Paediatric Nonalcoholic Fatty Liver Disease

Anna Alisi; Guido Carpino; Valerio Nobili

Disclosures

Curr Opin Gastroenterol. 2013;29(3):279-284. 

In This Article

Paediatric Nonalcoholic Steatohepatitis Treatment Options

The primary end-points of therapy for paediatric NASH are the normalization of liver enzyme levels and the recovery of normal liver histology. However, also the improvement of overweight/obesity, insulin resistance and oxidative stress is to be considered directly or indirectly effective on reduction of liver functional/histological damage.

Diet and Exercise

Weight loss is the main target of the first-line of nonpharmacological therapies for paediatric NAFLD. An efficient weight loss is mainly achieved by personalized diet and proper exercise.

Lifestyle modifications, based both on diet restriction and physical activity increase, may cause, similarly to adults, a significant reduction in body weight/BMI, and an improvement of liver function tests and liver damage in children with NAFLD.[41]

Although dietary composition and exercise may be useful in functional/structural recovery of the liver, their beneficial effects are reduced by the little information on the impact of specific diet and physical activity in paediatric NAFLD and the absence of guidelines to design personalized dietetic physical activity programmes.

Pharmacological Therapy

On the basis of the main factors involved in NAFLD pathogenesis, to date, three types of targeting pharmacological interventions have been tested in paediatric individuals: insulin sensitizers, antioxidant agents and cytoprotective agents. Metformin, one of the most used insulin sensitizers, is no more effective than lifestyle intervention in ameliorating liver function tests (i.e. ALT), steatosis and liver histology in children with NAFLD.[42,43] On the contrary, natural antioxidants, such as vitamin E, lead to a significant improvement of liver function, glucose metabolism and a moderate beneficial effect on hepatocyte ballooning compared with lifestyle intervention alone.[44,45] Finally, ursodeoxycholic acid, a cytoprotective agent, which requires further attention in paediatric NAFLD, appears to be ineffective both in reducing serum ALT and the ultrasound steatosis in obese children.[46]

Dietary Supplementations

Recently, interesting dietary supplementation such as probiotics and long-chain omega-3 polyunsaturated fatty acids has been proved in paediatric NAFLD.[3] However, despite that we wait for the results about the effects of agents restoring normal gut microbiota (i.e. probiotics) in NAFLD children (see clinicaltrials.gov), Nobili et alet al.[47,48] reported preliminary and final results of a randomized clinical trial based on the use of docosahexaenoic acid (DHA). DHA supplementation to lifestyle intervention ameliorates BMI, insulin sensitivity index, triglycerides and ALT serum levels, steatosis at 6 months by ultrasound and at 16 months by liver biopsy.[3,8]

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