Background: Non alcoholic fatty liver (NAFLD) is highly prevalent among obese children and represents a major risk factor for chronic liver diseases (steatohepatitis and fibrosis) and severe metabolic complications. While weight loss is the main treatment for pediatric NAFLD, little is known about the effects of dietary composition upon liver fat. The aim of the present study was to investigate predictors for fibrosis in obese pediatric patients and to assess the effect of low glycemic index diet on steatosis and fibrosis.
Methods: We conducted a cross-sectional study among obese pediatric children and adolescents attending the obesity clinic at the Dana-Dwek Children`s Hospital. Sociodemographic and clinical data were collected. Liver fibrosis was estimated by using ShearWave elastography (Supersonic) while liver steatosis was calculated by hepatorenal index and divided into 3 levels of severity (mild, moderate and severe). All participant received nutrition education to reduce high glycemic index carbohydrate and were foloowed regulary in our clinic. Blood tests and elastography were collected upon admission and after 3 months. Between- and within-group differences in steatosis, fibrosis and metabolic parameters at baseline and after nutritional intervention were determined.
Results: Forty children were recruited (24 male/16 female, mean ages 14.1±2.6 years, mean BMI 39.1±9.9). Of these, 25 (60%) had liver fibrosis and 22 (55%) had significant steatosis. Higher BMI Z score and moderate/ severe steatosis were correlated with significant fibrosis (BMI Z score 2.8±0.7 and 13 (76%) in subjects with significant fibrosis VS 2.4±0.5 and 9 (23%) in patients with mild/no Fibrosis, P<0.05, Table 1). Twelve patients completed 3 months follow up with repeated blood tests and elastography. After 3 month we found significant decrease in liver enzyme, level of steatosis and fibrosis with no significant decrease in BMI Z score (p<0.05, Table 2, Figure 1).
Conclusion: Steatosis and fibrosis are highly prevalent in pediatric obesity population. Patients with higher BMI and moderate/severe steatosis bear a greater risk for significant fibrosis. Low glycemic load diet improve hepatic steatosis and fibrosis over 3 month. Additional research is needed to determine effectiveness over the long term.
