Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD) can range from simple steatosis to steatohepatitis with or without fibrosis. The predictors for liver fibrosis and the effect of nutritional intervention on hepatic fibrosis in pediatric population are not well established. We aimed to investigate the predictors for liver fibrosis and the effects of short-term nutritional intervention on steatosis and fibrosis among obese adolescents with NAFLD.MethodsCross-sectional study among obese adolescents. Sociodemographic and clinical data were collected. Liver fibrosis was estimated by Shearwave elastography. All participants were recommended to consume a low carbohydrate diet and were followed biweekly. Blood tests and elastography were performed upon admission and repeated after 3 months.ResultsFifty-seven pediatric patients were recruited (35 males, mean age 13.5±2.9 years, mean body mass index [BMI] 38.8±9.7). Liver fibrosis was diagnosed in 34 (60%) subjects, which was moderate/severe (F≥2) in 24 (70%). A higher BMI Z score and moderate/severe steatosis correlated with moderate/severe fibrosis (P < 0.05). Seventeen patients completed 3 months of follow-up and displayed a decrease in BMI Z score (from BMI Z score 2.6±0.5 before intervention to 2.4±0.5 after intervention), with a significant decrease in liver fibrosis (P = 0.001).ConclusionPediatric patients with high BMIs and severe liver steatosis are at risk for severe liver fibrosis. Nutritional intervention with minimal weight loss may improves hepatic fibrosis among the pediatric population.Trial registrationTRN NCT04561804 (9/17/2020)
Highlights
Non-alcoholic fatty liver disease (NAFLD) can range from simple steatosis to steatohepatitis with or without fibrosis
Fifteen patients were excluded for refusal to undergo elastography examination, 13 patients were excluded for invalid elastography examinations, and 10 patients were subsequently excluded due to missing data
Their ethnic distribution revealed that 47% of the patients were Jews of mixed origin (Ashkenazi and Sephardi), 23% were Sephardi Jews, 21.9% were Ashkenazi Jews, and 8.1% were Arabs
Summary
Non-alcoholic fatty liver disease (NAFLD) can range from simple steatosis to steatohepatitis with or without fibrosis. The predictors for liver fibrosis and the effect of nutritional intervention on hepatic fibrosis in pediatric population are not well established. We aimed to investigate the predictors for liver fibrosis and the effects of short-term nutritional intervention on steatosis and fibrosis among obese adolescents with NAFLD. NAFLD encompasses a wide spectrum of histological and clinical manifestations, ranging from simple steatosis with debatable clinical significance to non-alcoholic steatohepatitis (NASH), with or without fibrosis that may develop into cirrhosis and liver failure, even in young children [3]. The aims of the present study were to investigate predictors for liver fibrosis in obese pediatric patients, and to assess the effects of short-term dietary intervention on steatosis and fibrosis The current mainstay of treatment for both adult and pediatric NAFLD is weight loss, but the effect of dietary intervention on hepatic fibrosis in pediatric population is not well established [7, 8].
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