery.

Objectives: To evaluate the serial changes in hepatic steatosis and abdominal adiposity following sleeve gastrectomy (SG).

Setting: University hospital, Taiwan.

Methods: In this prospective study, patients who underwent SG and intraoperative liver biopsy were enrolled. Magnetic resonance imaging (MRI) was performed to assess the liver fat fraction (LFF), visceral adipose tissue (VAT) area, and subcutaneous adipose tissue (SAT) area. Liver fibrosis was assessed preoperatively via biopsy and the fibrosis-4 index (FIB-4) and postoperatively with the FIB-4.

Results: Seventy-six metabolic dysfunction-associated steatotic liver disease (MASLD) patients, including 67 pure MASLD patients and 9 MASLD patients with combined etiologies, were enrolled. LFF and visceral-to-subcutaneous fat ratio were associated with metabolic dysfunction-associated steatohepatitis, and VAT area was associated with significant fibrosis (≥F2). Twelve months after SG, all MRI measurements significantly improved. The median LFF of pure MASLD patients decreased from 17.4% at baseline to 4.2% and 3.7% at the 6th and 12th postoperative months, respectively. Complete resolution of steatosis was achieved in 97.5% of patients at the 12th postoperative months. Using %VAT and %SAT reductions at the sixth postoperative month as references, LFF decreased more rapidly, with fold ratios of 1.3 and 1.8, respectively.

Conclusions: SG resulted in a significant decrease in hepatic steatosis and abdominal adiposity in patients with severe obesity, but hepatic steatosis improved faster than abdominal adiposity. Hepatic steatosis resolved in almost all patients 12 months after SG.

Keywords: Fat fraction; Fatty liver; Magnetic resonance imaging; Metabolic dysfunction-associated steatotic liver disease; Sleeve gastrectomy.