Martínez-Montoro José Ignacio, Arranz-Salas Isabel, Gutiérrez-Repiso Carolina, Sánchez-García Ana, Ocaña-Wilhelmi Luis, Pinazo-Bandera José M, Fernández-García Diego, Muñoz-Garach Araceli, Morales-García Dieter, García-Cortés Miren, García-Fuentes Eduardo, Tinahones Francisco J, Garrido-Sánchez Lourdes
Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain.
Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), 29010 Málaga, Spain.
Nutrients. 2024 Nov 12;16(22):3857. doi: 10.3390/nu16223857.
The role of metabolic dysfunction-associated steatotic liver disease (MASLD) in sleeve gastrectomy (SG)-related outcomes remains uncertain. In this study, we aimed to assess the influence of preoperative biopsy-proven MASLD and its stages on weight loss after SG.
One hundred sixty-three patients with obesity undergoing SG with concomitant intraoperative liver biopsy were followed up for 1 year. Fifty-eight participants were categorized as no MASLD, thirty-eight as metabolic dysfunction-associated steatotic liver (MASL), and sixty-seven as metabolic dysfunction-associated steatohepatitis (MASH). Percentage total weight loss (%TWL) and percentage excess weight loss (%EWL) 1 year after SG were calculated for the different groups. We also evaluated the association between preoperative MASLD (and its stages) and weight loss, after adjusting for potential confounders.
Significant differences among groups were detected in %EWL ( = 0.004, ANOVA test), but not in %TWL ( = 0.079). However, significant differences in %TWL were found when MASH and no MASH (i.e., participants with MASL and participants without MASLD) groups were compared (27.3 ± 9.9 vs. 30.7 ± 9, respectively, = 0.025). In the linear regression model for predicting %EWL 1 year after SG, the presence of MASH was independently associated with a lower %EWL, after adjusting for age, sex, baseline body mass index (BMI), and baseline glycated hemoglobin (HbA1c) (Beta -7.1; 95% CI -13.6, -0.5; = 0.035). The presence of MASLD, liver fibrosis, or advanced liver fibrosis (≥F2) was also associated with lower %EWL after SG in crude models, although they did not remain significant after adjusting for these confounders. The presence of MASH was inversely related to %TWL, although the association did not remain significant after adjustment (Beta -2.7; 95% CI -5.7, 0.2; = 0.069).
MASH may be independently associated with lower %EWL 1 year after SG in patients with obesity.
代谢功能障碍相关脂肪性肝病（MASLD）在袖状胃切除术（SG）相关结局中的作用仍不确定。在本研究中，我们旨在评估术前经活检证实的MASLD及其分期对SG术后体重减轻的影响。
对163例接受SG并同时进行术中肝活检的肥胖患者进行了1年的随访。58名参与者被归类为无MASLD，38名被归类为代谢功能障碍相关脂肪性肝病（MASL），67名被归类为代谢功能障碍相关脂肪性肝炎（MASH）。计算不同组SG术后1年的总体重减轻百分比（%TWL）和超重减轻百分比（%EWL）。在调整潜在混杂因素后，我们还评估了术前MASLD（及其分期）与体重减轻之间的关联。
各组之间在%EWL方面存在显著差异（F = 0.004，方差分析检验），但在%TWL方面无显著差异（F = 0.079）。然而，比较MASH组和非MASH组（即MASL参与者和无MASLD参与者）时，%TWL存在显著差异（分别为27.3±9.9和30.7±9，P = 0.025）。在预测SG术后1年%EWL的线性回归模型中，调整年龄、性别、基线体重指数（BMI）和基线糖化血红蛋白（HbA1c）后，MASH的存在与较低的%EWL独立相关（β -7.1；95%CI -13.6，-0.5；P = 0.035）。在未调整模型中，MASLD、肝纤维化或晚期肝纤维化（≥F2）的存在也与SG术后较低的%EWL相关，尽管在调整这些混杂因素后它们不再显著。MASH的存在与%TWL呈负相关，尽管调整后该关联不再显著（β -2.7；95%CI -5.7，0.2；P = 0.069）。
对于肥胖患者，MASH可能与SG术后1年较低的%EWL独立相关。
