Highlights
- •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.
Abstract
Background
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.
Objectives
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.
Setting
University hospital.
Methods
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).
Results
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.
Conclusions
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.
Key words
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Article info
Publication history
Published online: August 11, 2021
Accepted:
July 31,
2021
Received:
April 26,
2021
Footnotes
Both Alberto Goday and Helena Julià contributed equally to this work.
This article was supported by OCN Grants JR 17/00022 from ISCIII.
Identification
Copyright
© 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
