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A quarter of American adults have obesity, fatty liver due to non-drinking, and there is no medical treatment for it. Doctors say the only way to keep it under control is to lose weight and eat a healthier diet.

Now a new study reports that bariatric surgery can protect the liver as well as aid weight loss. The findings were striking: In a group of more than 1,100 patients with an aggressive form of fatty liver disease, those who had weight-loss surgery reduced their risk of advanced liver disease, liver cancer, or death from it by almost 90 percent in the next period. ten years.

Only five of the 650 patients who underwent bariatric surgery subsequently developed one of these serious liver outcomes, compared to 40 of the 508 patients who did not have the procedure.

Weight loss surgery patients were at significantly lower risk for cardiovascular disease, a finding consistent with previous research. They were 70 percent less likely to experience a heart attack, stroke, or heart failure, or die from heart disease, according to the study. The study, published Thursday in JAMA.

D., director of the Cleveland Clinic’s Bariatric and Metabolic Institute and lead author of the study. Ali Aminian said the weight loss likely stopped the disease in its tracks.

Dr. “Obesity is the main cause of fatty liver – it all starts with obesity,” Aminian said. “When we have excess fat accumulating in the liver, it causes fatty liver; then the inflammation comes and worsens and then scar tissue forms and leads to cirrhosis.

“When a patient loses weight, fat comes out from all parts of it, including the liver; the inflammation subsides and some of the scar tissue can be reversed and healed,” Dr. Aminian continued. “Weight loss is the main factor here.”

D., chief academic officer of the Cardiovascular Institute at Cleveland Clinic and senior author of the study. Steven Nissen said the results were remarkable.

The postoperative disease outcome was “the lowest I’ve seen in 30 years of studies, an 88 percent reduction in progression to advanced liver disease,” he said.

The observational study at the Cleveland Clinic that examined cases over 12 years found no causal link to lower risks of serious liver or heart conditions from weight loss procedures, but the findings add to the growing evidence that bariatric surgery may provide health benefits beyond weight loss. . About 100 million American adults are dangerously obese; Every year, approximately 250,000 bariatric surgeries are performed.

However, surgery carries serious risks. Of the 650 weight-loss surgery patients in the study group, 62 developed serious complications after surgery, and four died within one year of surgery.

The most common procedure is called sleeve gastrectomy. Only one-fifth of the patients studied in this report had this procedure. The vast majority had Roux-en-Y gastric bypass surgery.

More than 40 percent of American adults struggle with obesity. About 75 percent have nonalcoholic fatty liver disease, which is usually a silent condition with no obvious symptoms. But one in four or one in five will develop an aggressive form of the disease that causes liver fibrosis called nonalcoholic steatohepatitis or NASH, and one in five of these individuals will develop cirrhosis or scarring of the liver, which is their only treatment. liver transplant.

There are no approved medications or treatments for nonalcoholic fatty liver disease. Doctors often advise patients to lose weight and switch to a healthier diet to reduce fat, inflammation and fibrosis in the liver, a vital organ that converts food and drink into nutrients and filters harmful substances from the blood.

Obese patients undergoing bariatric surgery often lose up to 25 percent of their body weight, much more than patients who diet to lose weight. After surgery, they usually need less medication to keep conditions such as Type 2 diabetes, high blood pressure, and high cholesterol under control.

However, the new study is not conclusive. It was a retrospective observational study comparing the long-term outcomes of 650 bariatric surgical patients with 508 nonsurgical closely matched patients. Thus, it was not the kind of randomized controlled trial considered the gold standard in medicine, randomly assigning patients with similar characteristics to an intervention arm or a placebo.

A few of the paper’s 16 authors consult or receive research funding from companies that make devices used in weight loss surgery. Both Dr. Aminian and Dr. Nissen receives funding from Medtronic, the world’s largest medical device company, and Dr. Nissen also receives funding from Ethicon, a manufacturer of medical and surgical instruments. However, they received no outside funding for this study.

One concern in studies like this one is that patients who choose weight loss surgery may be inherently different from those who don’t. They may be more motivated; they have health insurance or the means to cover procedures; and they’re too healthy for surgeons to turn them down.

But in this case, Dr. Nissen said the benefit was so dramatic, “even if it’s doubly wrong, it still means the risk is significantly reduced.”

The study reviewed the Cleveland Clinic cases of 1,158 obese patients who, from 2004 to 2016, showed that they had advanced nonalcoholic fatty liver disease with fibrosis on liver biopsies. Women represented more than 60 percent of patients; the average age was just under 50; and a median body mass index of 44, considered dangerously overweight. Heart disease also decreased after weight-loss surgery, as previous studies have shown: About 8.5 percent of people who had bariatric surgery had a heart attack, compared with 15.7 percent of those who didn’t have surgery.

Dr. “Fatty liver disease is the most important disease most Americans know essentially nothing about,” Nissen said. “It is now a more important cause of liver failure than alcohol. And with the obesity epidemic, this disease is increasing at a truly frightening rate.”