Abstract
Seeberg KA, Borgeraas H, Hofsø H, et al. Gastric bypass versus sleeve gastrectomy in type 2 diabetes: effects on hepatic steatosis and fibrosis: a randomized controlled trial. Ann Intern Med 2022;175:74–83. Bariatric surgery has an increasingly recognized role in treating metabolic syndrome, and benefits nonalcoholic fatty liver disease (NAFLD) specifically (Gastroenterology 2020;159:1290–1301). However, the extent to which bariatric surgery might impact NAFLD progression and whether various bariatric approaches affect this differently remain relatively unexplored. Seeberg et al undertook a single-center randomized trial in which 100 participants with type 2 diabetes mellitus (T2DM) and obesity were randomized 1:1 to either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) and followed up to 1 year postoperatively. Although the primary trial outcomes related to T2DM remission have been published (Lancet Diabetes Endocrinol 2019;7:912–924), this present study described predefined outcomes related to hepatic steatosis (assessed via liver fat fraction on magnetic resonance imaging), enhanced liver fibrosis test (as a proxy of hepatic fibrosis), and other noninvasive NAFLD markers. At 1-year follow-up, there was a 20% reduction (95% CI, 23% to 17%) in liver fat fraction in the SG group and 22% (95% CI, 24% to 19%) observed in the RYGB group, with no significant difference between groups. Almost all patients—94% of the SG group and 100% of the RYGB group—had no or low-grade steatosis at 1 year (compared with ∼25% of participants at baseline). The enhanced liver fibrosis score category remained stable in 77% of patients, but 18% experienced worsening of fibrosis at 1 year, with no substantial between-group difference. Weight loss, improvements in lipid profile, and remission rates for T2DM favored RYGB compared with SG. Collectively, these data demonstrate that both evaluated forms of bariatric surgery are of comparable high efficacy in improving hepatic steatosis, although this may not translate into short-term improvements in hepatic fibrosis. Study limitations include it being a single-center trial, possible underpowering for NAFLD-related outcomes (given the primary outcome relating to T2DM), and the reliance on a noninvasive marker (enhanced liver fibrosis) as the main measure of hepatic fibrosis, with no liver biopsies obtained. Given that steatohepatitis typically progresses to fibrosis over the course of years rather than months in NAFLD, results of the already planned longer-term follow-up will be of great pertinence for gauging the full impact of bariatric surgery. Splitting Hairs: Folliculin Parts the Good From the Bad in mTORC1 Control Over Lipid MetabolismGastroenterologyVol. 163Issue 2PreviewGosis BS, Wada S, Thorsheim C, et al. Inhibition of nonalcoholic fatty liver disease in mice by selective inhibition of mTORC1. Science 2022;376(6590):eabf8271. Full-Text PDF
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