Highlights
- •This is the first systematic review and meta-analysis to examine the relationship between bariatric surgery and clinical outcomes in the liver.
- •Our meta-analysis showed that bariatric surgery reduced the risk of major hepatic adverse events.
- •Bariatric surgery also increased the risk of postoperative alcoholic cirrhosis.
Abstract
Background
Bariatric surgery has been reported to improve degeneration, inflammation, and fibrosis
in nonalcoholic fatty liver disease, but the effects of bariatric surgery on the associated
clinical outcomes is not known.
Objectives
This work aimed to assess the impacts of bariatric surgery on adverse liver outcomes
in people with obesity.
Setting
An electronic search was performed on EMBASE, PubMed, and Cochrane Central Register
of Controlled Trials (CENTRAL).
Methods
The primary outcome was the incidence of adverse liver outcomes following bariatric
surgery. Liver cancer, cirrhosis, liver transplantation, liver failure, and liver-related
mortality were defined as adverse hepatic outcomes.
Results
We analyzed data from 18 studies comprising 16,800,287 post bariatric surgical patients
and 10,595,752 control patients. We found that bariatric surgery reduced the risk
of adverse liver outcomes in people with obesity (hazard ratio [HR] = .33, 95% confidence
interval [CI] = .31–.34; I2 = 98.1%). The subgroup analysis showed that bariatric surgery reduced the risk of
nonalcoholic cirrhosis (HR = .07, 95% CI = .06–.08; I2 = 99.3%) and liver cancer (HR = .37, 95% CI = .35–.39; I2 = 97.8%), although bariatric surgery may also increase the risk of postoperative
alcoholic cirrhosis (HR = 1.32, 95% CI = 1.35–1.59).
Conclusions
This systematic review and meta-analysis revealed that bariatric surgery lowered the
incidence of adverse hepatic outcomes. However, bariatric surgery may also increase
the risk of alcoholic cirrhosis after surgery. Future randomized controlled trials
are required to further investigate the effects of bariatric surgery on liver of people
with obesity.
Keywords
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 accessOne-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 DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Humans against obesity: who will Win?.Adv Nutr. 2019; 10: S4-S9
- Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030.J Hepatol. 2018; 69: 896-904
- Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease.Hepatology. 2018; 67: 123-133
- Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.Hepatology. 2019; 69: 2672-2682
- The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe.Hepatology. 2016; 64: 1577-1586
- Therapies in non-alcoholic steatohepatitis (NASH).Liver Int. 2017; 37 Suppl 1: 97-103
- NAFLD and alcohol-associated liver disease will Be responsible for almost all new diagnoses of cirrhosis in Canada by 2040.Hepatology. 2021; 74: 3330-3344
- Epidemiology and risk-stratification of NAFLD-associated HCC.J Hepatol. 2021; 75: 1476-1484
- Prevention of NAFLD-associated HCC: role of lifestyle and chemoprevention.J Hepatol. 2021; 75: 1217-1227
- Bariatric surgery as a strategy for improving outcomes in nonalcoholic steatohepatitis.JAMA. 2021; 326: 2015-2017
- New trends on obesity and NAFLD in Asia.J Hepatol. 2017; 67: 862-873
- Lifestyle modifications for nonalcohol-related fatty liver disease: a network meta-analysis.Cochrane Database Syst Rev. 2021; 6: Cd013156
- Bariatric surgery and the liver-Mechanisms, benefits, and risks.Obes Rev. 2021; 22: e13294
- Bariatric surgery for non-alcoholic steatohepatitis in obese patients.Cochrane Database Syst Rev. 2010; 2010: Cd007340
- Liver: does bariatric surgery reduce the severity of NAFLD?.Nat Rev Gastroenterol Hepatol. 2010; 7: 11-13
- Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2019; 17 (60.e11): 1040
- Bariatric surgery improves nonalcoholic fatty liver disease: a contemporary systematic review and meta-analysis.Surg Obes Relat Dis. 2019; 15: 502-511
