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Intensive lifestyle management improves steatosis and fibrosis in pediatric non-alcoholic fatty liver disease

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Abstract
BACKGROUND & AIMS: Childhood obesity, with associated comorbidities such as nonalcoholic fatty liver disease (NAFLD), is an increasing global health problem. Although lifestyle management is the mainstay of treatment, its efficacy on liver fibrosis has not yet been established. METHODS: Children and adolescents admitted for severe obesity at a tertiary center (Zeepreventorium, De Haan, Belgium) were enrolled in this prospective study. Intensive lifestyle therapy encompassed caloric restriction, physical activity, education on a healthy lifestyle, and psychosocial support. At baseline, 6 months, and 12 months, liver ultrasound and transient elastography with controlled attenuation parameter were performed to assess liver steatosis and fibrosis. RESULTS: A total of 204 patients (median age, 14.0 y; body mass index Z-score, +2.8) were evaluated at admission. NAFLD on ultrasound was present in 71.1%, whereas 68.6% had controlled attenuation parameter values of 248 dB/m or greater. A total of 32.8% of patients had at least F2 fibrosis, including 10.3% with transient elastography of 9 kPa or greater. After 6 months, the median body weight loss was 16.0% in the 167 patients evaluated. Fibrosis improved in 75.0% (P < .001). Baseline severity of liver fibrosis and steatosis were predictors of fibrosis resolution. Seventy-nine patients had reached the 1-year time point. The improvements were sustained because fibrosis regressed at least 1 stage in all patients with baseline fibrosis. Fasting serum alanine aminotransferase and homeostasis model assessment of insulin resistance decreased significantly over the 1-year period (P < .001). CONCLUSIONS: NAFLD and associated fibrosis are highly prevalent in children and adolescents with severe obesity. An intensive multidisciplinary lifestyle management program that causes significant weight loss not only improves liver steatosis, but also fibrosis.
Keywords
Fibroscan, Weight Loss, Pediatric Obesity, Lifestyle Intervention, NAFLD

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MLA
Lefere, Sander, et al. “Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Non-Alcoholic Fatty Liver Disease.” CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, vol. 20, no. 10, 2022, pp. 2317-2326.e4, doi:10.1016/j.cgh.2021.11.039.
APA
Lefere, S., Dupont, E., De Guchtenaere, A., Van Biervliet, S., Vande Velde, S., Verhelst, X., … De Bruyne, R. (2022). Intensive lifestyle management improves steatosis and fibrosis in pediatric non-alcoholic fatty liver disease. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 20(10), 2317-2326.e4. https://doi.org/10.1016/j.cgh.2021.11.039
Chicago author-date
Lefere, Sander, Ellen Dupont, Ann De Guchtenaere, Stephanie Van Biervliet, Saskia Vande Velde, Xavier Verhelst, Lindsey Devisscher, Hans Van Vlierberghe, Anja Geerts, and Ruth De Bruyne. 2022. “Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Non-Alcoholic Fatty Liver Disease.” CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 20 (10): 2317-2326.e4. https://doi.org/10.1016/j.cgh.2021.11.039.
Chicago author-date (all authors)
Lefere, Sander, Ellen Dupont, Ann De Guchtenaere, Stephanie Van Biervliet, Saskia Vande Velde, Xavier Verhelst, Lindsey Devisscher, Hans Van Vlierberghe, Anja Geerts, and Ruth De Bruyne. 2022. “Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Non-Alcoholic Fatty Liver Disease.” CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 20 (10): 2317-2326.e4. doi:10.1016/j.cgh.2021.11.039.
Vancouver
1.
Lefere S, Dupont E, De Guchtenaere A, Van Biervliet S, Vande Velde S, Verhelst X, et al. Intensive lifestyle management improves steatosis and fibrosis in pediatric non-alcoholic fatty liver disease. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. 2022;20(10):2317-2326.e4.
IEEE
[1]
S. Lefere et al., “Intensive lifestyle management improves steatosis and fibrosis in pediatric non-alcoholic fatty liver disease,” CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, vol. 20, no. 10, pp. 2317-2326.e4, 2022.
@article{8728559,
  abstract     = {{BACKGROUND & AIMS: Childhood obesity, with associated comorbidities such as nonalcoholic fatty liver disease (NAFLD), is an increasing global health problem. Although lifestyle management is the mainstay of treatment, its efficacy on liver fibrosis has not yet been established.

METHODS: Children and adolescents admitted for severe obesity at a tertiary center (Zeepreventorium, De Haan, Belgium) were enrolled in this prospective study. Intensive lifestyle therapy encompassed caloric restriction, physical activity, education on a healthy lifestyle, and psychosocial support. At baseline, 6 months, and 12 months, liver ultrasound and transient elastography with controlled attenuation parameter were performed to assess liver steatosis and fibrosis.

RESULTS: A total of 204 patients (median age, 14.0 y; body mass index Z-score, +2.8) were evaluated at admission. NAFLD on ultrasound was present in 71.1%, whereas 68.6% had controlled attenuation parameter values of 248 dB/m or greater. A total of 32.8% of patients had at least F2 fibrosis, including 10.3% with transient elastography of 9 kPa or greater. After 6 months, the median body weight loss was 16.0% in the 167 patients evaluated. Fibrosis improved in 75.0% (P < .001). Baseline severity of liver fibrosis and steatosis were predictors of fibrosis resolution. Seventy-nine patients had reached the 1-year time point. The improvements were sustained because fibrosis regressed at least 1 stage in all patients with baseline fibrosis. Fasting serum alanine aminotransferase and homeostasis model assessment of insulin resistance decreased significantly over the 1-year period (P < .001).

CONCLUSIONS: NAFLD and associated fibrosis are highly prevalent in children and adolescents with severe obesity. An intensive multidisciplinary lifestyle management program that causes significant weight loss not only improves liver steatosis, but also fibrosis.}},
  author       = {{Lefere, Sander and Dupont, Ellen and De Guchtenaere, Ann and Van Biervliet, Stephanie and Vande Velde, Saskia and Verhelst, Xavier and Devisscher, Lindsey and Van Vlierberghe, Hans and Geerts, Anja and De Bruyne, Ruth}},
  issn         = {{1542-3565}},
  journal      = {{CLINICAL GASTROENTEROLOGY AND HEPATOLOGY}},
  keywords     = {{Fibroscan,Weight Loss,Pediatric Obesity,Lifestyle Intervention,NAFLD}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{2317--2326.e4}},
  title        = {{Intensive lifestyle management improves steatosis and fibrosis in pediatric non-alcoholic fatty liver disease}},
  url          = {{http://doi.org/10.1016/j.cgh.2021.11.039}},
  volume       = {{20}},
  year         = {{2022}},
}

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