Correspondence to letter to the editor on “Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis”

Article information

Clin Mol Hepatol. 2025;31(1):e103-e104
Publication date (electronic) : 2024 September 24
doi : https://doi.org/10.3350/cmh.2024.0818
1Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
2Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
Corresponding author : Yuri Cho Center for Liver and Pancreatobiliary Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel: +82-31-920-1680, Fax: +82-31-920-2799, E-mail: yuricho@ncc.re.kr
Editor: Gi-Ae Kim, Kyung Hee University, Korea
Received 2024 September 19; Accepted 2024 September 20.
Keywords: MASLD; Bariatric; Obesity; MASH

Dear Editor,

We would like to thank Dr. Li et al. for their comprehensive letter [1] regarding our recent study on bariatric intervention and its effects on metabolic dysfunction-associated steatohepatitis in patients with obesity [2]. We greatly appreciate your engagement with our research, as well as your comparisons to the work by Wong et al. Your insights shed valuable light on this critical area of investigation, which is increasingly relevant in today’s clinical landscape.

We agree that the findings from Wong et al. highlight a significant aspect of metabolic dysfunction-associated steatotic liver disease (MASLD) management: the importance of weight loss across MASLD populations. Their observation that non-obese individuals can achieve remission from MASLD with relatively modest weight loss is indeed compelling. This suggests that while bariatric surgery is a powerful tool for obese patients, lifestyle modifications and other interventions should also be prioritized for non-obese individuals. This holistic approach to treatment could ultimately enhance outcomes for a broader range of patients [3].

Your concern regarding the rising rates of obesity, particularly among adolescents, is shared by many experts [4]. As obesity prevalence continues to climb in younger populations, so too does the incidence of MASLD. Future research is imperative to explore how weight management strategies can be effectively implemented in adolescents, who may have unique physiological and psychosocial considerations. We believe that understanding the dynamics of MASLD in younger populations will be crucial for developing effective prevention and treatment strategies.

Additionally, we recognize the need for comprehensive follow-up care post-bariatric intervention. While many studies have demonstrated significant improvements in liver-related outcomes after bariatric intervention [2,5], further future research should focus on the long-term sustainability of these outcomes. Evaluating the long-term effects of weight loss on liver function, as well as overall metabolic function, will be essential for guiding clinical practice and patient care.

Furthermore, as we consider the implications of our findings, it is vital to address access to bariatric surgery and related interventions. Not all patients who would benefit from bariatric intervention can access them due to economic or geographic barriers. Advocacy for equitable healthcare access will be essential as we move forward in addressing the growing burden of MASLD. In closing, we appreciate your contribution to this important discussion. It is through collaborative efforts and dialogue that we can advance our understanding of MASLD and optimize treatment options for all MASLD patients. We look forward to future discussions and research that can further illuminate this pressing issue.

Notes

Authors’ contribution

Original Draft: Y.C., D.W.J; Critical revision: Y.C., D.W.J.

Conflicts of Interest

The authors have no conflicts to disclose.

Abbreviations

MASLD

metabolic dysfunction-associated steatotic liver disease

References

1. Li XS, Shen XP, Li H. Letter regarding Letter to the editor on “Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis”. Clin Mol Hepatol 2025;31:e15–e16.
2. Hwang J, Hwang H, Shin H, Kim BH, Kang SH, Yoo JJ, et al. Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis. Clin Mol Hepatol 2024;30:561–576.
3. Lee KC, Wu PS, Lin HC. Pathogenesis and treatment of nonalcoholic steatohepatitis and its fibrosis. Clin Mol Hepatol 2023;29:77–98.
4. Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022;18:1345–1356.
5. Lee Y, Doumouras AG, Yu J, Brar K, Banfield L, Gmora S, et al. Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2019;17:1040–1060.e11.

Article information Continued