Qu Yun-Fei, Wang Kang, Li Yue, Cheng Yu-Gang, Hu San-Yuan, Zhong Ming-Wei
Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, 250000, People's Republic of China.
Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine Shandong University, Jinan, Shandong, 250000, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Jul 29;18:2547-2560. doi: 10.2147/DMSO.S523771. eCollection 2025.
The impact of hepatic steatosis severity on postoperative weight loss outcomes remains unclear. This study aimed to evaluate the effect of fatty liver severity on percentage of excess weight loss (%EWL) in patients undergoing laparoscopic sleeve gastrectomy (LSG).
This retrospective cohort study included 226 patients with obesity who underwent LSG. Baseline data included liver biopsy grade (mild, moderate, or severe), body mass index (BMI), liver function, and metabolic parameters. Postoperative outcomes were assessed at 1, 3, 6, and 12 months. Statistical methods included the Pearson and Spearman correlations, chi-square test, Kruskal-Wallis test, general linear models, Kaplan-Meier analysis, and multivariate regression to identify the predictors of weight loss and cumulative rates of achieving 50% EWL and to plot the cumulative incidence curve.
Baseline BMI, homeostasis model assessment for insulin resistance, free fatty acids, and A1C levels were significantly associated with steatosis severity (P < 0.05). Severe metabolic dysfunction-associated steatotic liver disease (MASLD) was associated with a lower %EWL at 1, 3, 6, and 12 months (1 month %EWL: 32.34% vs 38.59% in the mild group; P < 0.05). The Kaplan-Meier analysis showed delayed achievement of 50% EWL in the severe group (P < 0.05). Multivariate regression analysis identified MASLD severity and preoperative BMI as independent predictors of %EWL. General linear models confirmed the significant dynamic effects of MASLD severity on weight loss over time (P < 0.05).
MASLD severity significantly affects postoperative weight loss and delays the achievement of optimal outcomes, especially in the early postoperative period. Preoperative evaluation of liver pathology is essential for optimizing surgical outcomes in patients with obese having MASLD.
肝脂肪变性严重程度对术后体重减轻结果的影响尚不清楚。本研究旨在评估脂肪肝严重程度对接受腹腔镜袖状胃切除术（LSG）患者的超重体重减轻百分比（%EWL）的影响。
这项回顾性队列研究纳入了226例接受LSG的肥胖患者。基线数据包括肝活检分级（轻度、中度或重度）、体重指数（BMI）、肝功能和代谢参数。在术后1、3、6和12个月评估术后结果。统计方法包括Pearson和Spearman相关性分析、卡方检验、Kruskal-Wallis检验、一般线性模型、Kaplan-Meier分析和多变量回归，以确定体重减轻的预测因素以及实现50%EWL的累积率，并绘制累积发病率曲线。
基线BMI、胰岛素抵抗的稳态模型评估、游离脂肪酸和糖化血红蛋白水平与脂肪变性严重程度显著相关（P<0.05）。严重代谢功能障碍相关脂肪性肝病（MASLD）与术后1、3、6和12个月时较低的%EWL相关（1个月时%EWL：轻度组为32.34%，重度组为38.59%；P<0.05）。Kaplan-Meier分析显示重度组实现50%EWL的时间延迟（P<0.05）。多变量回归分析确定MASLD严重程度和术前BMI是%EWL的独立预测因素。一般线性模型证实了MASLD严重程度对随时间体重减轻的显著动态影响（P<0.05）。
MASLD严重程度显著影响术后体重减轻，并延迟最佳结果的实现，尤其是在术后早期。对于患有MASLD的肥胖患者，术前评估肝脏病理对于优化手术结果至关重要。
