Effects of bariatric surgery on non-invasive markers of MASLD: a retrospective analysis

MASLD is common form of chronic liver disease leading to cirrhosis and liver cancer. This study evaluated the impact of bariatric surgery on the progression of MASLD.

This was a retrospective study of 181 patients undergoing weight loss surgery (sleeve gastrectomy (SG = 54) or Roux-en-Y gastric bypass (RGB = 127) at TidalHealth, Salisbury, MD from 2017 to 22. Non-invasive markers of fibrosis: FIB-4, MASLD Fibrosis Score (MFS), and BARD were assessed at baseline and 12-18 months post-op. Change in fibrosis was assessed using the paired t-test.

Baseline demographics, including BMI, AST, ALT, platelet count, and comorbidities (diabetes, hypertension), are presented in Table 1. Pre- and post-op changes in non-invasive fibrosis scores are summarized in Table 2. The majority of the included patients (127) underwent gastric bypass (70.2%); whereas 54 patients underwent a gastric sleeve procedure (29.8%). Mean change in BMI was 46.2 to 37.8 (p < 0.001). A statistically significant reduction in the mean MFS (0.205 to -0.373, p = 0.0001; 95% CI: 0.28 to 0.87) was observed, indicating a shift in fibrosis scores from the indeterminate to the low-risk fibrosis category for the entire cohort. In a subgroup of 25 patients with advanced baseline fibrosis (FIB-4 > 1.4[2] ), bariatric surgery resulted in a significant reduction in MFS from 1.63 to 0.84 (p = 0.001), indicative of meaningful score-based improvement in estimated fibrosis risk. In a subgroup of patients with advanced fibrosis at baseline (n = 25 patients), the drop in BARD score was statistically significant (3.48 to 3.28; p = 0.05). The FIB-4 score showed a modest but statistically significant increase in the overall cohort (0.95 to 1.02; p = 0.004), and remained essentially unchanged in the advanced fibrosis subgroup (1.94 to 1.92; p = 0.80), highlighting the limitations of this index for longitudinal monitoring.

Bariatric surgery resulted in significant improvement in non-invasive fibrosis scores of MASLD, as shown by reduction in the MFS and BARD scores in the group with advanced fibrosis. Changes in the FIB-4 scores were less consistent, suggesting this test is less useful for longitudinal assessment of fibrosis in patients with MASLD and is better suited as a screening tool.