Resolution of Biochemical and Histologic Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Adolescents with Severe Obesity after Metabolic Bariatric Surgery.

Abstract

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. We conducted a longitudinal study to determine biochemical and histologic outcomes of MASLD in adolescents undergoing MBS. 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). 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.