Impact of bariatric surgery on metabolic-dysfunction associated fatty liver disease in diabetic and non-diabetic patients: a cohort study

Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent, especially in type 2 diabetes mellitus (T2DM). This study evaluates the effect of bariatric surgery on MAFLD in patients with obesity with or without diabetes. This registry-based longitudinal cohort study examined the effects of bariatric surgery on MAFLD in patients with obesity (BMI > 30 kg/m2) from 2017 to 2023. Clinical data were collected at baseline, 3–6 months, and 9–12 months post-surgery. The primary objective was to assess changes in fatty liver grading. This longitudinal cohort study, involved 194 patients (100 non-diabetic and 94 diabetic) undergoing bariatric surgery. The mean age was 42.11 ± 11.54 years, with a majority being female (77.84%). The initial mean BMI was 42.42 ± 6.75 kg/m², with non-diabetic patients having a higher mean BMI than diabetic patients. Both groups showed significant decreases in liver enzymes levels post-surgery. Ordinal GEE analysis indicated significant improvements in fatty liver grading for both groups post-surgery. The study found that diabetes, BMI, and triglyceride levels were significantly associated with changes in fatty liver grading. Our study demonstrates that bariatric surgery leads to improved MAFLD grading within the first year. However, higher BMI and triglyceride (TG) levels post-surgery were linked to poorer outcomes. Additionally, patients with a history of diabetes exhibited a lower likelihood of improvement in MAFLD grading compared to non-diabetic patients. Further clinical trials with larger sample sizes and extended follow-up durations are necessary to substantiate these findings.