Severe obesity in kids tied to high prevalence of NAFLD and fibrosis

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.

Children and adolescents admitted for severe obesity at a tertiary centre (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 parameters were performed to assess liver steatosis and fibrosis.

Results:

• A total of 204 patients 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).

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 improves liver steatosis and fibrosis.

Reference:

Sander Lefere et al. Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease. Published:December 03, 2021 DOI:

https://doi.org/10.1016/j.cgh.2021.11.03