Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease

Sander Lefere; Ellen Dupont; Ann De Guchtenaere; Stephanie Van Biervliet; Saskia Vande Velde; Xavier Verhelst; Lindsey Devisscher; Hans Van Vlierberghe; Anja Geerts; Ruth De Bruyne

doi:10.1016/j.cgh.2021.11.039

Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease

Clin Gastroenterol Hepatol. 2022 Oct;20(10):2317-2326.e4. doi: 10.1016/j.cgh.2021.11.039. Epub 2021 Dec 4.

Authors

Affiliations

¹ Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Liver Research Center Ghent, Ghent, Belgium; Gut-Liver Immunopharmacology Unit, Department of Basic and Applied Medical Sciences, Liver Research Center Ghent, Ghent, Belgium. Electronic address: sander.lefere@ugent.be.
² Zeepreventorium, De Haan, Belgium.
³ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
⁴ Pediatric Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine and Pediatrics, Ghent, Belgium.
⁵ Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Liver Research Center Ghent, Ghent, Belgium.
⁶ Gut-Liver Immunopharmacology Unit, Department of Basic and Applied Medical Sciences, Liver Research Center Ghent, Ghent, Belgium.

PMID: 34871812
DOI: 10.1016/j.cgh.2021.11.039

Abstract

Background & aims: Childhood obesity, with associated comorbidities such as nonalcoholic fatty liver disease (NAFLD), is an increasing global health problem. Although lifestyle management is the mainstay of treatment, its efficacy on liver fibrosis has not yet been established.

Methods: Children and adolescents admitted for severe obesity at a tertiary center (Zeepreventorium, De Haan, Belgium) were enrolled in this prospective study. Intensive lifestyle therapy encompassed caloric restriction, physical activity, education on a healthy lifestyle, and psychosocial support. At baseline, 6 months, and 12 months, liver ultrasound and transient elastography with controlled attenuation parameter were performed to assess liver steatosis and fibrosis.

Results: A total of 204 patients (median age, 14.0 y; body mass index Z-score, +2.8) were evaluated at admission. NAFLD on ultrasound was present in 71.1%, whereas 68.6% had controlled attenuation parameter values of 248 dB/m or greater. A total of 32.8% of patients had at least F2 fibrosis, including 10.3% with transient elastography of 9 kPa or greater. After 6 months, the median body weight loss was 16.0% in the 167 patients evaluated. Fibrosis improved in 75.0% (P < .001). Baseline severity of liver fibrosis and steatosis were predictors of fibrosis resolution. Seventy-nine patients had reached the 1-year time point. The improvements were sustained because fibrosis regressed at least 1 stage in all patients with baseline fibrosis. Fasting serum alanine aminotransferase and homeostasis model assessment of insulin resistance decreased significantly over the 1-year period (P < .001).

Conclusions: NAFLD and associated fibrosis are highly prevalent in children and adolescents with severe obesity. An intensive multidisciplinary lifestyle management program that causes significant weight loss not only improves liver steatosis, but also fibrosis.

Keywords: Fibroscan; Lifestyle Intervention; NAFLD; Pediatric Obesity; Weight Loss.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Alanine Transaminase
Child
Elasticity Imaging Techniques*
Humans
Life Style
Liver / diagnostic imaging
Liver / pathology
Liver Cirrhosis / complications
Non-alcoholic Fatty Liver Disease* / complications
Obesity, Morbid*
Pediatric Obesity* / complications
Pediatric Obesity* / pathology
Pediatric Obesity* / therapy
Prospective Studies

Substances

Alanine Transaminase