Abstract

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.