- •21.5% of morbid-obese candidates for bariatric surgery fulfilled the MHMO criteria.
- •NAFLD and cardiometabolic markers improved at 1 year after surgery in MHMO.
- •Markers remained below baseline at 5 years post-surgery except for A1C.
- •76% of MUMO subjects shift to metabolically healthy at 5 years after surgery.
No studies have evaluated the effect of metabolic and bariatric surgery (MBS) on nonalcoholic fatty liver disease (NAFLD) and cardiometabolic markers in metabolically healthy patients with morbid obesity (MHMO) at midterm.
To assess the effect of MBS on NAFLD and cardiometabolic markers in MHMO patients and ascertain whether metabolically unhealthy patients with morbid obesity (MUMO) remain metabolically healthy at 5 years after MBS.
A total of 191 patients with a body mass index >40 kg/m2 and at least 5 years of follow-up were retrospectively analyzed. Lost to follow-up were 37.6% (151 of 401 patients). Patients were classified as MHMO if 1 or 0 of the cardiometabolic markers were present using the Wildman criteria. The degree of liver fibrosis was assessed using the NAFLD fibrosis score (NFS).
Forty-one patients (21.5%) fulfilled the criteria for MHMO. They showed significant improvements in blood pressure (from 135.1 ± 22.1 and 84.2 ± 14.3 mm Hg to 117.7 ± 19.2 and 73.0 ± 10.9 mm Hg), plasma glucose (from 91.0 ± 5.6 mg/dL to 87.2 ± 5.2 mg/dL), homeostatic model assessment for insulin resistance (from 2.2 ± .9 to 1.0 ± .8), triglycerides (from 88.0 [range, 79.5–103.5] mg/dL to 61.0 [range, 2.0–76.5] mg/dL), alanine aminotransferase, gamma-glutamyl transpeptidase NFS (from −1.0 ± 1.0 to −1.9 ± 1.2), and high-density lipoprotein cholesterol (from 56.9 ± 10.5 mg/dL to 77.9 ± 17.4 mg/dL) at 5 years after surgery. A total of 108 MUMO patients (84.4%) who became metabolically healthy after 1 year stayed healthy at 5 years.
MBS induced a midterm improvement in cardiometabolic and NAFLD markers in MHMO patients. Seventy-six percent of MUMO patients became metabolically healthy at 5 years after MBS.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery for Obesity and Related Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Bariatric surgery: a systematic review and meta-analysis.JAMA. 2004; 292: 1724-1737
- Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications.Lancet Diabetes Endocrinol. 2013; 1: 152-162
- Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient?.Surg Obes Relat Dis. 2014; 10: 871-876
- Comment on: can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient?.Surg Obes Relat Dis. 2014; 10: 876-877
- Improvement in non-alcoholic fatty liver disease score correlates with weight loss in obese patients undergoing laparoscopic sleeve gastrectomy: a two-centre study from an Asian cohort.Obes Surg. 2019; 29: 862-868
- Impact of weight regain on the evolution of non-alcoholic fatty liver disease after Roux-en-Y gastric bypass: a 3-year follow-up.Obes Surg. 2018; 28: 3131-3135
- Improvement in nonalcoholic fatty liver disease and metabolic syndrome in adolescents undergoing bariatric surgery.Surg Obes Relat Dis. 2015; 11: 442-449
- Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2008; 6: 1396-1402
- Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study.Ann Surg. 2014; 260: 893-899
- Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease.Gastroenterology. 2009; 137: 532-540
- The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome.Metabolism. 2016; 65: 1196-1207
- Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference. March 25–27, 1991, Bethesda, MD.Am J Clin Nutr. 1992; 55: 487S-619S
- Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance.Int J Surg. 2013; 11: 309-313
- The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD.Hepatology. 2007; 45: 846-854
- The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering.Arch Intern Med. 2008; 168: 1617
- Metabolically healthy but obese, a matter of time? Findings from the Prospective Pizarra Study.J Clin Endocrinol Metab. 2013; 98: 2318-2325
