title: Omega-3 fatty acids as a treatment for non-alcoholic fatty liver disease in children: A systematic review and meta-analysis of randomized controlled trials.
abstract: The most typical chronic liver disease in children and adolescents is non-alcoholic fatty liver disease (NAFLD). The dietary addition of ω-3 polyunsaturated fatty acids (PUFAs) provides a promising therapy for children with NAFLD due to its convenience and safety; however, several studies suggested contradictory results for PUFA supplementation in children. Hence, we performed a systematic review and meta-analysis to evaluate the effectiveness of PUFA supplementation in children with NAFLD.
  
  
  
  Published randomized controlled trials (RCTs) that evaluated the effectiveness of the dietary addition of PUFA in children with NAFLD were considered. The primary result was the alteration in hepatic steatosis grade on ultrasound after treatment. The secondary outcomes included alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP) and components of metabolic syndrome. Predefined sensitivity analysis was also performed to explore possible explanations for heterogeneity in the evaluations.
  
  
  
  In total, 4 studies with 263 subjects were identified. PUFA supplementation was associated with significantly improved hepatic steatosis grade on ultrasound (risk difference: 25%, 95% CI: 12-38%), without heterogeneity (P = 0.27, I2= 24%). Sensitivity analysis confirmed the robustness of our findings. PUFA supplementation could decrease AST levels after 6 months, but could only reduce ALT levels after 12 months. PUFA did not have a significant effect on most components of metabolic syndrome and the CRP level.
  
  
  
  ω-3 PUFA supplementation can improve liver steatosis and liver functions, and it is a potential food supplementation to treat NAFLD in children.
authors.affiliation: Department of Pediatrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
authors.forename: Lian-Hui
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China. Electronic address: pediatricsfe@gmail.com.
authors.forename: Yong-Fen
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
authors.forename: Qing-Hong
authors.initials: QH
authors.lastname: Xu
authors.affiliation: Department of Intensive Care Unit, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China.
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D002648:Child; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D006801:Humans; D065626:Non-alcoholic Fatty Liver Disease / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D015525:Fatty Acids, Omega-3
keywords: Children; Fish oil; Non-alcoholic fatty liver disease; Obesity; Polyunsaturated fatty acids