Journal article
Vertical Sleeve Gastrectomy Versus Comprehensive Lifestyle Intervention for Adolescents With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Controlled Cohort Study
Alimentary pharmacology & therapeutics
06/08/2026
DOI: 10.1111/apt.70766
PMID: 42259766
Abstract
Background Adolescents with severe obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) lack prospective comparative evidence to select between bariatric surgery and intensive lifestyle intervention.Aims To compare 52-week histological and cardiometabolic outcomes of vertical sleeve gastrectomy (VSG) versus comprehensive lifestyle intervention (CLI).Methods Single-centre, prospective, parallel-arm study of adolescents aged 12-19 with severe obesity and biopsy-confirmed MASLD with NAFLD Activity Score (NAS) >= 3. The primary endpoint was NAS >= 2-point decrease without fibrosis worsening; secondary endpoints included MASH resolution, fibrosis regression, MRI proton density fat fraction (MRI-PDFF) and elastography (MRE). Overlap-weighted adjusted analysis addressed baseline imbalance. Conservative unadjusted intention-to-treat analogue analyses treated missing Week 52 histology as nonresponse and missing continuous outcomes as no change.Results Forty-two adolescents enrolled (VSG = 17; CLI = 25) and 27 (64%) completed paired Week 52 histology. In the adjusted analysis, VSG was associated with a higher probability of NAS improvement (risk difference [RD] 0.68, 95% CI 0.45-0.91), fibrosis improvement (RD 0.36, 95% CI 0.12-0.59) and complete MASLD resolution (RD 0.49, 95% CI 0.26-0.72) when compared to CLI. VSG produced greater reductions in percent weight (-19.6%, 95% CI -30.0 to -9.1), percentage of the 95th percentile BMI (-27.6%, 95% CI -42.6 to -12.7), ALT (-54.0 U/L, 95% CI -80.8 to -27.1) and MRI-PDFF (-8.0%, 95% CI -13.0 to -2.9). Findings were directionally consistent in conservative unadjusted intention-to-treat and paired-biopsy completer analyses.Conclusion In this prospective cohort of adolescents with severe obesity and biopsy-confirmed MASLD, VSG achieved greater 52-week histological improvement, including steatosis and fibrosis, than CLI.Trial Registration ClinicalTrials.gov identifier: (NCT02412540)
Details
- Title: Subtitle
- Vertical Sleeve Gastrectomy Versus Comprehensive Lifestyle Intervention for Adolescents With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Controlled Cohort Study
- Creators
- Toshifumi Yodoshi - Cincinnati Children's Hospital Medical CenterNicholas J. Ollberding - Cincinnati Children's Hospital Medical CenterMeghan McNeill - Cincinnati Children's Hospital Medical CenterSanita L. Ley - Cincinnati Children's Hospital Medical CenterShelley Kirk - Cincinnati Children's Hospital Medical CenterDavid E. Kleiner - National Cancer InstituteAna Catalina Arce-Clachar - Cincinnati Children's Hospital Medical CenterKristin Bramlage - Cincinnati Children's Hospital Medical CenterThomas H. Inge - Northwestern UniversityMichael A. Helmrath - Cincinnati Children's Hospital Medical CenterKim M. Cecil - Cincinnati Children's Hospital Medical CenterAndrew T. Trout - Cincinnati Children's Hospital Medical CenterDeborah A. Elder - Cincinnati Children's Hospital Medical CenterMarialena Mouzaki - Cincinnati Children's Hospital Medical CenterStavra A. Xanthakos - Cincinnati Children's Hospital Medical Center
- Resource Type
- Journal article
- Publication Details
- Alimentary pharmacology & therapeutics
- DOI
- 10.1111/apt.70766
- PMID
- 42259766
- ISSN
- 0269-2813
- eISSN
- 1365-2036
- Publisher
- Wiley
- Number of pages
- 12
- Grant note
- DK100429 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Language
- English
- Electronic publication date
- 06/08/2026
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9985214168802771
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