Lifestyle intervention in obese children with non-alcoholic fatty liver disease: 2-year follow-up study.
OBJECTIVE
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in obese youth. Lifestyle intervention was demonstrated to improve NAFLD but follow-up studies after end of intervention are lacking. Furthermore the necessary degree of overweight reduction for improvement of NAFLD remains unknown.


METHODS
We examined standard deviation score of body mass index (SDS-BMI) and transaminases in 152 obese children with NAFLD diagnosed by ultrasound at baseline, at the end of a 1-year intervention and 2 years after baseline. Within-subject changes of these parameters were compared by participation in the intervention based on physical activity, nutrition education and behaviour therapy.


RESULTS
In contrast to 43 children without lifestyle intervention, participation in lifestyle intervention (n = 109) was associated with a significant decrease of transaminases and overweight 1 and 2 years after baseline (1 year: alanine transaminase (ALT) -10 U/l (-14 to -6); aspartate transaminase (AST) -5 U/l (-7 to -3); SDS-BMI -0.23 (-0.30 to -0.16); 2 years: ALT -9 U/l (-12 to -6); AST -6 U/l (-7 to -4); SDS-BMI -0.30 (-0.37 to -0.22); data as mean changes and 95% confidence interval compared to baseline). Any degree of overweight reduction was associated with a significant decrease of NAFLD prevalence. The greatest decrease of NAFLD prevalence (1 year: -89% (95% CI -72% to -100%); 2 years: -94% (95% CI -83% to -100%)) was observed in children with the greatest overweight reduction (SDS-BMI decrease >0.5).


CONCLUSIONS
Multidisciplinary lifestyle intervention is effective to improve NAFLD even in the 1-year follow-up after the end of intervention. A minimal reduction of overweight led to an improvement of NAFLD.


BACKGROUND
NCT00435734.
Reinehr
T
T
Vestische Hospital for Children and Adolescents, University of Witten-Herdecke, Datteln, Germany. T.Reinehr@kinderklinik-datteln.de
Schmidt
C
C
Toschke
A M
AM
Andler
W
W
D000293:Adolescent; D000410:Alanine Transaminase / Q000378:metabolism; D000886:Anthropometry; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002648:Child; D005234:Fatty Liver / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D017410:Practice Guidelines as Topic; D040242:Risk Reduction Behavior; D013997:Time Factors; D015431:Weight Loss / Q000502:physiology
D001786:Blood Glucose; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase