Title: Assessing hepatic steatosis following weight loss in adolescents with severe obesity: a randomized controlled trial
Source: Children (Basel) 2025, 12 (12): 1652
Date of publication: December 2025
Publication type: Randomised controlled trial
Abstract: Background/objectives: To assess whether laparoscopic adjustable gastric banding (LAGB) and combined lifestyle intervention (CLI) reduce hepatic steatosis more effectively than CLI alone in adolescents with severe obesity.
Methods: Adolescents aged 14-16 with a BMI ≥ 40 kg/m2 (or ≥35 kg/m2 with comorbidity) were randomized to receive LAGB + combined lifestyle intervention (CLI, n = 30) or CLI alone (n = 30). Hepatic fat was assessed at baseline and one year via ultrasound-based Hepatorenal Index (HRI), liver span, and ALAT levels.
Results: Of 59 participants (mean age 15.7, 80% female, BMI 44.3 kg/m2), 58.9% had steatosis at baseline (HRI ≥ 1.40). After one year, BMI decreased by 5.6 kg/m2 in the LAGB group but remained stable in controls. Steatosis resolution (HRI < 1.05) occurred in 21.4% of LAGB versus 4.4% of CLI patients (p = 0.078). Liver span declined by 1.09 cm post-LAGB (95% CI -2.05 to -0.13) and correlated with HRI improvement. ALAT levels were unchanged.
Conclusions: LAGB led to greater reductions in hepatic fat and size than lifestyle changes alone. Though steatosis resolution was not statistically significant, findings suggest bariatric surgery may be a promising strategy for mitigating early hepatic changes in severe adolescent obesity.
What is already known: Severe obesity in adolescents is frequently accompanied by hepatic steatosis, which can progress to metabolic dysfunction-associated steatotic liver disease (MASLD). Bariatric procedures-such as laparoscopic adjustable gastric banding (LAGB)-are proven to induce substantial weight loss and improve obesity-related comorbidities in youth.
What this study adds: This is the first randomized controlled trial to evaluate the effect of LAGB on hepatic steatosis specifically in adolescents. At one year, 21.4% of LAGB-treated patients no longer met the sensitive HRI cut-off for steatosis (<1.05) versus 4.4% of controls. Moderate weight loss after LAGB corresponded with significant improvements in the Hepatorenal Index and liver span, suggesting a reduction in hepatic fat content.
