
Interrupting Liver Disease in Obesity
A new paper this morning in Nature Medicine tells us that interrupting liver disease in obesity is possible with metabolic surgery. More specifically, in an observational study of patients with obesity and cirrhosis due to MASH, Ali Aminian and colleagues found a 72% lower risk of major complications from liver disease in patients who received the surgery. Risk of progression toward liver failure (decompensated cirrhosis) was 80% lower.
This is nothing short of remarkable. Cardiologist Steven Nissen explains why:
“Currently, lifestyle intervention is the only therapeutic recommendation for compensated MASH-related cirrhosis. However, lifestyle changes alone rarely provide the weight loss and metabolic changes needed to reduce the risk of liver complications in this patient population. The SPECCIAL study shows that bariatric surgery is an effective treatment that can influence the trajectory of cirrhosis progression in select patients.”
SPECCIAL stands for Surgical Procedures Eliminate Compensated Cirrhosis in Advancing Long Term.
The First Ever Study of Long-Term Outcomes
This study of long-term outcomes from metabolic surgery in MASH-related cirrhosis is the first of its kind. Researchers followed 62 surgery patients and 106 nonsurgical controls. The mean follow-up was 10 years. They used a doubly robust estimation methodology to balance baseline characteristics between the surgery and control groups.
These findings are important because MASH with cirrhosis is growing more common as a complication of obesity. Yet the options for treatment are few. Diet and exercise can help, but only modestly. Last year, FDA approved resmitirom for treating MASH with fibrosis that has not yet progressed to cirrhosis. But there’s no evidence that it works for patients with cirrhosis.
MASH with cirrhosis is a serious condition that can lead to liver cancer, liver failure, and death. People need treatment options and this study strongly suggests that metabolic surgery is a good one. This is good news.
Click here for the new study, here, here, and here for further perspective on it.
Girl Interrupted at Her Music, painting by Johannes Vermeer / WikiArt
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January 27, 2025