{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:19:08Z","timestamp":1792592348718,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DK100429"],"award-info":[{"award-number":["DK100429"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescents with severe obesity and metabolic dysfunction\u2013associated steatotic liver disease (MASLD) lack prospective comparative evidence to select between bariatric surgery and intensive lifestyle intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare 52\u2010week histological and cardiometabolic outcomes of vertical sleeve gastrectomy (VSG) versus comprehensive lifestyle intervention (CLI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single\u2010centre, prospective, parallel\u2010arm study of adolescents aged 12\u201319 with severe obesity and biopsy\u2010confirmed MASLD with NAFLD Activity Score (NAS) \u2265\u20093. The primary endpoint was NAS \u2265\u20092\u2010point decrease without fibrosis worsening; secondary endpoints included MASH resolution, fibrosis regression, MRI proton density fat fraction (MRI\u2010PDFF) and elastography (MRE). Overlap\u2010weighted adjusted analysis addressed baseline imbalance. Conservative unadjusted intention\u2010to\u2010treat analogue analyses treated missing Week 52 histology as nonresponse and missing continuous outcomes as no change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010two adolescents enrolled (VSG\u2009=\u200917; CLI\u2009=\u200925) 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\u20130.91), fibrosis improvement (RD 0.36, 95% CI 0.12\u20130.59) and complete MASLD resolution (RD 0.49, 95% CI 0.26\u20130.72) when compared to CLI. VSG produced greater reductions in percent weight (\u221219.6%, 95% CI \u221230.0 to \u22129.1), percentage of the 95th percentile BMI (\u221227.6%, 95% CI \u221242.6 to \u221212.7), ALT (\u221254.0\u2009U\/L, 95% CI \u221280.8 to \u221227.1) and MRI\u2010PDFF (\u22128.0%, 95% CI \u221213.0 to \u22122.9). Findings were directionally consistent in conservative unadjusted intention\u2010to\u2010treat and paired\u2010biopsy completer analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this prospective cohort of adolescents with severe obesity and biopsy\u2010confirmed MASLD, VSG achieved greater 52\u2010week histological improvement, including steatosis and fibrosis, than CLI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: (NCT02412540)\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70766","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T02:50:04Z","timestamp":1780973404000},"page":"758-769","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Vertical Sleeve Gastrectomy Versus Comprehensive Lifestyle Intervention for Adolescents With Metabolic Dysfunction\u2013Associated Steatotic Liver Disease: A Prospective Controlled Cohort Study"],"prefix":"10.1111","volume":"64","author":[{"given":"Toshifumi","family":"Yodoshi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Division of Gastroenterology, Hepatology, Pancreatology, and Nutrition, Stead Family Children's Hospital, Department of Pediatrics University of Iowa  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Ollberding","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"McNeill","sequence":"additional","affiliation":[{"name":"Division of Nutrition Therapy Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanita L.","family":"Ley","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"Kirk","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"The Heart Institute, Center for Better Health and Nutrition Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3442-4453","authenticated-orcid":false,"given":"David E.","family":"Kleiner","sequence":"additional","affiliation":[{"name":"Laboratory of Pathology, National Cancer Institute National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Catalina","family":"Arce\u2010Clachar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Bramlage","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7782-1112","authenticated-orcid":false,"given":"Thomas H.","family":"Inge","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H. 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