The Efficacy of Pharmacological Treatment in Pediatric Nonalcoholic Fatty Liver Disease

Cho, Taeshik; Kim, Yong Joo; Paik, Seung Sam

doi:10.5223/pghn.2012.15.4.256

Cited by 10 publications

(15 citation statements)

References 26 publications

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“…The authors recommended that the primary recommendation should be the BMI reduction, however pharmacological treatment plus BMI reduction could have a more therapeutic effect in this children with NAFLD. Although Urso administration without BMI reduction did not demonstrate any improvement in disease process (1).…”

Section: Discussionmentioning

confidence: 99%

“…A body mass index (BMI) reduction combined with vitamin E and ursodeoxycholic acid (UDCA) showed a significantly higher rate of improvement in a clinical profiles study of 29 children and demonstrated that the first-line therapy should consist of BMI reduction (1).…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of NAFLD that can lead to end-stage liver disease is reportedly 3% -10 % in all children in the US, 2.6% in Japanese children, 3.6% in boys, and 2.8% in girls in Korea with an increased alanine aminotransferase (ALT) level; the overall prevalence adjusted for race, ethnicity, sex, and age is 0.7% -33% (1,3).…”

Section: Contextmentioning

confidence: 99%

“…NASH can cause severe complications such as cirrhosis (1). Treatment of NAFLED is a major challenge in this field.…”

Section: Nafldmentioning

confidence: 99%

“…NAFLD can result in progressive fibrosis that leads to end-stage liver disease. Pediatric NAFLD has become a serious public health issue due to the striking increase in its spread (1).…”

Section: Contextmentioning

confidence: 99%

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Treatment of Nonalcoholic Fatty Liver Disease in Children: A Systematic Review

Shahmirzadi

Barati

2017

J Pediatr Rev

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Context: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver illness that results from exceeding fat cumulating in the liver. NAFLD can result in progressive fibrosis, which leads to end-stage liver disease. It has rapidly evolved into the most common liver disease seen in the pediatric and adolescent population, being an increasingly common indication for liver transplant even in youths. Best practices in the management of pediatric NAFLD have not been clearly defined.Objectives: Due to increasing prevalence and the nature of the disease as well as importance of treatment plans and efficacy of each mode of treatment, all studies for pediatric fatty liver disease have been investigated for introducing definite or potential therapies. Data Sources:This systematic review aimed to include and analyze all studies descry the effectiveness of lifestyle modification, pharmacological, non-pharmacological, and dietary supplement treatments in children suffered from fatty liver, NAFLD, or NASH. The PUBMED/MEDLINE for Controlled Trials, Scopus, and OVID databases were searched for articles published up to and including December 2016.Study Selection, Data Extraction: All study in the pediatric group with diagnosis of fatty liver spectrum were included in this review. Adult studies were excluded. The results extracted and expanded.Results: A total of 27 randomized controlled trials were identified after the complete search, deletion of duplicates, removal of irrelevant studies, and final assessment of studies. Treatment plans of interest in these pediatrics articles included: lifestyle modifications, fish oil, and omega-3 fatty acids, including docosahexaenoic acid (DHA), probiotics, vitamin E, metformin, ursodeoxycholic acid, vitamin D, and bariatric surgery. Conclusions:Lifestyle modification is the only approved treatment modality for which evidence-based studies have documented benefits. Omega-3 fatty acids, particularly DHA, are probably effective. Probiotics likely have therapeutic effects in cases of fatty liver; however, further research is needed. Vitamin E and metformin have equivocal results. Ursodeoxycholic acid is recommended as an adjuvant; however, the data are insufficient for vitamin D. Bariatric surgery is not an acceptable plan in pediatric patients. Research of fatty liver diseases in children in all aspects of treatments is urgently needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Contextmentioning

confidence: 99%

“…NASH can cause severe complications such as cirrhosis (1). Treatment of NAFLED is a major challenge in this field.…”

