Lifestyle intervention and antioxidant therapy in children with nonalcoholic fatty liver disease

Abstract

No proven treatment exists for nonalcoholic fatty liver disease (NAFLD) in children and adolescents. We sought to determine the efficacy of lifestyle intervention with or without antioxidant therapy in pediatric NAFLD. A total of 53 patients (age 5.7-18.8 years, 37 boys) were included. Lifestyle intervention consisting of a diet tailored to the patient's calorie needs, and increased physical activity was prescribed in all. Patients were concomitantly randomized to alpha-tocopherol 600 IU/day plus ascorbic acid 500 mg/day (n ‫؍‬ 25) or placebo (n ‫؍‬ 28), and treated for 24 months. The study was an extension of a previous study aimed at evaluating the effect of 12-month lifestyle intervention and antioxidant therapy on serum levels of aminotransferases. The primary end point of the present study was change in liver histology on repeated biopsy at 24 months. Secondary end points were changes in body weight, liver enzymes, and insulin sensitivity indices on 2-hour oral glucose tolerance test. The amount of weight lost at 24 months was similar in the placebo and antioxidant groups (؊4.75 [range, ؊16-4.0] versus ؊5.5 [range, ؊12.2-0.4] kg, respectively, P ‫؍‬ 0.9). A significant improvement occurred in the grade of steatosis, lobular inflammation, and hepatocyte ballooning, and in the NAFLD activity score in both groups. Levels of aminotransferases, triglycerides, cholesterol, fasting glucose, and insulin, and insulin sensitivity indices improved significantly as well. The improvement in all these parameters was not significantly different between the two groups. Conclusion: Lifestyle intervention with diet and increased physical activity induces weight loss and is associated with a significant improvement in liver histology and laboratory abnormalities in pediatric NAFLD. Alpha-tocopherol plus ascorbic acid does not seem to increase the efficacy of lifestyle intervention alone. (HEPATOLOGY 2008; 48:119-128.)

Inpatients' Knowledge about Primary Liver Cancer and Hepatitis

“…Secondly, there are a lack of regular medical physical examinations conducted amongst chronic virus carriers and many other people are asymptomatic and unaware of their carrier status (Lok et al, 1991). Thirdly, there is a lack of public knowledge about factors such as lifestyle which are important for the prevention of hepatitis and liver cancer (Nobili et al, 2008;Giles et al, 2013). Lastly, liver cancer in adults has a poor prognosis, because it tends to be diagnosed at the advanced stages of the disease, and also, many people with liver cancer also develop comorbid liver disease such as cirrhosis, which is frequently fatal, leading to low survival rates.…”

Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials

“…Eight RCTs (373 participants, 39% diabetic; six RCTs with a low risk of bias, four RCTs with post-treatment histology) assessed the effect of lifestyle-or drug-induced weight loss in NAFLD [6][7][8][9][10][11][12][13] (ESM Table 1). …”

The management of childhood liver diseases in adulthood

“…Dietary modifications including improving the quality of school dinners and increased exercise are critical interventions in reducing patient body weight. A study that used an improvement in liver histology as its primary endpoint demonstrated that two years of increased physical activity and lifestyle intervention with an individual calorie diet resulted in a significant improvement in the severity of steatosis, inflammation and hepatocyte ballooning and the NAFLD activity score [128]. The study also reported an improvement in liver enzymes, insulin resistance and serum lipid levels [128].…”

“…A study that used an improvement in liver histology as its primary endpoint demonstrated that two years of increased physical activity and lifestyle intervention with an individual calorie diet resulted in a significant improvement in the severity of steatosis, inflammation and hepatocyte ballooning and the NAFLD activity score [128]. The study also reported an improvement in liver enzymes, insulin resistance and serum lipid levels [128]. The TONIC study, a double-blind placebo controlled trial compared vitamin E or metformin for 96 weeks [129].…”