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The current systemic review aimed to assess the changes in MRI-determined hepatic proton density fat fraction (MRI-PDFF) and nonalcoholic fatty liver disease activity score (NAS) after bariatric surgery or intragastric balloon\/gastric banding in MASLD patients with obesity.Methods: We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH).Results: Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3\u20136 months compared to baseline, 40% at 12\u201324 months, and 50% at 36\u201360 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3\u20136 months, 37% at 12\u201324 months, and 29% at 36\u201360 months; lobular inflammation by 36% at 12\u201324 months and 51% at 36\u201360 months; ballooning degeneration by 38% at 12\u201324 months; significant fibrosis (\u2265F2) by 18% at 12\u201324 months and by 17% at 36\u201360 months after intervention.Conclusions: Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.<\/jats:p>","DOI":"10.3350\/cmh.2023.0384","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:24:36Z","timestamp":1717460676000},"page":"561-576","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Bariatric intervention improves metabolic dysfunction-associated steatohepatitis in patients with obesity: A systematic review and 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