Surgery for weight loss may lower the risk of liver disease.

According to a new study, bariatric surgery may help the expanding global population of obese people avoid the hazardous repercussions of a condition known as fatty liver disease.

Fatty liver disease affects one-quarter of the world's population, primarily owing to obesity, and there is no treatment approved by US regulators. According to the study, which looked at the records of over 1,000 patients over the course of a decade, weight-loss treatments can reduce the chance of cirrhosis and other liver-disease complications or mortality by 88 percent in individuals with inflammation and scarring in their livers.

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Previous research has demonstrated the benefits of bariatric surgery as a treatment for diabetes and other illnesses in people who meet the criteria for bariatric surgery because of excessive obesity or excess weight combined with a major chronic condition. While weight-loss operations are not without risk, doctors claim they have gotten safer in recent years and have assisted patients in maintaining healthier weights when used in conjunction with exercise, better diets, and other measures.

According to data that the authors of the new study expect to publish later, bariatric surgery may even repair some liver damage. According to a research published Thursday in the Journal of the American Medical Association, the operation may lower the risk of heart attacks, strokes, heart failure, and other major cardiovascular disorders or mortality by 70%. Cardiovascular disease is the major cause of death in persons with fatty livers.

"This was a well-done study," said Manal Abdelmalek, a hepatologist and director of Duke University's nonalcoholic fatty liver disease clinical research program who wasn't involved in the study. Dr. Abdelmalek says she talks to patients who are candidates for bariatric surgery on the long-term health benefits of the procedure. Cirrhosis is more likely to develop in people who have mild scarring of the liver, she noted.

According to Ali Aminian, director of the Cleveland Clinic's Bariatric and Metabolic Institute and lead author of the study, "the study suggests bariatric surgery as a potentially effective treatment for patients who qualify for the procedure due to their obesity and who have a more severe form of fatty liver disease called nonalcoholic steatohepatitis, or NASH." NASH causes inflammation in the liver, which can lead to scarring and cirrhosis, as well as other consequences. Experts estimate that NASH affects more than 25% of persons in the United States who have fatty liver disease.

The most frequent cause of chronic liver disease worldwide is nonalcoholic fatty liver disease, or fat deposited in the liver. According to a research published earlier this year in The Lancet, it is directly linked to the obesity epidemic, which affects up to 64 percent of persons with Type 2 diabetes and up to 80 percent of obese people. It can also happen in persons of normal weight who have other metabolic risk factors, according to the study.

The Covid-19 epidemic may have exacerbated the situation: Obesity rates have likely increased, at least among children and adolescents, according to the Centers for Disease Control and Prevention.

The disease can range from basic liver fat to inflammation and scarring comparable to that caused by high alcohol consumption, and it can lead to liver cancer, liver failure, and death, in addition to cirrhosis.

A liver biopsy is required for diagnosis. "Most individuals don't know they have it until they start getting into problems and having awful outcomes," said Steven Nissen, senior author of the study and chief academic officer of the Cleveland Clinic's Heart and Vascular Institute.

The study was observational, which means it found a correlation rather than a cause and effect relationship. It involved 1,158 obese patients who had liver biopsies at the Cleveland Clinic between 2004 and 2016, which revealed mild to severe scarring of their livers.

Ten years after enrollment, 2.3 percent of the 650 patients who had bariatric surgery developed cirrhosis, liver cancer, required a liver transplant, or died of liver disease. The problems were found in 9.6% of the 508 people who did not have surgery but were advised to exercise and consume a healthy diet. 8.5 percent of those who had surgery and 15.7 percent of those who did not experienced a heart attack or other major cardiovascular event.

Within 30 days of surgery, 62 (9.5%) of the surgical patients experienced significant problems, and four patients died within the first year.

Follow-up liver biopsies were performed on some of the patients, allowing the researchers to compare their fatty liver disease before and after surgery. Dr. Aminian noted that in half of the patients, inflammation in their livers had reduced and scar tissue had vanished, indicating a reversal of liver damage. Those figures have yet to be made public, he said.

Dawn Gerz, a study participant and former Cleveland Clinic nurse, discovered she had fatty liver disease after a biopsy during bariatric surgery. She had the weight-loss treatment in her mid-40s after gaining 305 pounds and being unable to shed weight despite making lifestyle modifications. Ms. Gerz, who is now the chief nursing officer at East Liverpool City Hospital in Ohio, said, "I couldn't do the things I wanted to do."

Her doctors kept an eye on her liver, and when she lost weight following the surgery, it returned to normal, she added. Ms. Gerz, who is 61 years old and weighs around 155 pounds, now eats a lot of salads, participates in Weight Watchers, and walks a lot. She speculates on what may have happened if she hadn't had the surgery and discovered she had liver illness.

"It's almost like you're a ticking time bomb that you're not even aware of," she remarked.