Title: Resolution of biochemical and histologic metabolic dysfunction-associated steatotic liver disease (MASLD) in adolescents with severe obesity after metabolic bariatric surgery
Source: The Journal of Pediatrics 2025, Dec 22. [E–publication]
Date of publication: December 2025
Publication type: Longitudinal study
Abstract: 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.
