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Home / Journal of Pediatric Gastroenterology and Nutrition, Volume 65, Number 2

Systematic Review: Nutrition and Physical Activity in the Management of Paediatric Nonalcoholic Fatty Liver Disease

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Objectives:

The aim of the study was to evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric nonalcoholic fatty liver disease. The prevalence of paediatric nonalcoholic fatty liver disease continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first-line treatment, although supplementation of specific dietary components may be beneficial.Methods:

Medline, CINAHL, EMBASE, Scopus, and Cochrane Libraries were systematically searched to identify randomized controlled trials assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology, or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist.Results:

Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega-3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No randomized controlled trials examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, whereas omega-3 fatty acids decreased hepatic fat content. Probiotics gave mixed results, whereas reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low-fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist.Conclusions:

The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first-line treatment until high-quality evidence emerges that support specific interventions that offer additional clinical benefit.

Keywords: fructose; omega 3 fatty acids; probiotics; vitamin E

Document Type: Research Article

Affiliations: 1: Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK 2: Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK, Department of Nutrition and Dietetics, School of Clinical Sciences, Monash University, Melbourne, Australia 3: Paediatric Liver Centre, King's College London School of Medicine at King's College Hospital, London 4: Department of Nutrition and Dietetics, School of Clinical Sciences, Monash University, Melbourne, Australia 5: Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK, School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK.

Publication date: 01 August 2017

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