The Journal of pediatrics · 2025
Resolution of Biochemical and Histologic Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Adolescents with Severe Obesity after Metabolic Bariatric Surgery.
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Sundaram Shikha S, Kelsey Megan, Nadeau Kristen J, Cooper Emily, Sokol Ronald J, Ma Yamin, Ben Abdallah Miriam, Chaidez Alex, Inge Thomas H
Аннотация
OBJECTIVE: To improve gaps in our understanding of the impact of metabolic bariatric surgery (MBS) on pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) biochemical and histologic outcomes.
METHODS: We conducted a longitudinal study to determine biochemical and histologic outcomes of MASLD in adolescents undergoing MBS.
RESULTS: In total, 101 adolescents (mean age 17.5 ± 2.1 years, 68% female, 46% Hispanic, body mass index 47.1 ± 8.4 kg/m2) underwent MBS. At MBS, 76% had an elevated alanine transaminase (ALT), 61% histologically confirmed MASLD, and 45% fibrosis. Patients with more severe histologic MASLD and fibrosis had greater ALT levels at MBS (P < .05). One-year post-MBS, patients had a mean body mass index decrease of 12.9 ± 7.9 kg/m2. ALT levels decreased from 41 ± 38 to 27 ± 33 IU/L, with 35% still having an elevated ALT. One-year post-MBS, 23 patients had repeat liver biopsy; 50% of patients experienced histologic resolution of MASH and half resolved all fibrosis, with the remainder having mild fibrosis post-MBS (P < .001).
CONCLUSIONS: The significant improvements in both biochemical and histologic MASLD observed in this study lend further credence to the utility of MBS in pediatric patients with severe obesity and MASLD.
METHODS: We conducted a longitudinal study to determine biochemical and histologic outcomes of MASLD in adolescents undergoing MBS.
RESULTS: In total, 101 adolescents (mean age 17.5 ± 2.1 years, 68% female, 46% Hispanic, body mass index 47.1 ± 8.4 kg/m2) underwent MBS. At MBS, 76% had an elevated alanine transaminase (ALT), 61% histologically confirmed MASLD, and 45% fibrosis. Patients with more severe histologic MASLD and fibrosis had greater ALT levels at MBS (P < .05). One-year post-MBS, patients had a mean body mass index decrease of 12.9 ± 7.9 kg/m2. ALT levels decreased from 41 ± 38 to 27 ± 33 IU/L, with 35% still having an elevated ALT. One-year post-MBS, 23 patients had repeat liver biopsy; 50% of patients experienced histologic resolution of MASH and half resolved all fibrosis, with the remainder having mild fibrosis post-MBS (P < .001).
CONCLUSIONS: The significant improvements in both biochemical and histologic MASLD observed in this study lend further credence to the utility of MBS in pediatric patients with severe obesity and MASLD.