Bariatric Surgery Could Finally Bring Treatment Options for NAFLD

Marta Borges-Canha, MD

While non-alcoholic fatty liver disease (NAFLD) is a condition at a bereft for treatments, bariatric surgery could be a viable option.

A team, led by Marta Borges-Canha, MD, Saint John Hospital, evaluated the change in the first year following bariatric surgery in hepatic function, as well as in hepatic scores, Fatty Liver Index (FLI), and BARD, body mass index (BMI), AST/ALT ratio, and DM.

NAFLD is a condition where excess fat is stored in the liver. However, this condition does not usually cause symptoms and is most often found when blood tests indicate elevated liver enzymes.

When the fat builds up, it can cause inflammation and damage, causing non-alcoholic steatohepatitis (NASH), which can lead to scarring of the liver and cirrhosis.

Non-alcoholic fatty liver disease is often linked to obesity, with the prevalence of both diseases becoming increasingly notable. Research indicates that NAFLD is found in 40-80% of individuals who have type 2 diabetes and 30-90% of people who are obese.

However, there is a lack of effective treatments currently available for NAFLD, leading to many researchers taking alternative approaches for new treatments. There are currently no medicines approved by the US Food and Drug Administration (FDA) to treat NAFLD.

In the observational retrospective cohort study, the investigators examined 1955 morbidly obese patients that underwent bariatric surgery between January 2010 and July 2018. The team excluded patients that were missing hepatic function parameters before or 1 year after surgery.

The investigators used both an unadjusted linear regression model and a model adjusted for surgery type—gastric sleeve, gastric band, and gastric bypass—sex, age, BMI, diabetes, and dyslipidemia.

The study population had an average age of 3.1±10 years old and was 85.8% female.

The investigators observed a relevant decreases in transaminases (pre-operative AST and ALT, 24.8±12.4 and 29.5±19.5U/L, vs. 22.4 ± 11.1 and 22.2±14.7 post-operatively, respectively; P <0.01) and gamma-glutamyltransferase (36.9±35.4 vs 21.4±22.0U/L; P <0.01).

They also found an increase in total bilirubin (0.56±0.23 vs. 0.68±0.24mg/dL; P <0.01).

Both the Fiber Liver Index and BARD were markedly decreased a year following bariatric surgery (P <0.01). When comparing surgical procedures, the investigators found gastric sleeve surgery was linked to a greater reduction of hepatic enzymes and of both FLI and BARD when compared to gastric band procedures.

Compared to gastric bypass surgery, gastric sleeve was linked to a greater reduction of transaminases and alkaline phosphatase, but a smaller reduction in FLI and BARD.

NAFLD is considered an unmet need requiring new research in the field of gastroenterology.

During the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019) in San Antonio, TX, Brooks Cash, MD, AGAF, FACG, FACP, FASGE, chief of gastroenterology, hepatology, and nutrition at University of Texas Health Science Center at Houston, said NAFLD treatments is a pressing area of unmet need.

However, bariatric surgery could help treat this difficult group of patients to treat.

“Bariatric surgery is associated with a reduction of the hepatic enzymes and an improvement of FLI and BARD,” the authors wrote. “Bariatric surgery may represent an effective therapeutic approach to NAFLD.”