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Lifestyle Interventions Including Nutrition, Exercise, and Supplements for Nonalcoholic Fatty Liver Disease in Children

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Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease among children. Lifestyle interventions, such as diet and exercise, are frequently recommended. Children with NAFLD have a distinct physiology that is different from obesity alone and has the potential to influence lifestyle treatments. Studies of diet alone in the treatment of pediatric NAFLD have focused on sugar and carbohydrate, but did not indicate any one dietary approach that was superior to another. For children who are obese and have NAFLD, weight loss may have a beneficial effect regardless of the diet used. Exercise is widely believed to improve NAFLD because a sedentary lifestyle, poor aerobic fitness, and low muscle mass are all risk factors for NAFLD. However, there have been no randomized controlled trials of exercise as a treatment for children with NAFLD. Studies of the combination of diet and exercise suggest a potential for improvement in serum alanine aminotransferase activity and/or magnetic resonance imaging liver fat fraction with intervention. There is also enthusiasm for the use of dietary supplements; however, studies in children have shown inconsistent effects of vitamin E, fish oil, and probiotics. This review presents the available data from studies of lifestyle intervention and dietary supplements published to date and highlights challenges that must be addressed in order to advance the evidence base for the treatment of pediatric NAFLD.

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Acknowledgments

This work was supported in part by R01DK088925, R56DK090350, R01DK088831, and U01DK61734. The funders did not participate in the preparation, review, or approval of the manuscript. The contents of this work are solely the responsibility of the author and do not necessarily represent the official views of the National Institutes of Health.

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  1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA

    Jonathan A. Africa, Kimberly P. Newton & Jeffrey B. Schwimmer

  2. Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, CA, USA

    Jonathan A. Africa, Kimberly P. Newton & Jeffrey B. Schwimmer

  3. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, 3020 Children’s Way, MC 5030, San Diego, CA, 92123, USA

    Jeffrey B. Schwimmer

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Africa, J.A., Newton, K.P. & Schwimmer, J.B. Lifestyle Interventions Including Nutrition, Exercise, and Supplements for Nonalcoholic Fatty Liver Disease in Children. Dig Dis Sci 61, 1375–1386 (2016). https://doi.org/10.1007/s10620-016-4126-1

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