Pediatric Fatty Liver Disease is a Reversible Disease

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

In this prospective study with 204 children with severe obesity, intensive lifestyle changes were implemented. 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) (33% had F2 or higher fibrosis at baseline per elastography)
  • Fasting serum alanine aminotransferase and homeostasis model assessment of insulin resistance decreased significantly over the 1-year period (P < .001)

T Khurana et al. J Pediatr 2022; 250: 61-66. Clinically Meaningful Body Mass Index Change Impacts Pediatric Nonalcoholic Fatty Liver Disease

In this retrospective study with 784 children, Key findings:

  • Of these children, 168 (31%) had a BMIz (BMI z-score) change of >−.25 from baseline over a median of 367 days (IQR, 201-678 days). Thus, ~1/3rd of children achieved a drop in BMIz with lifestyle advice
  • A BMIz reduction of >.25 was associated with significant improvements in serum aminotransferase levels.

My take: These pediatric studies replicate similar findings from adult studies showing that modest reductions in weight are associated with improvement in NAFLD. However, most patients are not successful with lifestyle advice which underscores the need for pharmacotherapy.

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