Impact of multidisciplinary steatotic liver disease management on bariatric surgery referral and clinical outcomes: A retrospective cohort study

Figure 1 Flowchart representing patient evaluation and characterization in this retrospective cohort study. ¹Standard eligibility criteria are body mass index > 40 kg/m² or > 35 kg/m² plus obesity-associated comorbidity. MASLD: Metabolic dysfunction-associated steatotic liver disease; BSE: Bariatric surgery eligible; BSNE: Bariatric surgery non-eligible; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy; MBSAQIP: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

Figure 2 Weight and liver-related outcomes in patients with metabolic dysfunction-associated steatotic liver disease undergoing bariatric surgery vs lifestyle management/medication. A: Comparison between total body weight loss in patients who underwent gastric bypass or sleeve gastrectomy vs non-surgical management (lifestyle/medication). P < 0.0001 for weight loss through either type of bariatric surgery compared to non-surgical management (unpaired t-test, Welch’s); B: Comparison between actual vs predicted body mass index post bariatric surgery (P = 0.12, unpaired t-test, Welch’s). The predicted body mass index was obtained using the Metabolic and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Bariatric Surgical Risk/Benefit Calculator; C: Change in fibrosis-4 in patients who underwent bariatric surgery vs lifestyle/medication management (P < 0.048, unpaired t-test, Welch’s); D: Change in nonalcoholic fatty liver disease fibrosis score in patients who underwent bariatric surgery vs lifestyle/medication management (P = 0.005); E: Number of patients with each fibrosis stage pre-surgery. Categories are as follows: F0-1: 2.0-8.4 kPa, F2: 8.5-9.4 kPa, F3: 9.5-13.5 kPa, F4 > 13.5 kPa; F: Change in liver stiffness from pre-surgery to post-surgery for patients undergoing bariatric surgery. TBWL: Total body weight loss; BMI: Body mass index; FIB-4: Fibrosis-4; NFS: Nonalcoholic fatty liver disease fibrosis score; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy.