Lifestyle advice has been only somewhat effective in controlling or slowing the progression of nonalcoholic fatty liver disease in children, according to a recent study published in Gastroenterology.
Examining data from two previous trials, the investigators found that while nearly 50 percent of children showed improvement, more than 30 percent experienced worsening disease. Early intervention is crucial for controlling nonalcoholic fatty liver disease (NAFLD) in children, so these findings point to the shortfalls of lifestyle advice in children, according to Mark Fishbein, MD, associate professor of Pediatrics in the Division of Gastroenterology, Hepatology and Nutrition and co-author of the study.
“I think we can say that lifestyle advice has no downside but is often ineffective in this population,” Fishbein said. “Many come from homes where parents may have obesity and fighting the same challenges as their children. This study highlights the need to address childhood obesity and fatty liver at a young age rather than await adolescence.”
NAFLD, a condition in which excess fat is stored in the liver, is the most common liver disease affecting children. While some people experience NAFLD with few symptoms, some develop nonalcoholic steatohepatitis (NASH), in which the liver is inflamed causing cell damage and scarring. There is no recommended drug therapy for children with NAFLD or NASH, so lifestyle advice is the standard of care.
Coaching is aimed at improving diet and exercise to lower body-mass index and reduce incidence of obesity, and can improve NAFLD if successful. However, its overall effectiveness is unclear, according to Fishbein.
In the study, investigators analyzed liver biopsies from 122 children who received placebo drugs and lifestyle advice in two drug trials that ran from 2005 to 2015. According to the biopsies, 31 percent of children had NASH at the beginning of the trial.
Over a time period of about two years, NASH had resolved in 30 percent of those children, but 20 percent of children with fatty liver had progressed to NASH by the end of the trial. Similar results were seen in liver fibrosis, or scarring, with a mixture of improvement for some and disease progression for others.
Disease progression was associated with adolescent age and higher waist circumference, some key risk factors that clinicians should look out for, Fishbein said.
“This population does not tend to do well with just lifestyle advice as indicated and therefore the liver disease does need to be monitored,” Fishbein said.
In the future, Fishbein said he plans to examine the children who successfully improved their liver disease through lifestyle changes, hoping to tease out common threads that could be applied more broadly. In addition, the search for effective drug treatments will continue through the Nonalcoholic Steatohepatitis Clinical Research Network, supported by the National Institute of Diabetes and Digestive and Kidney Diseases.
This study was also supported by the National Center for Advancing Translational Sciences and the Intramural Research Program of the National Institutes of Health, National Cancer Institute.