Reversing Pediatric Nonalcoholic Fatty Liver Disease

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S Lefere et al. Clin Gastroenterol Hepatol 2022; 20: 2317-2326. Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease

In this prospective study, pediatric patients with NAFLD received intensive lifestyle therapy which encompassed caloric restriction, physical activity, education on a healthy lifestyle, and psychosocial support. Key findings:

  • After 6 months, the median body weight loss was 16.0% in the 167 patients evaluated. Fibrosis improved in 75.0% (P < .001).
  • Fasting serum alanine aminotransferase and homeostasis model assessment of insulin resistance decreased significantly over the 1-year period (P < .001).

Related article: MH Malespin et al. Clin Gastroenterol Hepatol 2022; 20: 2393-2395. In this study, adults who were enrolled in TARGET-NASH (n=2019) were reviewed. Only 32% of overweight/obese adults with NAFLD receiving usual care in the U.S. achieved weight loss of 5% or more. In addition, only 25% who lost 5% or more of their weight maintained weight loss at follow-up at 5 years.

My take: Together these studies show that weight loss can reverse liver damage (steatosis and fibrosis) in NAFLD; however, maintaining weight loss with lifestyle treatment is quite difficult. As such, it is anticipated that newer pharmacologic agents (eg. semaglutide) will be available (after appropriate trials), especially for more severe NAFLD.

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