Bariatric surgeries reduced hepatic steatosis in type 2 diabetes at one year

Patients who were randomized to either sleeve gastrectomy or Roux-en-Y gastric bypass showed similar improvements in hepatic steatosis and fibrosis, a randomized trial in Norway found.

Both sleeve gastrectomy and Roux-en-Y gastric bypass reduced hepatic steatosis in patients with type 2 diabetes, according to a new analysis of a trial.

The single-center trial included 100 patients in Norway with type 2 diabetes (65% female; mean age, 47.5 years; mean body mass index, 42 kg/m2) who were randomized to either sleeve gastrectomy or Roux-en-Y gastric bypass. The study's primary outcome was diabetes remission, but this analysis looked at the predefined secondary outcomes of hepatic steatosis and fibrosis assessed by MRI (liver fat fraction), enhanced liver fibrosis (ELF) test, noninvasive indices, and liver enzymes. Results were published by Annals of Internal Medicine on Dec. 1.

At one-year follow-up, liver fat fraction had declined similarly with sleeve gastrectomy (−19.7%; 95% CI, −22.5% to −16.9%) and Roux-en-Y (−21.5%; 95% CI, −24.3% to −18.6%). Almost all patients (94% and 100%, respectively) had no or low-grade steatosis at one year. The ELF score category remained stable in 77% of patients, but 18% experienced worsening of fibrosis, with no substantial difference between the groups.

“Hence, both procedures stand out as appropriate treatment options to reduce the burden of [nonalcoholic fatty liver disease],” wrote the study authors, who also noted that not all the findings were encouraging. “We were concerned that the majority of patients (69%) had an increase in their ELF score, and 1 of 5 patients progressed to a higher grade of fibrosis (ELF category) during the study.”

They said that longer-term data on fibrosis after bariatric surgery is needed and noted that a five-year analysis of this trial is planned. Limitations of the study include that it may have been underpowered for secondary outcomes.