- Effects of a lifestyle intervention in metabolically benign and malign obesity.Diabetologia. 2011; 54: 864-868
- The prevalence, metabolic risk and effects of lifestyle intervention for metabolically healthy obesity: a systematic review and meta-analysis.Medicine (Baltimore). 2017; 96e8838
- Metabolically healthy obesity.Endocr Rev. 2020; 41: 405-420
- Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis.Eur J Prevent Cardiol. 2015; 23: 956-966
- Bariatric surgery in patients with non-alcoholic fatty liver disease: from pathophysiology to clinical effects.World J Hepatol. 2019; 11: 138-249
- Changes in the lipid profile 5 years after bariatric surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy.Surg Obes Relat Dis. 2018; 14: 1099-1105
- Large-scale analysis of factors influencing nonalcoholic fatty liver disease and its relationship with liver enzymes.Genet Mol Res. 2014; 13: 5880-5891
- Prevalence and predictors of nonalcoholic steatohepatitis in obese patients undergoing bariatric surgery: a Department of Defense experience.Am Surg. 2014; 80: 595-599
- Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease.Hepatology. 2010; 52: 913-924
- Association between liver enzymes with metabolically unhealthy obese phenotype.Lipids Health Dis. 2018; 17: 1-8
- Less liver fibrosis in metabolically healthy compared with metabolically unhealthy obese patients with non-alcoholic fatty liver disease.Diabetes Metab. 2017; 43: 332-337
- The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity.Aliment Pharmacol Ther. 2018; 48: 1260-1270
- Independent association between nonalcoholic fatty liver disease and cardiovascular disease: a systematic review and meta-analysis.Int J Endocrinol. 2013; 2013: 124958
- Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients.Diabetes Care. 2007; 30: 2119-2121
- Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis.Nat Rev Gastroenterol Hepatol. 2013; 10: 330-344
- Metabolically healthy obesity, presence or absence of fatty liver, and risk of type 2 diabetes in Japanese individuals: Toranomon Hospital Health Management Center Study 20 (TOPICS 20).J Clin Endocrinol Metab. 2014; 99: 2952-2960
- Predictors of excess weight loss in obese patients after gastric bypass: a 60-month follow-up.Obes Surg. 2016; 26: 1178-1185
- Effects of bariatric surgery in different obesity phenotypes: Tehran Obesity Treatment Study (TOTS).Obes Surg. 2020; 30: 461-469
- Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals.Surg Obes Relat Dis. 2016; 12: 49-56
- Bariatric surgery versus conventional medical therapy for type 2 diabetes.Surv Anesthesiol. 2013; 57: 24-25
- Loss to follow-up after bariatric surgery: are lost patients doing better or worse?.Surg Obes Relat Dis. 2016; 12: S145-S146
- Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up.Surg Obes Relat Dis. 2011; 7: 575-580
- The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies.BMC Endocr Disord. 2014; 14: 9
- Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity.Ann Med. 2011; 43: 617-649
- Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery.Arq Gastroenterol. 2010; 47: 170-173
- Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters.Obes Surg. 2012; 22: 62-69
- Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement.Obes Surg. 2006; 16: 1278-1286
- Gamma glutamyl transferase is an independent determinant for the association of insulin resistance with nonalcoholic fatty liver disease in Bangladeshi adults: association of GGT and HOMA-IR with NAFLD.Diabetes Metab Syndr Clin Res Rev. 2016; 10: S25-S29
- Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology.Obes Surg. 2015; 25: 2280-2289
Published online: August 11, 2021
Accepted: July 31, 2021
Received: April 26, 2021
Both Alberto Goday and Helena Julià contributed equally to this work.
This article was supported by OCN Grants JR 17/00022 from ISCIII.
© 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.