Obesity Surgery

, Volume 29, Issue 4, pp 1295–1300 | Cite as

Weight Loss After Bariatric Surgery Predicts an Improvement in the Non-alcoholic Fatty Liver Disease (NAFLD) Fibrosis Score

  • Shanwen Charleen YeoEmail author
  • Weijie Marc Ong
  • Kui Sing Anton Cheng
  • Chun Hai Tan
Original Contributions



Non-alcoholic fatty liver disease (NAFLD) is present in up to 90% of bariatric surgery patients. Previous literature has demonstrated an improvement in liver steatosis and fibrosis in post-bariatric surgery patients. Our study aims to investigate if bariatric surgery results in an improvement in NAFLD fibrosis scores, and if this correlates with weight loss.


A retrospective study was conducted on all patients who underwent bariatric surgery from 2010 to 2016 in our institution. Patients who had a redo bariatric surgery or concomitant gastric pathologies were excluded. Indications for bariatric surgery followed the Asia-Pacific Metabolic and Bariatric Surgery Society guidelines.


There were 192 patients in this study, with the majority being females (n = 120, 63%). Mean age was 42.7 ± 10.2 years old. Pre-operative mean weight and body mass index (BMI) were 113 ± 27.9 kg and 41.6 ± 7.98 kg/m2 respectively. The mean pre-operative NAFLD fibrosis score was − 1.27. Six-month and 1-year follow-up post-surgery demonstrated a decrease in mean weight to 90.6 and 85.9 kg and a decrease in mean BMI to 33.8 and 31.6 kg/m2. Mean NAFLD scores improved from − 1.27 to − 1.56 to − 2.00. The correlation between weight loss and NAFLD fibrosis score improvement was statistically significant at the first post-operative year (r-coefficient = 0.36, p value ≤ 0.001).


Bariatric surgery results in weight reduction as well as an improvement in the NAFLD fibrosis score. The degree of weight loss predicts the extent of improvement in NAFLD fibrosis scores. More long-term studies need to be conducted to assess if this effect is permanent.


Bariatric surgery Metabolic surgery Weight loss Non-alcoholic fatty liver disease Liver fibrosis NAFLD fibrosis score 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

For this type of study, formal consent is not required.


  1. 1.
    Pillai AA, Rinella ME. Non-alcoholic fatty liver disease: is bariatric surgery the answer? Clinics in Liver Disease. 2009;13(4):689–710.CrossRefGoogle Scholar
  2. 2.
    Sasaki A, Nitta H, Otsuka K, et al. Bariatric surgery and non-alcoholic fatty liver disease: current and potential future treatments. Front Endocrinol. 2014;5:164.CrossRefGoogle Scholar
  3. 3.
    Kleiner DE, Makhlouf HR. Histology of NAFLD and NASH in adults and children. Clinics in liver disease. 2016;20(2):293–312.CrossRefGoogle Scholar
  4. 4.
    Musso G, Gambino R, Cassader M, et al. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43(8):617–49.CrossRefGoogle Scholar
  5. 5.
    Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.CrossRefGoogle Scholar
  6. 6.
    Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95.CrossRefGoogle Scholar
  7. 7.
    Ekstedt M, Franzén LE, Mathiesen UL, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44:865–73.CrossRefGoogle Scholar
  8. 8.
    Adams LA, Lymp JF, St Sauver J, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113–21.CrossRefGoogle Scholar
  9. 9.
    Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45(4):600–6.CrossRefGoogle Scholar
  10. 10.
    Cimini FA, Barchetta I, Carotti S, et al. Relationship between adipose tissue dysfunction, vitamin D deficiency and the pathogenesis of non-alcoholic fatty liver disease. World J Gastroenterol. 2017 May 21;23(19):3407–17.CrossRefGoogle Scholar
  11. 11.
    Oh MK, Winn J, Poordad F. Review article: diagnosis and treatment of non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2008;28:503–22.CrossRefGoogle Scholar
  12. 12.
    Nakano M, Murohisa T, Imai Y, et al. Validity of the NAFLD fibrosis score in a Japanese population. Nihon Shokakibyo Gakkai Zasshi. 2012;109:751–9.Google Scholar
  13. 13.
    Treeprasertsuk S, Björnsson E, Enders F, et al. NAFLD fibrosis score: a prognostic predictor for mortality and liver complications among NAFLD patients. World J Gastroenterol. 2013;19(8):1219–29.CrossRefGoogle Scholar
  14. 14.
    Lassailly G, Caiazzo R, Pattou F, et al. Bariatric surgery for curing NASH in the morbidly obese. J Hepatol. 2013;58(6):1249–51.CrossRefGoogle Scholar
  15. 15.
    Mummadi RR, Kasturi KS, Chennareddygari S, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.CrossRefGoogle Scholar
  16. 16.
    Gasteyger C, Larsen TM, Vercruysse F, et al. Effect of a dietary-induced weight loss on liver enzymes in obese subjects. Am J Clin Nutr. 2008;87(5):1141–7.CrossRefGoogle Scholar
  17. 17.
    Mathurin P, Hollebecque A, Amalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. Aug 2009;137(2):532–40.CrossRefGoogle Scholar
  18. 18.
    Cazzo E, Jimenez LS, Pareja JC, et al. Effect of Roux-en-Y gastric bypass on non-alcoholic fatty liver disease evaluated through NAFLD fibrosis score: a prospective study. Obes Surg. 2015;25:982–5.CrossRefGoogle Scholar
  19. 19.
    Abangah G, Yousefi A, Asadollahi R, et al. Correlation of body mass index and serum parameters with ultrasonographic grade of fatty change in non-alcoholic fatty liver disease. Iran Red Cres Med J. 2014 January;16(1):e12669.CrossRefGoogle Scholar
  20. 20.
    Fassio E, Alvarez E, Dominguez N, et al. Natural history of non-alcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology. 2004;40(4):820–6.Google Scholar
  21. 21.
    Nickel F, Tapking C, Benner L, et al. Bariatric surgery as an efficient treatment for non-alcoholic fatty liver disease in a prospective study with 1-year follow up. Obes Surg. 2017 Nov 9;[Epubaheadofprint].
  22. 22.
    Fischer L, Wekerle AL, Bruckner T, et al. BariSurg trial: sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2—a multi-centre randomized patient and observer blind non-inferiority trial. BMC Surg. 2015;15(1):87.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Bariatric SurgeryKhoo Teck Puat HospitalSingaporeSingapore

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