Teen-LABS is a multicenter, prospective observational study of adolescents undergoing bariatric surgery. Predictors of resolution of NAFLD post-surgery are unclear. We evaluated changes in serum ALT levels, an acceptable surrogate when liver biopsy is not feasible, in 219 Teen-LABS subjects 3 years post gastric bypass or vertical sleeve gastrectomy. Three years post-surgery, median BMI declined to 38.4 from 52.6 kg/m2 at baseline (p<0.01). Median ALT (IU/L) decreased between baseline (36.5 ± 2.6 [95% CI: 31.4, 41.7]) and 6 months after surgery (28.9 ± 2.5 [95% CI: 24.4, 33.9]), and remained stable at 1, 2 and 3 years, all p<0.01 vs. baseline. 58% had abnormal ALT at baseline, which decreased to 10% at 3 years. After adjustment by logistic regression, 6 month improvement in BMI, fasting glucose, HOMA-IR, triglycerides, TG/HDL, and HDL were independently associated with reduced ALT. Improvement in metabolic indices remained significantly associated with decline in ALT, after adjusting for BMI (Table).

In conclusion, while weight loss was associated with decreased ALT by 6 months post-surgery, improved fasting glycemia, insulin resistance and dyslipidemia indices were also independently associated with ALT decline.

Association between change in predictor variables and decline in ALT from baseline to 6 months.

Change in predictor variables over 6 months Estimate (SE) adjusted for age, race, sex p-value Estimate (SE) adjusted for age, race, sex, change in BMI p-value 
Decline in BMI 0.64 (0.13) <0.01   
Decline in fasting glucose 0.40 (0.07) <0.01 0.28 (0.08) 0.01 
Decline in HbA1C 4.59 (2.28) 0.04 1.57 (2.32) 0.50 
Decline in HOMA-IR 1.11 (0.22) <0.01 0.82 (0.27) <0.01 
Decline in Triglycerides 0.17 (0.02) <0.01 0.15 (0.02) <0.01 
Increase in HDL -0.75 (0.15) <0.01 -0.52 (0.16) <0.01 
Decline in TG/HDL ratio 5.11 (0.56) <0.01 4.85 (0.66) <0.01 
Change in predictor variables over 6 months Estimate (SE) adjusted for age, race, sex p-value Estimate (SE) adjusted for age, race, sex, change in BMI p-value 
Decline in BMI 0.64 (0.13) <0.01   
Decline in fasting glucose 0.40 (0.07) <0.01 0.28 (0.08) 0.01 
Decline in HbA1C 4.59 (2.28) 0.04 1.57 (2.32) 0.50 
Decline in HOMA-IR 1.11 (0.22) <0.01 0.82 (0.27) <0.01 
Decline in Triglycerides 0.17 (0.02) <0.01 0.15 (0.02) <0.01 
Increase in HDL -0.75 (0.15) <0.01 -0.52 (0.16) <0.01 
Decline in TG/HDL ratio 5.11 (0.56) <0.01 4.85 (0.66) <0.01 
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Disclosure

F. Bacha: Research Support; Self; AstraZeneca, JAEB Center For Health Research, National Institutes of Health, Pediatric Diabetes Consortium. R. Gupta: None. T.M. Jenkins: None. M. Brandt: None. T.H. Inge: Consultant; Self; Standard Bariatrics, Independent Medical Expert Consulting Services, UpToDate. D. Kleiner: None. S. Xanthakos: None.

© 2018 by the American Diabetes Association.
2018
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