Article1 min read·Published Jun 2026

Vertical Sleeve Gastrectomy Versus Comprehensive Lifestyle Intervention for Adolescents With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Controlled Cohort Study

Part of Adolescent Bariatric Surgery 39 items

pubmed.ncbi.nlm.nih.gov

Michael Helmrath

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 -1

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Article · Jun 2026 · 1 min read

In brief

This prospective study compared vertical sleeve gastrectomy to comprehensive lifestyle intervention in adolescents with severe obesity and MASLD over 52 weeks. VSG demonstrated superior outcomes in liver histology improvement, fibrosis regression, and weight reduction compared to lifestyle intervention alone.

Written by the GCMD Library team from the article.

Michael Helmrath

Statements in this article

The study enrolled adolescents aged 12-19 with severe obesity and biopsy-confirmed MASLD with NAFLD Activity Score (NAS) ≥ 3.
EstablishedMethods
The primary endpoint was NAS ≥ 2-point decrease without fibrosis worsening.
EstablishedMethods
Forty-two adolescents enrolled (VSG = 17; CLI = 25) and 27 (64%) completed paired Week 52 histology.
ResearchResults
In the adjusted analysis, VSG was associated with a higher probability of NAS improvement (risk difference 0.68, 95% CI 0.45-0.91) compared to CLI.
ResearchResults
VSG was associated with a higher probability of fibrosis improvement (risk difference 0.36, 95% CI 0.12-0.59) compared to CLI.
ResearchResults
VSG was associated with a higher probability of complete MASLD resolution (risk difference 0.49, 95% CI 0.26-0.72) compared to CLI.
ResearchResults
VSG produced greater reductions in percent weight (-19.6%, 95% CI -30.0 to -9.1) compared to CLI.
ResearchResults
VSG produced greater reductions in percentage of the 95th percentile BMI (-27.6%, 95% CI -42.6 to -12.6) compared to CLI.
ResearchResults