- Bariatric surgery is associated with decreased progression of nonalcoholic fatty liver disease to cirrhosis: a retrospective cohort analysis.Ann Surg. 2020; 272: 32-39
- Bariatric surgery and the risk of alcohol-related cirrhosis and alcohol misuse.Liver Int. 2021; 41: 1012-1019
- Changes in alcohol use after metabolic and bariatric surgery: predictors and mechanisms.Curr Psychiatry Rep. 2019; 21: 85
- Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2008; 6: 1396-1402
- Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology.Obes Surg. 2015; 25: 2280-2289
- Systematic review and meta-analysis of Roux-en-Y gastric bypass against laparoscopic sleeve gastrectomy for amelioration of NAFLD using four criteria.Surg Obes Relat Dis. 2019; 15: 2123-2130
- Pioglitazone and bariatric surgery are the most effective treatments for non-alcoholic steatohepatitis: a hierarchical network meta-analysis.Diabetes Obes Metab. 2021; 23: 980-990
- Gastric bypass compared with sleeve gastrectomy for nonalcoholic fatty liver disease: a systematic review and meta-analysis.Obes Surg. 2021; 31: 2762-2772
- Insulin resistance is central to long-term reversal of histologic nonalcoholic steatohepatitis after metabolic surgery.J Clin Endocrinol Metab. 2021; 106: 750-761
- Gut microbiota and related metabolites in the pathogenesis of nonalcoholic steatohepatitis and its resolution after bariatric surgery.Obes Rev. 2022; 23: e13367
- The effect of the magnitude of weight loss on non-alcoholic fatty liver disease: a systematic review and meta-analysis.Metabolism. 2021; 115: 154455
- Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease.Ann Hepatol. 2020; 19: 674-690
- Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004-2012.Surg Obes Relat Dis. 2018; 14: 74-80
- Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis.JAMA. 2021; 326: 2031-2042
- Bariatric surgery versus standard obesity treatment and the risk of severe liver disease: data from the Swedish obese subjects study.Clin Gastroenterol Hepatol. 2021; 19 (6.e2): 2675
- Bariatric surgery is associated with reduction in non-alcoholic steatohepatitis and hepatocellular carcinoma: a propensity matched analysis.Am J Surg. 2020; 219: 504-507
- Bariatric surgery reduces cancer risk in adults with nonalcoholic fatty liver disease and severe obesity.Gastroenterology. 2021; 161 (84.e10): 171
- Does bariatric surgery reduce the risk of cirrhosis and HCC.Am Coll Gastroenterol. 2021; (S 1174)
- The metabolic and liver-related outcomes of bariatric surgery in adult patients with insulin-treated type 2 diabetes and nonalcoholic fatty liver disease at high risk of liver fibrosis.Surg Obes Relat Dis. 2021; 17: 792-798
- Bariatric surgery and the risk of cancer in a large multisite cohort.Ann Surg. 2019; 269: 95-101
- Development of cancer after bariatric surgery.Surg Obes Relat Dis. 2020; 16: 1586-1595
- Risk factors associated with primary liver cancer in severely obese subjects and the impact of metabolic surgery as a primary preventive measure a national case-control analysis.J Am Coll Surg. 2020;
- Cancer risk after bariatric surgery in a cohort study from the five nordic countries.Obes Surg. 2020; 30: 3761-3767
- Bariatric surgery and liver cancer in a consortium of academic medical centers.Obes Surg. 2016; 26: 696-700
- Effect of bariatric surgery on cancer risk: results from an emulated target trial using population-based data.Br J Surg. 2022; 109: 433-438
- Association of bariatric surgery and risk of cancer in patients with morbid obesity.Ann Surg. 2022; 275: 1-6
- Association of bariatric surgery with cancer incidence in patients with obesity and diabetes: long-term results from the Swedish obese subjects study.Diabetes Care. 2022; 45: 444-450
Article info
Publication history
Published online: December 21, 2022
Accepted:
December 10,
2022
Received:
June 2,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Supported by: This work was funded by the National Natural Science Foundation of China (81700537) and a major project of the Changzhou Health Care Commission (ZD202114).
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
