Clin Mol Hepatol > Volume 30(3); 2024 > Article
Clinical and Molecular Hepatology 2024;30(3): 561-576.
Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis
Juchul Hwang1, Hyeyoung Hwang1, Hyunjae Shin1, Bo Hyun Kim1, Seong Hee Kang2, Jeong-Ju Yoo3, Mi Young Choi4, Dong eun Lee5, Dae Won Jun6 , Yuri Cho1
1Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
3Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
4National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
5Biostatistics Collaboration Team, Research Institute, National Cancer Center, Goyang, Korea
6Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
Correspondence :  Dae Won Jun ,
Tel: +82-2-2290-8334, Fax: +82-2-2298-9183, Email:
Yuri Cho ,
Tel: +82-31-920-1680, Fax: +82-31-920-2799, Email:
Received: September 27, 2023  Revised: May 26, 2024   Accepted: June 1, 2024
Bariatric intervention has been reported to be an effective way to improve metabolic dysfunction-associated steatotic liver disease (MASLD) in obese individuals. The current systemic review aimed to assess the changes in MRI-determined hepatic proton density fat fraction (MRI-PDFF) and nonalcoholic fatty liver disease activity score (NAS) after bariatric surgery or intragastric balloon/gastric banding in MASLD patients with obesity.
We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH).
Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3–6 months compared to baseline, 40% at 12–24 months, and 50% at 36–60 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3–6 months, 37% at 12–24 months, and 29% at 36–60 months; lobular inflammation by 36% at 12–24 months and 51% at 36–60 months; ballooning degeneration by 38% at 12–24 months; significant fibrosis (≥F2) by 18% at 12–24 months and by 17% at 36–60 months after intervention.
Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.
KeyWords: MASH; Obesity; Bariatric intervention; MRI-PDFF; NAS

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