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Changes in Total Homocysteine and Glutathione Levels After Laparoscopic Sleeve Gastrectomy in Children with Metabolic-Associated Fatty Liver Disease

Obesity Surgery volume 32, pages 82–89 (2022)Cite this article

Abstract

Purpose

Paediatric obesity is a well-known risk factor for metabolic-associated fatty liver disease (MAFLD). The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the levels of total homocysteine (tHcy) and total glutathione (tGSH) plasma levels in children with MAFLD.

Material and Methods

Twenty-four children with severe obesity who underwent LSG were included in the study. The metabolic parameters, systemic inflammatory markers, one-carbon metabolism products, ultrasound and histological improvement were evaluated at baseline (T0M) and after 12 months from LSG (T12M).

Results

The patients exhibited a significant amelioration of several metabolic parameters at T12M. A significant reduction of steatosis was observed at ultrasound (from 72.7% of moderate-severe grade to 0% severe steatosis), accompanied by a statistically significant improvement of ballooning, portal and lobular inflammation and fibrosis. A statistically significant decrease of tumour necrosis factor circulating levels was also observed (T0M median = 290.3, IQR = 281.0–317.0 pg/mL; T12M median = 260.4, IQR = 240.0–279.0 pg/mL; p < 0.0001). After 12 months from LSG, a significant increase of mean plasma levels of tHcy(T0M mean = 15.7 ± 4.1 μmol/L; T12M mean = 21.1 ± 9.3 μmol/L; p = 0.0146) was also observed. The increase of tHcy showed no causal link with the improvement of MAFLD-related inflammatory, metabolic and histological pattern.

Conclusion

LSG in children with obesity induces an improvement of MAFLD-related metabolic derangement and liver damage, but also a mild hyperhomocysteinemia that should be avoided to prevent cardiovascular risk.

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Funding

This work was supported by the Italian Ministry of Health (Ricerca Corrente 2021 to A.A.).

Author information

Authors and Affiliations

  1. Research Unit of Diagnostical and Management Innovations, Bambino Gesù Children’s Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy

    Anna Pastore & Andrea Onetti Muda

  2. Research Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy

    Nadia Panera, Annalisa Crudele, Cristiano De Stefanis & Anna Alisi

  3. Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy

    Antonella Mosca & Arianna Alterio

  4. Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy

    Romina Caccamo, Daniela Camanni, Sonia Battaglia & Francesco De Peppo

  5. Research Biobank, Bambino Gesù Children’s Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy

    Gianna Di Giovamberardino

  6. Pathology Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy

    Rita De Vito & Paola Francalanci

Authors
  1. Anna Pastore
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  2. Nadia Panera
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  3. Antonella Mosca
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  13. Andrea Onetti Muda
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Correspondence to Anna Pastore or Anna Alisi.

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Anna Pastore, Francesco De Peppo And Anna Alisi have contributed equally to this work

Key Points

• Weight loss is the mainstay of treatment of obesity-related metabolic-associated fatty liver disease (MAFLD).

• Bariatric surgery is recommended in adolescents with non-cirrhotic NAFLD and body mass index (BMI) ≥ 40 kg/m2.

• After 12 months, laparoscopic sleeve gastrectomy (LSG) decreased BMI and improved systemic inflammation, metabolic alterations and liver damage.

• Adolescents who underwent LSG showed an increase in homocysteine circulating levels.

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Cite this article

Pastore, A., Panera, N., Mosca, A. et al. Changes in Total Homocysteine and Glutathione Levels After Laparoscopic Sleeve Gastrectomy in Children with Metabolic-Associated Fatty Liver Disease. OBES SURG 32, 82–89 (2022). https://doi.org/10.1007/s11695-021-05701-6

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  • DOI: https://doi.org/10.1007/s11695-021-05701-6

Keywords

  • Bariatric surgery
  • Children
  • Homocysteine
  • Glutathione
  • MAFLD
  • NAFLD

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