Obesity Surgery May Reduce Risk of Severe Liver Disease, New Research Discovers

One in four adults in the United States suffers from fatty liver disease caused by obesity rather than drinking alcohol, and there is no cure for it. Doctors say the only way to control it is to lose weight and eat a healthier diet.

Currently, new studies report that obesity surgery can protect the liver in addition to helping with weight loss. The findings were impressive: of a group of more than 1,100 patients with aggressive forms of fatty liver disease, those who underwent weight loss surgery were at risk of advanced liver disease, liver cancer, or associated death. Decreased by almost 90% in the next period.

Only 5 of the 650 patients who underwent obesity surgery later developed one of these serious liver outcomes, while 40 of the 508 patients who did not undergo surgery did.

Patients with weight loss surgery also have a significantly lower risk of cardiovascular disease, a finding that is consistent with previous studies. According to the report, the chances of experiencing a heart event, stroke, heart failure, or dying from heart disease were 70% lower. A study presented at JAMA on Thursday..

Dr. Ali Aminian, director of the Cleveland Clinic’s Institute for Obesity Metabolism and lead author of the study, said weight loss probably put the disease on track and stopped it.

“Obesity is the main cause of fatty liver — it all starts with obesity,” said Dr. Aminian. “Excessive fat buildup in the liver causes fatty liver. It then becomes inflamed, exacerbated, scar tissue is formed, and cirrhosis occurs.

“When a patient loses weight, fat disappears everywhere, including the liver. Inflammation can subside and some of the scar tissue can reverse and improve,” continued Dr. Aminian. “Weight loss is the main factor here.”

Dr. Steven Nissen, Chief Academic Officer and Lead Author of the Study at the Cleveland Clinic’s Cardiovascular Institute, said the results were impressive.

Postoperative disease results were “the lowest I’ve seen in a 30-year study, with an 88% reduction in progression to advanced liver disease,” he said.

An observational study reviewing 12 years of cases at the Cleveland Clinic did not establish a causal relationship that reduced the risk of severe liver or heart condition from weight loss procedures, but the findings show that obesity surgery reduces weight loss. Increasing evidence that it can provide beyond health benefits. .. About 100 million American adults are dangerously obese. About 250,000 people undergo obesity surgery every year.

However, surgery carries serious risks. Of the 650 patients in the study group who underwent weight loss surgery, 62 developed serious complications after surgery, and 4 of them died within 1 year of surgery.

The most commonly performed procedure is called sleeve gastrectomy. Only one-fifth of the patients studied in this report had that procedure. The majority underwent Ruwai gastric bypass surgery.

Over 40% of American adults suffer from obesity. About 75% have non-alcoholic fatty liver disease and are often asymptomatic with no obvious symptoms. However, 1 in 4 to 5 develops an aggressive form of disease called nonalcoholic steatohepatitis (NASH), causing liver fibrosis, and 1 in 5 has cirrhosis or scarring of the liver. Onset. It is a liver transplant.

There are no approved medications or treatments available for non-alcoholic fatty liver disease. Doctors generally lose weight and switch to a healthier diet to turn food and drink into nutrients and reduce liver fat, inflammation, and fibrosis, which are important organs that filter harmful substances from the blood. I advise the patient.

Obese patients who undergo obesity surgery generally lose up to 25% of their body weight, much more than those who eat to lose weight. After surgery, the dosage required to control conditions such as type 2 diabetes, high blood pressure, and high cholesterol is often low.

However, new research is not definitive. This was a retrospective observational study comparing the long-term outcomes of 650 obese patients and 508 patients who had not undergone closely matched surgery. As such, it was not a type of randomized controlled trial that was considered the gold standard of medicine, randomly assigning patients with similar characteristics to either the intervention group or placebo.

Some of the 16 authors of this paper consult with companies that manufacture devices used in weight loss surgery and receive research funding. Both Dr. Aminian and Dr. Nissen are funded by Medtronic, the world’s largest medical device company, and Dr. Nissen is also funded by Ethicon, a manufacturer of medical devices and surgical instruments. However, they were not externally funded for this study.

One concern in such studies is that patients who choose to have weight loss surgery and those who do not may be essentially different. They may be more motivated. They have health insurance or a means to cover the procedure. And they are healthy enough that the surgeon can’t turn them away.

But in this case, Dr. Nissen said the advantage of “even if it was twice as wrong, it still meant a dramatic reduction in risk” was very impressive.

This study reviewed cases from the Cleveland Clinic of 1,158 obese patients who showed advanced non-alcoholic fatty liver disease with fibrosis on liver biopsies from 2004 to 2016. Females accounted for more than 60% of patients. The average age was just under 50. The median body mass index is 44, which is considered dangerously overweight. As previous studies have shown, heart disease also decreased after weight loss surgery: about 8.5% of people who had obesity surgery had heart events, compared to 15.7% of those who did not. Was so.

“Fatty liver disease is the most important disease that most Americans know essentially nothing,” said Dr. Nissen. “Now it is a more important cause of liver failure than alcohol, and the obesity epidemic is increasing the disease at a truly terrifying rate.”