The Steatohepatitis Center at Cincinnati Children’s provides comprehensive care for children with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), which can lead to cirrhosis and liver failure. The first-line treatment for both diseases is weight loss, but achieving that goal proves challenging. Research indicates that only two percent of severely obese teenagers were able to lose weight and keep it off without surgery. New treatments are being tested in clinical trials, but are not yet approved or available to children.

Specialists at the Steatohepatitis Center work with others at Cincinnati Children’s and beyond to improve the care available for these children. Stavra Xanthakos, MD, a pediatric gastroenterologist and director of the center, recently co-authored a study of bariatric surgery in severely obese teens that showed significant health benefits three years after the procedure. The study, led by pediatric surgeon, Thomas Inge, MD, PhD, and published in the New England Journal of Medicine (Jan. 14, 2016), was sponsored by Teen-LABS, a five-center consortium created in 2006 to investigate the safety and health effects of surgical weight loss procedures in adolescents.

This study, the largest and most comprehensive analysis of bariatric outcomes in adolescents to date, enrolled 242 severely obese teens with an average weight of 325 pounds and an average body mass index of 53 kg/m². Three years after surgery:

• Average weight had decreased by over 90 pounds — 27 percent
• Reversal of type 2 diabetes was seen in 95 percent
• Normalization of kidney function was seen in 86 percent
• Hypertension corrected in 74 percent
• Lipid abnormalities reversed in 66 percent

Can surgery treat NASH?

A subset of patients in this study also took part in a prospective observational study in which core liver biopsies were collected and analyzed for the presence of NAFLD. The study found that NAFLD was present in 59 percent of study subjects. Of those, 24 percent had borderline and 10 percent had definite NASH. Presence of NASH was closely related to diabetes and cardiometabolic risk factors. The study appeared in Gastroenterology (September 2015).

“The Teen-LABS study shows remarkable improvements in metabolic risk factors closely linked to NASH, and should pave the way for more physicians to recommend bariatric surgery for patients with NAFLD,” Xanthakos says. “Based on the study results, it is likely that patients with NASH would experience similar health benefits from bariatric surgery. But we need to study the mechanisms of improvement in NASH patients before we can confidently recommend this therapy for them.”

To that end, the Steatohepatitis Center is leading a new National Institutes of Health-funded study to establish to what degree bariatric surgery can reverse the effects of NASH and identify predictors of improvement.