One in four adult Americans has fatty liver disease caused by obesity — not alcohol — and there is no medical treatment for it. Doctors say the only way to control the disease is to lose weight and eat a healthier diet.
Now, a new study reports that bariatric surgery, in addition to helping with weight loss, can protect the liver. The results were impressive: from a group of more than 1,100 patients who had an aggressive form of fatty liver disease, those who had surgery to lose weight reduced their risk of developing advanced liver disease by almost 90% over the next decade. liver cancer or related death.
Only 5 of 650 patients who had bariatric surgery later developed one of these serious liver problems, compared with 40 of 508 patients who did not have the procedure.
Weight loss surgery patients also had a significantly lower risk of cardiovascular disease, a finding consistent with previous research.
They were 70% less likely to suffer a cardiac event, stroke, heart failure, or even die of heart disease, according to the study published last week in JAMA (Journal of the American Medical Association).
The Doctor. Ali Aminian, director of the Cleveland Clinic’s Bariatric and Metabolic Institute (USA) and lead author of the study, said the weight loss contained the disease.
“Obesity is the main factor in fatty liver; it all starts with obesity,” said Aminian. “When excess fat accumulates in the liver, it causes fatty liver, then inflammation comes on and gets worse, and then scar tissue and cirrhosis form.”
“When a patient loses weight, the fat goes away from everywhere, including the liver. The inflammation subsides and some of the scar tissue can reverse and improve,” continued Aminian. “Weight loss is the main factor in this.”
The results were remarkable, said Dr. Steven Nissen, academic director of the Cleveland Clinic Cardiac and Vascular Institute and lead author of the study.
The post-surgical disease outcome “was the lowest I’ve seen in 30 years of studies, an 88% reduction in progression to advanced liver disease,” he said.
The observational study that reviewed Cleveland Clinic cases over 12 years did not establish a causal relationship for lower risks of serious liver or heart disease from weight-loss procedures, but the findings add to the evidence that bariatric surgery It can have health benefits beyond weight loss.
About 100 million American adults are dangerously obese; each year, approximately 250,000 undergo bariatric operations.
Surgery carries serious risks, however. Of the 650 weight-loss surgery patients in the study group, 62 developed serious complications after the operation, and four died within a year.
The most commonly performed procedure is called a sleeve gastrectomy. Only one-fifth of the patients included in this study had this procedure. The vast majority had Roux-en-Y gastric bypass surgery.
More than 40% of American adults struggle with obesity. About 75% have nonalcoholic fatty liver disease, which is usually a silent condition with no obvious symptoms. But one in four or five will develop an aggressive form of the disease called nonalcoholic fatty liver disease, or NASH, which causes fibrosis of the liver. In addition, one in five of these individuals will develop cirrhosis or scarring of the liver, for which the only cure is a transplant.
There are no approved drugs or therapies available for nonalcoholic fatty liver disease. Doctors often advise patients to lose weight and adopt a healthier diet in an attempt to reduce fat, inflammation and fibrosis in the liver, a vital organ that turns food and drink into nutrients and filters harmful substances from the blood.
Obese patients undergoing bariatric surgery generally lose up to 25% of their body weight, much more than patients on a weight-loss diet. After surgery, they usually need less medication to keep conditions like type 2 diabetes, high blood pressure and high cholesterol under control.
The new study is not definitive, however. It was a retrospective observational study that compared the long-term outcomes of 650 bariatric surgery patients with 508 matched patients who did not undergo surgery. As such, it was not a randomized controlled trial of the type considered the gold standard in medicine that randomly assigns patients with similar characteristics to an intervention arm or a placebo.
Several of the paper’s 16 authors consult or receive research funding from companies that manufacture devices used in weight loss surgery. Both Aminian and Nissen receive funding from Medtronic, the world’s largest medical device company, and Nissen also receives funding from Ethicon, a maker of medical devices and surgical instruments. However, they did not receive external funding for this study.
“Fatty liver disease is really the single most important disease that most Americans know essentially nothing about,” Nissen said. “Today it is a more important cause of liver failure than alcohol. And with the obesity epidemic this disease is really increasing at a frightening rate.”
Translated by Luiz Roberto M. Gonçalves
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