A Multidisciplinary Clinical Program Is Effective in Stabilizing BMI and Reducing Transaminase Levels in Pediatric Patients With NAFLD

Abstract

Weight loss is an effective treatment for children with non-alcoholic fatty liver disease (NAFLD) but it is very difficult to achieve outside of an intensive weight management program. We hypothesized that one can achieve success in improving NAFLD and weight-related outcomes in a structured and focused multidisciplinary clinical program feasible to implement in a gastroenterology clinic. Methods We prospectively tracked the clinical status of our patients enrolled in a multidisciplinary program of dietary and exercise advice through an Institutional Review Board-approved NAFLD registry. Each patient met with a gastroenterologist and dietician every 3 months for 30 minutes to set individualized goals and monitor progress. Results 108 children have been enrolled in the registry and of the 83 that were eligible for 1 year follow-up and included in the analysis, 39 patients returned, resulting in a 47% follow-up rate. These 39 patients showed statistically significant improvements in mean BMI z-score (−0.1 units, p<0.05), total (−11 mg/dL, p<0.05) and low density lipoprotein cholesterol (−9 mg/dL, p<0.05), and serum alanine aminotransferase (ALT) levels (−36 U/L) and aspartate amino transferase (AST) levels (−22 U/L) levels. Conclusion A clinically feasible multidisciplinary program of every 3 month 30 minute visits to set and monitor nutrition and exercise goals, stabilized mean BMI z-score and significantly improved aminotransferase levels at 1 year follow-up in obese pediatric patients with NAFLD.

More Frequent Clinic Visits Are Associated with Improved Outcomes for Children with NAFLD

“…The results of this study are in agreement with adult data showing that clinic visit frequency is a predictor of weight loss in patients with NAFLD [4, 15]. In children, Devore et al recently reported the outcomes of a multidisciplinary clinical program caring for patients with NAFLD at a university hospital [8]. The frequency of monitoring was every 3 months; however, only 47% of the 108 patients who were followed in the clinic returned for a 1-year visit.…”

“…As a similar study had not been done in children or adults previously, we based our sample size calculation on the study by Devore et al [8]. In order to identify a difference in the change in BMI z- score by 0.2 between the groups with a power of 0.9 and a significance threshold set at 0.05 and assuming a SD of 0.2 [8], 22 patients would have to be included in each arm. We aimed at including 28 patients in each group to maximize our power, in case the actual SD was higher than 0.2.…”

“…Literature on this topic is limited in the pediatric population. To our knowledge, the only relevant study to-date was published by Devore et al and it evaluated the experience of a multidisciplinary clinical program aimed at treating children with NAFLD [8]. In the program, patients were seen every 3 months.…”

Lifestyle Interventions Including Nutrition, Exercise, and Supplements for Nonalcoholic Fatty Liver Disease in Children

“…Notably, children that had a liver biopsy were nearly twice as likely to continue with gastroenterology care for 1 year (71%) than those children who did not have a liver biopsy for diagnosis (37%). For those children who continued to be followed for 1 year, there was a decrease in serum ALT and stabilization of BMI z-score [27]. …”

High prevalence of hepatitis B non-immunity in paediatric non-alcoholic fatty liver disease patients

“…We identified a very high prevalence of hepatitis B non-immunity (72%) in a prospective, single center cohort of children with NAFLD [4]. No prior reports exist evaluating the status of hepatitis B immunity in children affected by NAFLD.…”