Arch Dis Child 94:437-442 doi:10.1136/adc.2008.143594
  • Original article

Lifestyle intervention in obese children with non-alcoholic fatty liver disease: 2-year follow-up study

  1. T Reinehr1,
  2. C Schmidt1,
  3. A M Toschke2,
  4. W Andler1
  1. 1
    Vestische Hospital for Children and Adolescents, University of Witten-Herdecke, Datteln, Germany
  2. 2
    King’s College London, Division of Health and Social Care Research, London, UK
  1. Thomas Reinehr, Head of the Department of Paediatric Nutrition Medicine, Vestische Children’s Hospital, University of Witten-Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany; T.Reinehr{at}
  • Accepted 3 February 2009
  • Published Online First 17 February 2009


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/l (−14 to −6); aspartate transaminase (AST) −5 U/l (−7 to −3); SDS-BMI −0.23 (−0.30 to −0.16); 2 years: ALT −9 U/l (−12 to −6); AST −6 U/l (−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.

Trial registration number: NCT00435734.


  • Funding: Grant support from of the German “Competence Net Obesity”, which is supported by the German Federal Ministry of Education and Research (grant number 01 GI0839).

  • Competing interests: None.

  • Ethics approval: The study was approved by the local ethics committee of the University of Witten-Herdecke.

  • Patient consent: Obtained.