Bariatric-metabolic surgery more effective than lifestyle modification plus best medical care
By Elana Gotkine HealthDay Reporter
WEDNESDAY, May 3, 2023 (HealthDay News) — For patients with nonalcoholic steatohepatitis (NASH), bariatric-metabolic surgery is more effective than lifestyle modification plus best medical care, according to a study published online April 20 in The Lancet.
Ornella Verrastro, Ph.D., from the Università Cattolica del Sacro Cuore in Rome, and colleagues conducted a multicenter randomized trial involving patients aged 25 to 70 years with obesity, with or without type 2 diabetes, with histologically confirmed NASH. Participants were randomly assigned to lifestyle modification plus best medical care, Roux-en-Y gastric bypass, or sleeve gastrectomy (96 patients to each group).
The researchers found that the percentage of patients who met the primary end point of histological resolution of NASH without worsening of fibrosis at one-year follow-up was significantly higher in the Roux-en-Y gastric bypass and sleeve gastrectomy groups compared with the lifestyle modification group (56 and 57 percent, respectively, versus 16 percent) in the intention-to-treat analysis. In the per-protocol analysis, the primary end point was met by 70, 70, and 19 percent, respectively. There were no reports of deaths or life-threatening complications. Ten participants who had bariatric-metabolic surgery had severe adverse events; they did not require reoperations.
“The presence of NASH predicts a significant risk of complications and mortality in people with severe obesity and type 2 diabetes,” a coauthor said in a statement. “The results of this study provide a compelling case for prioritization of metabolic surgery in this patient population.”
Two authors disclosed financial ties to the pharmaceutical industry.
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