Review of paediatric obesity and non‐alcoholic fatty liver disease—A focus on emerging non‐pharmacologic treatment strategies

Abstract

SummaryObesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with several comorbidities, both physical and psychological. Within gastroenterology, non‐alcoholic fatty liver disease (NAFLD) is now the most common cause of paediatric liver disease and the most common cause of liver transplantation in young adults. Treatment for NAFLD largely focuses on treatment of obesity with weight loss strategies. Unfortunately, the traditional method of weight loss using multicomponent lifestyle modification (dietary changes, increased exercise and behavioural modification) has often led to disappointing results. In adult patients with obesity, treatment strategies have evolved to include bariatric surgery and, more recently, bariatric endoscopy. In paediatrics, the obesity and NAFLD epidemics will likely require this variety of treatment to address children in a personalized manner. Here, we present a review of paediatric obesity, paediatric NAFLD and the various treatment strategies to date. We focus on non‐pharmacologic and emerging therapies, including bariatric surgery and bariatric endoscopy‐based treatments. With such a large population of children and adolescents with obesity, further development of these treatments, including paediatric‐focused clinical trials, is essential for these emerging modalities.

Sex differences in cardiometabolic risk factors and in response to lifestyle intervention in prepubertal and pubertal subjects with obesity

“…The increased ALT levels are a surrogate marker for NAFLD, which has now become the most frequent cause of chronic liver disease, both in children and adults, and predicts later development of diabetes and metabolic syndrome in adults ( 36 ). Lifestyle changes with a healthier diet, gradual weight loss, and increased physical activity seem to be the first-line treatment for this disease at present and several studies demonstrated the beneficial effect of weight loss on fatty liver disease ( 37 ). In a cohort of 117 Danish children with obesity, a 10-week “weight loss camp” induced a significant reduction in transaminase levels, without gender difference ( 38 ).…”

The Ongoing Impact of COVID-19 on Pediatric Obesity

“…School closures and other restrictions due to the COVID-19 pandemic upset the everyday routine of children and adolescents, resulting in changes in eating behaviors and physical activity. Several papers were reported during the pandemic, suggesting particular attention Obesity in children is a significant risk factor for cardiovascular and metabolic connected diseases [50], including hypertension, metabolic syndrome, insulin resistance, type 2 diabetes mellitus, hyperlipidemia, polycystic ovarian syndrome [51], non-alcoholic fatty liver infiltration [52], later-life kidney disorders [53], precocious puberty, and early accelerated growth [54]. There is a close relationship between obesity, hypertension, and COVID-19, which should be taken into consideration due to the long-term cardiovascular risk in children.…”