According to the American Liver Foundation, 40% of American adults have fatty liver disease. It often goes undetected until it progresses to irreversible cirrhosis, which can lead to serious complications or death.
Until recently, doctors could only suggest changes to diet and lifestyle or help with related issues like diabetes and high cholesterol, but these methods weren’t consistently successful. Now, a new study shows that bariatric surgery (also called weight-loss surgery) might lower the chance of serious problems, even for some patients with cirrhosis.
Per a report by The New York Times, the study, which was published in Nature Medicine, analyzed data from patients with obesity and cirrhosis caused by metabolic dysfunction-associated steatohepatitis (MASH), a severe fatty liver disease linked to obesity. After 15 years, those who underwent bariatric surgery were 72% less likely to experience serious complications such as liver cancer compared to similar patients who did not have the surgery.
These results, along with new studies highlighting the advantages of weight-loss medications, have given doctors renewed confidence in addressing fatty liver disease.
MASH starts when fat accumulates in the liver, and for some people, this leads to swelling and scarring. While research has shown that losing weight can have a positive impact on those affected by MASH – this is particularly important because liver scarring can lead to cirrhosis – doctors say that there is still a need for more research on cirrhosis itself and its long-term effects.
“Most people assume that cirrhosis is a death sentence,” Dr. Rotonya Carr, the division head of gastroenterology at the University of Washington, told Nina Agrawal, a health reporter at The Times. However, she explains that emerging information suggests this might not be true for all patients anymore.
This new study, conducted at the Cleveland Clinic, examined records of 168 adults with obesity (BMI of 30 or higher) and cirrhosis from MASH, focusing on those with “compensated” cirrhosis, meaning they hadn’t had any serious complications from it.
Among the patients who underwent surgical weight loss procedures, 21% had serious liver issues within 15 years. In contrast, 46% of those who didn’t have the surgery had similar complications. These complications included fluid buildup, brain confusion from toxins, esophageal bleeding and liver cancer.
Dr. Ali Aminian, who leads the Bariatric and Metabolic Institute at the Cleveland Clinic and wrote the paper, told Agrawal that the study shows that substantial weight loss – and keeping it off – can help stop serious problems from MASH, even in patients who are very ill.
“We have been trying to show, if we take care of obesity and if we help people lose weight, how can we change the trajectory of the disease?” Dr. Aminian said.
Agrawal also mentions that Dr. Vandana Khungar, an associate professor of medicine and who also works as an associate medical director for liver transplants at Yale University School of Medicine, has highlighted that patients with cirrhosis face a greater risk of problems when having surgery. However, she found the results of this study to be impressive because they indicated that some patients could achieve “good safety outcomes and excellent liver outcomes” after surgery. It’s important to note that Dr. Khungar did not participate in the study.
She warned that individual risk and access to experienced centers should guide decisions about surgery for cirrhosis patients because the study had several limitations: 1. It used past patient data instead of randomly assigning patients to different treatment groups and tracking them over time. 2. The number of patients in the study was small and mostly consisted of white patients. 3. Even though the researchers tried to consider different factors that could affect the results, it’s still possible that the two groups of patients were different in important ways.
Still, experts are hopeful about what this study could mean, especially if the weight loss from new medications helps with cirrhosis because liver disease is a major cause of death for Black people specifically. Agrawal has pointed out that in the past few months, some early tests of weight-loss medications have shown that patients taking these drugs often see significant signs of MASH, like liver swelling and inflammation, improve. Plus, early findings from a Phase 3 study of semaglutide (known as the brands, Ozempic and Wegovy) shared at a medical conference in December showed impressive results. About 63% of patients taking the drug had their MASH improve, compared to 34% of those given a placebo. Patients on semaglutide were also more likely to see their fibrosis, which ranges from Stages 0 to 4, decrease by at least one stage.
None of these studies looked specifically at how weight-loss drugs affect cirrhosis, which is the most severe stage of liver scarring. But, experts are optimistic that improved treatments for cirrhosis, including possibly bariatric surgery, may be coming soon.
Given the potential long-term effects of the Trump administration’s cuts to medical research funding, it’s important for us to keep track of research and push for updates. This way, we can help influence policies that ensure we have access to quality healthcare.
