Clinical

Lifestyle intervention improves non-alcoholic fatty liver disease in obese children

Last Updated: 2009-06-19 15:22:19 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A multidisciplinary lifestyle intervention results in weight loss and improvement of transaminases in obese children with non-alcoholic fatty liver disease (NAFLD), and these improvements are sustained 1 year after the end of the intervention.

"Despite the well-established short-term benefit of lifestyle intervention on NAFLD, follow-up studies after intervention are still missing, questioning the long-term effect," lead author Dr. Thomas Reinehr of the University of Witten-Herdecke, Datteln, Germany, and colleagues report.

"Furthermore it is unknown which degree of overweight reduction is necessary to improve NAFLD," they write in the June issue of the Archives of Disease in Childhood.

In a longitudinal study, the researchers examined the long-term effect of a lifestyle intervention in 152 obese children with NAFLD and assessed the effects of weight reduction, disease improvement, longitudinal changes in transaminase levels, and insulin resistance in this population.

The children, who were 6 to 16 years of age and diagnosed by ultrasound at baseline, were evaluated at the end of the 1-year intervention and again 2 years after baseline. The intervention involved physical activity, nutrition education, and behavior therapy. Complete follow-up data were available for 109 patients in the intervention group and 43 patients in the control group.

In the intervention group, the mean change in the standard deviation score of body mass index (SDS-BMI) at 1 year was -0.23 and the mean change between baseline and 2 years was -0.30.

Compared with children in the control group, those in the intervention group had a significant decrease of transaminases and weight at 1 and 2 years after baseline. At 1-year follow-up, children with lifestyle intervention had significant decreases in ALT (-10 U/L), AST (-5 U/L), and NAFLD (-50%). The decreases between baseline and 2-year follow-up were maintained at -9 U/L, -6 U/L, and -45% in ALT, AST, and NAFLD prevalence, respectively.

The largest improvement in transaminases and the largest decrease of NAFLD prevalence were observed in the children with the largest weight reduction, Dr. Reinehr's group reports.

No significant correlations were observed between changes of transaminases after 1-year or 2-year follow-up, and changes in insulin or insulin resistance index.

Arch Dis Child 2009;94:437-442.