Supplementary Box 1 | Outcomes of bariatric surgery in adolescents and adults
Bariatric surgery can substantially reduce BMI in severely obese adolescents by an average of 10.6–13.7 BMI units.S1–S4
Studies have shown that adolescent bariatric surgery can produce meaningful weight loss, improvements in cardiometabolic risk
factors and quality of life.S1–S6
Among eight outcome studies of bariatric surgery in adolescents, only three studies included any measure of liver disease at
baseline (only one with liver histology in a subset of patients) and only one provided any outcome data (ALT and AST change
only).S5,S7,S8
Preliminary uncontrolled observational studies in adults suggest bariatric surgery might benefit many, but not all adults with
incidental NASH.S9,S10 However, four studies with larger cohorts and longer follow-up reported some progression of liver
fibrosis.S11
Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase.
S1. Treadwell, J. R., Sun, F & Schoelles, K. Systematic review and meta-analysis of bariatric surgery for pediatric
obesity. Ann. Surg. 248, 763–776 (2008).
S2. Messiah, S. E. et al. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery:
1-year results from the Bariatric Outcomes Longitudinal Database. Surg. Obes. Relat. Dis. 9, 503–513 (2013).
S3. Inge, T. H. et al. Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J. Pediatr.
156, 103–108 e1 (2010).
S4. Alqahtani, A. et al, Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative
study. Surg. Endosc. 26, 3094–3100 (2012).
S5. Holterman, A. X. et al. A prospective trial for laparoscopic adjustable gastric banding in morbidly obese
adolescents: an interim report of weight loss, metabolic and quality of life outcomes. J. Pediatr. Surg. 45, 74–78
(2010).
S6. O’Brien, P. E. et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial.
JAMA 303, 519–526 (2010).
S7. Boza, C. et al. Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients. Surg. Obes.
Relat. Dis. 8, 133–137 (2012).
S8. Olbers, T. et al. Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe
obesity: results from a Swedish Nationwide Study (AMOS). Int. J. Obes. (Lond.) 36, 1388–1395 (2012).
S9. Mathurin, P. et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients
without advanced disease. Gastroenterology 137, 532–540 (2009).
S10.
Mummadi, R. R. et al. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and
meta-analysis. Clin. Gastroenterol. Hepatol. 6, 1396–1402 (2008).
S11.
Chavez-Tapia, N. C. et al. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane
Database of Systematic Reviews, Issue 1 Art. No.: CD007340.
http://dx.doi.org/10.1002/14651858.CD007340.pub2.
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