Endocrine Abstracts

Introduction: In 2020, a group of experts proposed to change the term “non-alcoholic fatty liver disease” (NAFLD) to “metabolic-associated fatty liver disease” (MAFLD), which includes hepatic steatosis (HS) (using imaging or analytical scores) associated with overweight or obesity, type 2 diabetes (T2D), or the presence of two other metabolic disorders.

Objectives: Analyse the impact of bariatric surgery on MAFLD.

Methods: A total of 43 patients with obesity diagnosed with MAFLD were analysed before and 12 months after bariatric surgery. We compared body mass index (BMI), abdominal perimeter, body fat, HS, and liver fibrosis. HS was diagnosed using abdominal ultrasound and/or NAFLD Liver Fat Score (NAFLD-LFS: metabolic syndrome, T2D, plasma insulin, AST, and ALT). Liver fibrosis risk was assessed using NAFLD Fibrosis Score (NAFLD-FS: age, BMI, fasting glucose, AST, ALT, platelets, and albumin).

Results: Median pre-surgery age was 52 years (44-57), 51% were female. Median BMI was 42kg/m2 (40-43), median abdominal perimeter and body fat were 130 cm (122-139) and 37% (34-38) in males, and 123 cm (116-134) and 49% (45-50) in females. Regarding comorbidities, 72% had MS, 56% had T2D, 93% had HS identified with abdominal ultrasound and 98% using NAFLD-LFS. Hepatomegaly was observed in 56%. A high risk of fibrosis was calculated in 25%, no fibrosis risk in 19% and an indetermined score in 56%. Laboraty result revealed increased transaminases In 21%, increased gamma-GT in 30%, 2% thrombocytopenia, 5% hypoalbuminemia, and 2% hyperalbuminemia. After surgery, we observed 60.5% remission of MAFLD, with reduction in BMI (-13.2kg/m2, P<0.001), abdominal perimeter (-28cm in males and -25cm in females, P<0.001) and body fat (-19% in males and -15% in females, P<0.001). There was also 50% and 79% remission of MS and T2D, as well as 58% and 88% regression of steatosis and hepatomegaly in abdominal ultrasound, and 82% reduction of NAFLD-LFS steatosis. NAFLD-FS showed an overall reduction, with 60% at no risk and 40% with indeterminate scores after surgery. There was a significant reduction in platelet count (244x109/l (191-278), P=0.002), ALT (20U/l (14-33), P<0.001), gamma-GT (15U/l (11 -22), P<0.001) and insulin (6mU/ml (4-8), P<0.001), but no change in AST (19U/l (16-29), P=0.125), nor albumin levels (44g/l (43-46), P=21).

Conclusions: Following bariatric surgery, we observed similar outcomes in MAFLD as those described for NAFLD (66% remission). These results are associated with a significant improvement in comorbidities, with an overall reduction in liver fibrosis risk.