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NAFLD and interactions with insulin resistance
BARIATRIC SURGERY: A CURE FOR NASH?
Carel le Roux
Diabetes Complications Research Centre, Conway Institute,
University College Dublin, Ireland
E-mail: c.leroux@imperial.ac.uk
Take home messages
• Bariatric surgery is the most effective treatment for weight loss and its long-term maintenance; the
most commonly performed procedures are laparoscopic gastric bypass, adjustable gastric banding
and vertical sleeve gastrectomy.
• Bariatric surgery improves obesity-related comorbidities and reduces overall and cardiovascular
mortality.
• Gastric bypass works by reducing hunger, increasing satiation, changing food preferences and
increasing diet-induced energy expenditure.
• Adjustable gastric banding works probably through the reduction in hunger, which might be mediated
through vagal signalling.
• Some of the clinical and physiological effects of vertical sleeve gastrectomy are similar to gastric
bypass.
• NAFLD has been shown to improve significantly after bariatric surgery, but the evidence that NASH
improves is less clear.
• Understanding the mechanisms of action of these procedures could accelerate their optimization and
the development of novel, and hopefully safer, medications for obesity and T2DM.
Introduction [1-3]
The progression and pathophysiology of NASH has been covered previously in this session, suffice
to say that substantial weight loss leads to an attenuation of insulin resistance and related metabolic
syndrome and, concomitantly, a regression of liver steatosis. Bariatric surgery (Fig. 1) is the most effective
treatment option for severe obesity and associated metabolic comorbidities. Several longitudinal studies
have documented the marked benefit of bariatric surgery on NAFLD in close relation to the reversal of
insulin resistance, but evidence for reversal of NASH is less clear.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 53
BARIATRIC SURGERY: A CURE FOR NASH?
Carel le Roux
Diabetes Complications Research Centre, Conway Institute,
University College Dublin, Ireland
E-mail: c.leroux@imperial.ac.uk
Take home messages
• Bariatric surgery is the most effective treatment for weight loss and its long-term maintenance; the
most commonly performed procedures are laparoscopic gastric bypass, adjustable gastric banding
and vertical sleeve gastrectomy.
• Bariatric surgery improves obesity-related comorbidities and reduces overall and cardiovascular
mortality.
• Gastric bypass works by reducing hunger, increasing satiation, changing food preferences and
increasing diet-induced energy expenditure.
• Adjustable gastric banding works probably through the reduction in hunger, which might be mediated
through vagal signalling.
• Some of the clinical and physiological effects of vertical sleeve gastrectomy are similar to gastric
bypass.
• NAFLD has been shown to improve significantly after bariatric surgery, but the evidence that NASH
improves is less clear.
• Understanding the mechanisms of action of these procedures could accelerate their optimization and
the development of novel, and hopefully safer, medications for obesity and T2DM.
Introduction [1-3]
The progression and pathophysiology of NASH has been covered previously in this session, suffice
to say that substantial weight loss leads to an attenuation of insulin resistance and related metabolic
syndrome and, concomitantly, a regression of liver steatosis. Bariatric surgery (Fig. 1) is the most effective
treatment option for severe obesity and associated metabolic comorbidities. Several longitudinal studies
have documented the marked benefit of bariatric surgery on NAFLD in close relation to the reversal of
insulin resistance, but evidence for reversal of NASH is less clear.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 53
