Differential Impact of Metabolic Bariatric Surgery Versus Semaglutide on Adverse Hepatic and Extrahepatic Outcomes in Individuals With Metabolic Dysfunction-Associated Steatotic Liver Disease and Type 2 Diabetes.

Stupalkowska W, Henney AE, Riley DR, Sheu EG, Alam U, Cuthbertson DJ

Diabetes, obesity & metabolism13 Apr 2026

PMID41969188PMCIDPMC13243962DOI10.1111/dom.70757PepBankPUB-41969188

Summary

AimWe compared the impact of metabolic bariatric surgery (MBS) versus semaglutide on clinical outcomes in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D).MethodsPatients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database). The primary outcome was a composite of major adverse liver outcomes (MALO): decompensation events or liver transplant. Secondary outcomes included a composite of major adverse cardiovascular events (MACE), first diagnosis of cirrhosis, heart failure, or obesity-associated cancer (OAC), and all-cause mortality (ACM). Subgroup analyses were performed for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).ResultsMBS, compared with semaglutide, was associated with a higher hazard rate (HR) of MALO (HR 1.63; 95% CI 1.12-2.37); this was driven by RYGB (2.01; 1.26-3.20) but not by SG (0.97; 0.52-1.78). However, after excluding patients with pre-existing cirrhosis, MBS was associated with a reduced HR of new cirrhosis (0.46; 0.29-0.73). For extrahepatic events, MBS was associated with a reduced HR of MACE (0.51; 0.38-0.67), heart failure (0.41; 0.27-0.62), and OAC (0.56; 0.34-0.92). There was no difference in ACM between MBS and semaglutide, but in subgroup analysis, RYGB was associated with increased ACM compared to semaglutide (1.64; 1.01-2.67).ConclusionIn patients with MASLD and T2D, MBS, and specifically RYGB, as compared to semaglutide, may drive a relatively increased risk of MALO despite protection against MACE, the first diagnosis of cirrhosis, heart failure, and OAC. Liver evaluation in individuals with T2D referred for MBS may help optimize their treatment.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study9

9 results from studies that gave the peptide. 9 results from people.

01HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, semaglutide use was associated with a lower hazard of major adverse liver outcomes than metabolic bariatric surgery.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide use was linked to fewer major liver events than weight-loss surgery.
Peptide
Semaglutide
Outcome
DecreaseMajor adverse liver outcomes (decompensation or liver transplant)
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Primary
Outcome group
Liver fat and liver function · Liver
Studied dose
Dose not stated
Measurements
Hazard ratio, MBS vs semaglutide
1.63 HR
MALO
Source sentences
Summary
MBS, compared with semaglutide, was associated with a higher hazard rate (HR) of MALO (HR 1.63; 95% CI 1.12-2.37)
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918801
02HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes without pre-existing cirrhosis, semaglutide use was associated with a higher hazard of new cirrhosis than metabolic bariatric surgery.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide use was linked to more new cirrhosis than weight-loss surgery.
Peptide
Semaglutide
Outcome
IncreaseNew cirrhosis after excluding pre-existing cirrhosis
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Secondary
Outcome group
Liver fat and liver function · Liver
Studied dose
Dose not stated
Measurements
Hazard ratio, MBS vs semaglutide
0.46 HR
new cirrhosis
Source sentences
Summary
However, after excluding patients with pre-existing cirrhosis, MBS was associated with a reduced HR of new cirrhosis (0.46; 0.29-0.73).
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918804
03HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, semaglutide use was associated with a higher hazard of major adverse cardiovascular events than metabolic bariatric surgery.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide use was linked to more major heart and vessel events than weight-loss surgery.
Peptide
Semaglutide
Outcome
IncreaseMajor adverse cardiovascular events
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Secondary
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Measurements
Hazard ratio, MBS vs semaglutide
0.51 HR
MACE
Source sentences
Summary
For extrahepatic events, MBS was associated with a reduced HR of MACE (0.51; 0.38-0.67), heart failure (0.41; 0.27-0.62), and OAC (0.56; 0.34-0.92).
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918805
04HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, semaglutide use was associated with a higher hazard of heart failure than metabolic bariatric surgery.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide use was linked to more heart failure than weight-loss surgery.
Peptide
Semaglutide
Outcome
IncreaseHeart failure
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Secondary
Outcome group
Heart function · Cardiovascular
Studied dose
Dose not stated
Measurements
Hazard ratio, MBS vs semaglutide
0.41 HR
heart failure
Source sentences
Summary
For extrahepatic events, MBS was associated with a reduced HR of MACE (0.51; 0.38-0.67), heart failure (0.41; 0.27-0.62), and OAC (0.56; 0.34-0.92).
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918806
05HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, semaglutide use was associated with a higher hazard of obesity-associated cancer than metabolic bariatric surgery.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide use was linked to more obesity-related cancer than weight-loss surgery.
Peptide
Semaglutide
Outcome
IncreaseObesity-associated cancer
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Secondary
Outcome group
Tumor growth · Cancer
Studied dose
Dose not stated
Measurements
Hazard ratio, MBS vs semaglutide
0.56 HR
obesity-associated cancer
Source sentences
Summary
For extrahepatic events, MBS was associated with a reduced HR of MACE (0.51; 0.38-0.67), heart failure (0.41; 0.27-0.62), and OAC (0.56; 0.34-0.92).
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918807
06HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, all-cause mortality did not differ between metabolic bariatric surgery and semaglutide.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, death from any cause did not differ between weight-loss surgery and semaglutide.
Peptide
Semaglutide
Outcome
No significant changeAll-cause mortality
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Secondary
Outcome group
Mortality · Whole body
Studied dose
Dose not stated
Source sentences
Summary
There was no difference in ACM between MBS and semaglutide
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918808
07HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, semaglutide use was associated with a lower hazard of all-cause mortality than Roux-en-Y gastric bypass.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide use was linked to fewer deaths than gastric bypass surgery.
Peptide
Semaglutide
Outcome
DecreaseAll-cause mortality, gastric bypass subgroup
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Analysis
Secondary
Outcome group
Mortality · Whole body
Studied dose
Dose not stated
Measurements
Hazard ratio, RYGB vs semaglutide
1.64 HR
all-cause mortality
Source sentences
Summary
in subgroup analysis, RYGB was associated with increased ACM compared to semaglutide (1.64; 1.01-2.67)
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918809
08HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, semaglutide use was associated with a lower hazard of major adverse liver outcomes than Roux-en-Y gastric bypass.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, semaglutide was linked to fewer major liver events than gastric bypass surgery.
Peptide
Semaglutide
Outcome
DecreaseMajor adverse liver outcomes, gastric bypass subgroup
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Outcome group
Liver fat and liver function · Liver
Studied dose
Dose not stated
Measurements
Hazard ratio, RYGB vs semaglutide
2.01 HR
MALO
Source sentences
Summary
this was driven by RYGB (2.01; 1.26-3.20)
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918802
09HumanObservational studyEfficacy outcome
In adults with MASLD and type 2 diabetes, major adverse liver outcomes did not differ between sleeve gastrectomy and semaglutide.
In plain wordsIn adults with fatty liver disease and type 2 diabetes, major liver events did not differ between sleeve gastrectomy and semaglutide.
Peptide
Semaglutide
Outcome
No significant changeMajor adverse liver outcomes, sleeve gastrectomy subgroup
Study
n: not reported in source
Comparator
Metabolic bariatric surgery
Outcome group
Liver fat and liver function · Liver
Studied dose
Dose not stated
Measurements
Hazard ratio, SG vs semaglutide
0.97 HR
MALO
Source sentences
Summary
but not by SG (0.97; 0.52-1.78)
1 context sentence(design, population, supporting numbers)
Summary · context
Patients with MASLD and T2D who had MBS or semaglutide in 2018-2023 were identified (TriNetX database).
Show in the study text Report a problemFND-4196918803

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

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Version 2Current
11 Oct 2026, 00:04 UTC
Study results updated
Version 1
9 Oct 2026, 03:06 UTC
First added · source update from Europe PMC

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Terms as the source lists them.

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Differential Impact of Metabolic Bariatric Surgery Versus Semaglutide on Adverse Hepatic and Extrahepatic Outcomes in Individuals With Metabolic Dysfunction-Associated Steatotic Liver Disease and Type 2 Diabetes.

Summary

Results from this study9

Version history

Subjects

Publication types

MeSH terms

Keywords