Dear Editor,
We recently read a study by Hwang et al., published in
Clinical and Molecular Hepatology, which investigated the relationship between bariatric intervention and metabolic dysfunction-associated steatotic liver disease (MASLD) in obese patients [
1]. MASLD, formerly known as non-alcoholic fatty liver disease, is a complex chronic liver disease related to increasingly common metabolic disorders (especially obesity and type 2 diabetes mellitus) and is believed to affect more than 25% of adults worldwide [
2,
3]. MASLD has a significant impact on clinical work and the economy, as it increases the risk of hepatocellular carcinoma, non-liver cancers, and cardiovascular diseases, while also incurring significant medical expenses.
In this study, the results demonstrated that bariatric intervention can significantly improve the magnetic resonance imaging-determined hepatic proton density fat fraction and histological features of metabolic dysfunction-associated steatohepatitis in obese patients. Consequently, the authors believed that bariatric intervention is a viable treatment option for patients with MASLD. Additionally, we have further thoughts and considerations regarding this topic.
First, we would like to compare this study [
1] with another study conducted by Wong et al. [
4], which aimed to investigate the efficacy of lifestyle interventions in non-obese MASLD patients. Wong et al. discovered that despite having a relatively normal body mass index, a decrease in weight and waist circumference is still a crucial predictor of MASLD remission in non-obese patients. Compared with obese patients, a greater percentage of non-obese patients can achieve MASLD remission with the same amount of weight loss. These two studies imply that weight loss, whether through changes in lifestyle or surgical methods, may be advantageous for individuals with MASLD, regardless of whether they are obese or not.
Second, obesity is a globally prevalent chronic disease that is becoming increasingly more common among younger individuals [
5]. The increasing obesity rate among adolescents is a global health problem; thus, adolescent obesity also needs to be taken seriously. MASLD is one of the most common causes of chronic liver disease in adolescents in developed countries [
6]. However, since the subjects of this particular study were all adults, it is necessary to conduct further research to investigate the impact of weight control on MASLD, specifically in minors.
In summary, we appreciate the contributions made by Hwang et al, as their research provides new insights into the treatment of MASLD.
ACKNOWLEDGMENTS
This study was supported by the Medical Innovation Project of the Suzhou Science and Technology Bureau (No. SKYD2022068).
FOOTNOTES
-
Authors’ contribution
Drafting and writing of the article: Xiao-Song Li and Xi- Ping Shen; Conceptualization and supervision: Hang Li; Approval of the final article: All authors.
-
Conflicts of Interest
The authors have no conflicts to disclose.
Abbreviations
metabolic dysfunction-associated steatotic liver disease
non-alcoholic fatty liver disease
magnetic resonance imaging
REFERENCES
- 1. Hwang J, Hwang H, Shin H, Kim BH, Kang SH, Yoo JJ, et al. Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis. Clin Mol Hepatol 2024;30:561-576.
- 2. Le MH, Le DM, Baez TC, Dang H, Nguyen VH, Lee K, et al. Global incidence of adverse clinical events in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Clin Mol Hepatol 2024;30:235-246.
- 3. Duell PB, Welty FK, Miller M, Chait A, Hammond G, Ahmad Z, et al. Nonalcoholic fatty liver disease and cardiovascular risk: A scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol 2022;42:e168-e185.
- 4. Wong VW, Wong GL, Chan RS, Shu SS, Cheung BH, Li LS, et al. Beneficial effects of lifestyle intervention in non-obese patients with non-alcoholic fatty liver disease. J Hepatol 2018;69:1349-1356.
- 5. Kotanidou EP, Tsinopoulou VR, Karasogiannidou V, Stabouli S, Sapountzi E, Serbis A, et al. Evaluation of health-related quality of life in adolescents with obesity: A randomized qualitative study among healthcare professionals. Cureus 2024;16:e51928.
- 6. Anderson EL, Howe LD, Fraser A, Callaway MP, Sattar N, Day C, et al. Weight trajectories through infancy and childhood and risk of non-alcoholic fatty liver disease in adolescence: the ALSPAC study. J Hepatol 2014;61:626-632.
Citations
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- Correspondence to letter to the editor on “Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and meta-analysis”
Yuri Cho, Dae Won Jun
Clinical and Molecular Hepatology.2025; 31(1): e103. CrossRef
