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

BACKGROUND AND AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.