Section: Nafldmentioning

confidence: 99%

“…NAFLD can result in progressive fibrosis that leads to end-stage liver disease. Pediatric NAFLD has become a serious public health issue due to the striking increase in its spread (1).…”

Section: Contextmentioning

confidence: 99%

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Treatment of Nonalcoholic Fatty Liver Disease in Children: A Systematic Review

Shahmirzadi

Barati

2017

J Pediatr Rev

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Improvement in Liver Histology Is Associated With Reduction in Dyslipidemia in Children With Nonalcoholic Fatty Liver Disease

Corey

Vuppalanchi

Vos

et al. 2015

J. pediatr. gastroenterol. nutr.

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Objectives Nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease among American children, may be associated with cardiovascular disease (CVD) risk. This study sought to determine the prevalence of dyslipidemia in children with NAFLD, assess dyslipidemia by liver histology and histologic changes. Methods Individuals in the Treatment of NAFLD in Children (TONIC) trial were included (N=173). In the TONIC trial children with NAFLD were randomized to vitamin E, metformin or placebo for 96 weeks. Nonalcoholic steatohepatitis (NASH) improved in 56 individuals. Change in lipid levels from baseline and 96 weeks was compared between subjects with and without histologic improvement and with and without NASH. Results Dyslipidemia was frequent, with low high-density lipoprotein (HDL) (<40 mg/dL) in 61.8%, hypertriglyceridemia (≥130 mg/dL) in 50.3%, hypercholesterolemia (≥200 mg/dL) in 23.7%, elevated low-density lipoprotein (LDL) (≥130 mg/dL) in 21.5%, elevated non-HDL cholesterol (non-HDL-C) (≥145 mg/dL) in 35.2%, and triglycerides/HDL>3.0 in 57.2% of subjects. Histologic improvement was associated with significant decreases in cholesterol (−11.4 mg/dL vs. −1.9 mg/dL, p=0.04), LDL (−11.2 mg/dL vs. −2.1 mg/dL, p=0.04) and non-HDL-C (−8.8 mg/dL vs. 0.5 mg/dL, p=0.03) compared to those without improvement. Children with NASH resolution had significant decreases in cholesterol (−10.0 mg/dL vs. −0.9 mg/dL, p=0.02) and non-HDL-C (−7.3 mg/dL vs. 1.1 mg/dL, p=0.01) compared to those without NASH resolution. Neither triglycerides, HDL level nor triglycerides/HDL ratio improved in either group. Conclusions Dyslipidemia is frequent in children with NAFLD. NASH resolution and histologic improvement are associated with improvements in some forms of dyslipidemia.

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Laboratory screening in overweight/obese adolescents: do the results change the management?

Morris

Feinstein

Fisher

2016

International Journal of Adolescent Medicine and Health

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Due to the growth of the epidemic of obesity and the association of obesity with both short-term and long-term medical complications, many professional organizations have recommended performing laboratory testing as part of the initial evaluation of overweight and obese children and adolescents. We report on the results of laboratory testing performed on 110 patients (mean age 14.0 years, range 8-20 years) referred to our weight management program between 2011 and 2013. Our results showed mild abnormalities in levels of cholesterol, glucose, liver enzymes, and thyroid stimulating hormone (TSH) in fewer than 5% of patients for each test and no changes in management based on these results for any of the patients. We call for re-consideration of the recommendations for laboratory testing in children and adolescents being evaluated and treated for overweight and obesity.

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The Efficacy of Pharmacological Treatment in Pediatric Nonalcoholic Fatty Liver Disease

Cited by 10 publications

References 26 publications

Treatment of Nonalcoholic Fatty Liver Disease in Children: A Systematic Review

Treatment of Nonalcoholic Fatty Liver Disease in Children: A Systematic Review

Improvement in Liver Histology Is Associated With Reduction in Dyslipidemia in Children With Nonalcoholic Fatty Liver Disease

Laboratory screening in overweight/obese adolescents: do the results change the management?

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