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

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

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Original Article

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

Juchul Hwang¹, Hyeyoung Hwang¹, Hyunjae Shin¹, Bo Hyun Kim¹, Seong Hee Kang², Jeong-Ju Yoo³, Mi Young Choi⁴, Dong eun Lee⁵, Dae Won Jun⁶, Yuri Cho¹

¹Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Republic of Korea
²Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
³Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
⁴National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
⁵Biostatistics Collaboration Team, Research Institute, National Cancer Center, Goyang, Republic of Korea
⁶Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Republic of Korea

Correspondence :

Dae Won Jun ,
Tel: +82-2-2290-8334, Fax: +82-2-2298-9183, Email: noshin@hanyang.ac.kr
Yuri Cho ,
Tel: +82-31-920-1680, Fax: +82-31-920-2799, Email: yuricho@ncc.re.kr

Received: September 27, 2023 Revised: May 26, 2024 Accepted: June 1, 2024

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% of 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 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.
CONCLUSIONS
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 MASLD who do not respond to life style modification or medical treatment.

KeyWords: MASH, obesity, bariatric intervention, MRI-PDFF, NAS