Standard of care counselling insufficient for kids with NAFLD

While many children with nonalcoholic fatty liver disease (NAFLD) see improvements in relation to standard of care lifestyle counselling, a substantial portion continues to experience degree progression, a new study has found.

“Trials of novel therapies are urgently needed to identify efficacious and accessible interventions for children failing to respond to lifestyle counselling,” the researchers said.

The study included 122 children with NAFLD (mean age, 13±3 years; 74 percent male) who had been assigned to the placebo arms of two previous randomized controlled trials; those who had received active interventions were ineligible. The only exposure the current sample had was standard nutrition and exercise counselling.

Participants were observed for an average of 1.8±0.4 years, over which time levels of both alanine and aspartate aminotransferases dropped significantly (p<0.01), while no such change in gamma-glutamyl transferase was reported.

In terms of NAFLD severity, improvements were reported in 52 percent of the participants, who either saw the resolution of nonalcoholic steatohepatitis (NASH) or a regression of fibrosis; 20 percent achieved the composite of both endpoints. The average composite NAFLD activity scores likewise dropped significantly over time (4.6±1.4 to 3.9±1.7; p=0.001).

Nevertheless, the researchers found that NAFLD progressed in 36 percent of the participants, who developed fibrosis or whose diseases worsened to definite NASH. Meeting both endpoints, as a composite, was reported in 11 percent.