A new study found that Roux-en-Y gastric bypass therapy showed good results in patients having low-body mass index with insulin-treated type 2 diabetes and having complete histologic resolution. The study was published in the 'Annals of Surgery.'
Metabolic dysfunction-associated fatty liver disease (MAFLD) is the multifactorial pathogenesis of fatty liver disease in metabolically sick patients. It is associated with many metabolic diseases like the type 2 diabetes (T2D), dyslipidemia, and obesity. There is uncertainty on the effects of metabolic surgery on MAFLD. Hence, researchers conducted a study to assesses the impact of Roux-en-Y gastric bypass (RYGB) on MAFLD in a prototypical cohort outside the guidelines for obesity surgery.
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A prospective, single-arm trial was carried out on twenty patients investigating the effects of RYGB on advanced metabolic disease. Patients aged 18 to 70 years having an insulin-dependent type 2 diabetes, with a body mass index of 25 to 35 kg/m2, glucagon-stimulated C-peptide of >1.5 ng/mL, glycated hemoglobin >7%, were included in the study. A RYGB with intraoperative liver biopsies and follow-up liver biopsies 3 years later was performed. Liver pathologists assessed the Steatohepatitis. Data were analyzed using the Wilcoxon rank sum test and a P value <0.05 was defined as significant.
Results:
MAFLD completely resolved after RYGB while fibrosis improved as well in all patients after 3 years.
Fifty-five percent were off insulin therapy with a significant reduction in glycated hemoglobin.
By upregulation of NRF1 and its dependent antioxidative and mitochondrial genes, RYGB reduced systemic and hepatic nitrotyrosine levels.
Central metabolic regulators such as SIRT1 and FOXO1 were upregulated while de novo lipogenesis was reduced, and β-oxidation was improved in line with an improvement of insulin resistance.
Lastly, gastrointestinal hormones and adipokines secretion were changed favorably.
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Thus, in low-body mass index patients with insulin-treated type 2 diabetes and with complete histologic resolution, RYGB appears to be a promising therapy for MAFLD. It also restores the oxidative balance, adipose tissue function, and gastrointestinal hormones.
Further reading: 10.1097/SLA.0000000000005631
Billeter AT, Scheurlen KM, Israel B, Straub BK, Schirmacher P, Kopf S, Nawroth PP, Müller-Stich BP. Gastric Bypass Resolves Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) in Low-BMI Patients: A Prospective Cohort Study. Ann Surg. 2022 Nov 1;276(5):814-821.