Lifestyle intervention in obese children with nonalcoholic 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/I (-14 to -6); aspartate transaminase (AST) -5 U/I (-7 to -3); SDS-BMI -0.23 (-0.30 to -0.16); 2 years: ALT -9 U/I (-12 to -6); AST -6 U/I (-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.