Children, adolescents with NAFLD see decrease in liver steatosis, fibrosis with lifestyle therapy
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Intensive lifestyle therapy in children and adolescents with nonalcoholic fatty liver disease led to significant weight loss and improvements in liver steatosis and fibrosis, according to study results.
“The implementation of a structured lifestyle program is a promising therapeutic approach for pediatric NAFLD,” Sander Lefere, MD, PhD, of the hepatology research unit in the department of internal medicine and pediatrics at Ghent University’s Liver Research Center in Belgium, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Alternative weight loss programs for NAFLD in the outpatient setting should be developed and evaluated.”
Lefere and colleagues assessed 204 children (median age, 14 years; 51% girls; median BMI, 36 kg/m2 corresponding to BMI z score of +2.76) and adolescents who were admitted at a tertiary center for severe obesity. Investigators noted the intensive lifestyle therapy included caloric restriction, physical activity, education on a healthy lifestyle and psychosocial support. Liver ultrasound and transient elastography with controlled attenuation parameter (CAP) were performed at baseline, 6 and 12 months to evaluate liver stenosis and fibrosis.
In 71.1% of patients, investigators observed NAFLD present on ultrasound, which was severe in 20.1%. There were 68.6% who had CAP values of 248 dB/m or greater. Lefere and colleagues noted 32.8% of patients had at least F2 fibrosis, with 10.3% who had a transient elastography of 9 kPa or greater.
According to researchers, the median weight loss was 16% in 167 patients who were assessed at 6 months. In 75% of patients, fibrosis had improved (P < .001). Predictors of fibrosis resolution included baseline severity of liver fibrosis and steatosis.
Investigators noted there were 79 patients who reached the 1-year timepoint. Improvements in patients were sustained. In all patients with baseline fibrosis, fibrosis had regressed at least one stage. Over the 1-year period, fasting serum alanine aminotransferase and homeostasis model assessment of insulin resistance had decreased (P < 0.001).
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