Changes in Hepatic Fat Content by CT 1 Year After Sleeve Gastrectomy in Adolescents and Young Adults With Obesity

Abstract

Context Obesity is associated with non-alcoholic fatty liver disease (NAFLD). Sleeve gastrectomy (SG) is an effective means of weight loss and improvement of NAFLD in adults; however, data regarding the efficacy of SG in the early stages of pediatric NAFLD are sparse. Objective To assess the impact of SG on hepatic fat content one year after SG in youth with obesity compared with non-surgical controls with obesity (NS). Design 12-month prospective study in 52 participants [mean age: 18.2 ± 0.36 years] with obesity, comprising 25 subjects who underwent SG [84% female; median BMI 44.6 (42.1, 47.9) kg/m2], and 27 who were NS [70% female; median BMI 42.2 (38.7, 47.0) kg/m2]. Main outcome measures Hepatic fat content by CT (liver/spleen ratio), abdominal fat by MRI Results Mean 12-month decrease in BMI was greater in SG vs. NS (-12.5±0.8 vs. -0.2±0.5 kg/m2, p<0.0001). There was a within-group increase in the L/S ratio in SG (0.13± 0.05, p=0.014) but not NS with a trend for a difference between groups (p=0.055). All SG participants with an L:S ratio <1.0 (threshold for the diagnosis of NAFLD) before surgery had a ratio of >1.0 a year after surgery, consistent with resolution of NAFLD. Within SG, the 12-month change in L/S ratio was negatively associated with 12-month change in visceral fat (ρ=-0.51 p=0.016). Conclusions Hepatic fat content as assessed by non-contrast CT improved after SG over 1-year in youth with obesity with resolution of NAFLD in all subjects. This was associated with decreases in visceral adiposity.