Weight Loss as a Determinant of Histological Improvement in Metabolic Dysfunction‐Associated Steatotic Liver Disease in People With Obesity. A Systematic Review and Network Meta‐Analysis of Randomised Clinical Trials
Authors' conclusion
Weight loss was consistently associated with histologic improvement across available RCTs. However, the limited evidence base, sparse network structure and ecological nature of the meta-regression preclude causal inference. These findings should be considered exploratory and hypothesis-generating, underscoring the need for adequately powered head-to-head trials.
Study context
- Population
- Adults with BMI ≥ 27 kg/m² and biopsy-confirmed MASH
- Participants
- 1,379 adults6 RCTs
- Comparison
- Obesity-management modalities vs placebo or standard care
- Outcome
- MASH resolution without worsening of fibrosis
Methodological detailsstudy-level meta-regression
- Study-level meta-regression
Pooled result
As reported in the abstract
MASH resolution
- Tirzepatide, semaglutide, SG and RYGB were superior to placebo or standard care for achieving MASH resolution
- Network weakly connected and largely placebo-anchored; indirect estimates imprecise
Further pooled results
Association of TBWL% with histologic outcomes (meta-regression)
- Greater TBWL% associated with higher rates of MASH resolution and fibrosis improvement; strongly influenced by a small number of high-weight-loss surgical arms
Original publication
Weight Loss as a Determinant of Histological Improvement in Metabolic Dysfunction‐Associated Steatotic Liver Disease in People With Obesity. A Systematic Review and Network Meta‐Analysis of Randomised Clinical Trials. Diabetes Obes Metab. Published 9 March 2026. doi:10.
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