Author information

¹Internal Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands w.theel@franciscus.nl.

²Centrum Gezond Gewicht, Rotterdam, The Netherlands.

³Endocrinology, Erasmus MC, Rotterdam, The Netherlands.

⁴Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

⁵Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.

⁶Gastroenterology & Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

⁷Pediatrics, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

⁸Bariatric Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

⁹Cardiology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

¹⁰Gastroenterology and Hepatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands.

¹¹Pathology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

¹²Clinical Chemistry, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.

¹³Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.

¹⁴Analytical Biosciences, Leiden Academic Centre for Drug Research, Leiden, The Netherlands.

¹⁵Internal Medicine, Franciscus Gasthuis & Vlietland Berkel, Rotterdam, The Netherlands.

Abstract

Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) ranges from 25% in the general population to 90% in patients with obesity scheduled for bariatric surgery. NAFLD can progress towards non-alcoholic steatohepatitis (NASH) associated with complications such as cirrhosis, hepatocellular carcinoma and cardiovascular disease. To date, losing weight and lifestyle modifications are the best known treatments for NASH. Bariatric surgery significantly improves NAFLD/NASH in the short term. However, the extent of this improvement is not yet clear and long-term data on the natural course of NAFLD/NASH after bariatric surgery are lacking. The factors involved in NAFLD/NASH regression after bariatric surgery have not been elucidated.

Methods and analysis: This is an observational prospective cohort study including patients scheduled for bariatric surgery. Extensive metabolic and cardiovascular analyses will be carried out including measurements of carotid intima media thickness and pulse wave velocity. Genomic, proteomic, lipidomic and metabolomic studies will be done. Microbioma analyses before and 1 year after surgery will be done. Transient elastography measurements will be performed before and at 1, 3 and 5 years after surgery. For those with an elevated preoperative transient elastography measurement by Fibroscan, a laparoscopic liver biopsy will be performed during surgery. Primary outcome measures are the change of steatosis and liver fibrosis 5 years after surgery. Secondary outcome measure is the comparison of the transient elastography measurements with the NAFLD Activity Score from the biopsies.

Ethics and dissemination: The protocol has been approved by the Medical Research Ethics Committees United, Nieuwegein, on 1 March 2022 (registration code R21.103/NL79423.100.21). The study results will be submitted for publication in peer-reviewed journals and data will be presented at scientific meetings.

Trial registration number: NCT05499949.