TOPLINE

Among patients who underwent metabolic-bariatric surgery, the cardiometabolic cluster of metabolic dysfunction-associated steatotic liver disease (MASLD) was associated with a lower percentage of total body weight loss (%TBWL) after surgery and inferior type 2 diabetes outcomes compared with the liver-specific and control clusters.

METHODOLOGY

• Researchers conducted a retrospective analysis to evaluate whether MASLD clusters were associated with postoperative weight loss and diabetes outcomes during mid-term follow-up in patients who underwent metabolic-bariatric surgery.
• They included 588 patients (mean age, 45.1 years; 67.9% female; mean preoperative BMI, 51.4) who underwent metabolic-bariatric surgery at a centre in Germany between 2015 and 2025. Of these, 330 patients underwent Roux-en-Y gastric bypass and 258 underwent sleeve gastrectomy.
• Using a proposed algorithm, patients were grouped into the cardiometabolic cluster (n = 49), the liver-specific cluster (n = 52), and the control cluster (n = 487). Intraoperative liver biopsy data were obtained for 263 patients, and histologic findings were evaluated using the steatosis, activity, and fibrosis score.
• Changes in total body weight were assessed at 6 and 12 months and at 12-month intervals thereafter up to 4 years after surgery; %TBWL was also estimated.
• Diabetes outcomes were evaluated at 1, 2, and 5 years after surgery based on A1c levels and classified as no diabetes (A1c levels < 6.0%), remission (A1c levels < 6.5%), improvement (a decrease in A1c levels of 1.0% or an A1c level < 7.0%), no change (a difference in A1c levels of < 1.0%), or worsening (any increase in A1c levels).

TAKEAWAY

• Among patients who underwent liver biopsy, the overall prevalence of MASLD was 72.2%. It was higher in the cardiometabolic cluster group (90.0%) and the liver-specific cluster group (100%) than in the control cluster group (66.8%).
• Patients in the cardiometabolic cluster group had lower %TBWL than those in the liver-specific cluster group and control cluster group at 6 months (14.6% vs 17.4% vs 16.5%; P = .043) and 12 months (22.1% vs 29.5% vs 28.6%; P < .001) after surgery, with similar findings at 24 months (P < .001), 36 months (P = .01), and 48 months (P = .044).
• Among patients with type 2 diabetes, those in the cardiometabolic cluster group had a lower remission rate (23.5%) than those in the liver-specific cluster group (87.5%) and control cluster group (66.0%) at 1 year after surgery.
• In a multivariable analysis at 12 months, assignment to the cardiometabolic cluster (P = .034), a diagnosis of diabetes (P = .048), and older age (P < .001) were each associated with reduced weight loss after surgery.

IN PRACTICE

"Perioperative data-driven clustering for MASLD seems to identify distinct types of MASLD in MBS [metabolic-bariatric surgery] candidates, correlating with histological liver results," the authors wrote. "Incorporation of MASLD clustering into preoperative assessment may enhance counselling, individual treatment planning and the establishment of realistic expectations," they added.

SOURCE

This study was led by Jakob Lauerer, Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany. It was published online on October 27, 2026, in Obesity Surgery.

LIMITATIONS

The retrospective design limited the generalisability of the findings. About two thirds of patients who underwent surgery lacked the laboratory data required for the clustering process, which may have introduced selection bias. The follow-up rate was low and declined steadily over time, which may have skewed the results towards certain patient populations.

DISCLOSURES

No specific funding was reported for the study. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.