Koot B G P, van der Baan-Slootweg O H, Vinke S, Bohte A E, Tamminga-Smeulders C L J, Jansen P L M, Stoker J, Benninga M A
Department of Paediatric Gastroenterology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
Childhood Obesity Centre Heideheuvel, Hilversum, The Netherlands.
Int J Obes (Lond). 2016 Jan;40(1):51-7. doi: 10.1038/ijo.2015.175. Epub 2015 Aug 28.
BACKGROUND/AIMS: Lifestyle intervention is the only established therapy for non-alcoholic fatty liver disease (NAFLD). The optimal treatment schedule and predictors of response of this treatment have not been established in children. We aimed to evaluate the 2-year efficacy of an inpatient versus ambulatory intensive lifestyle intervention for treating NAFLD in children with severe obesity.
A cohort study of 51 severely obese non-diabetic children (mean age 14.7 (±2.4) years; BMI-z-score 3.5 (±0.5)) with liver steatosis were non-randomly allocated to inpatient treatment (2 or 6 months), ambulatory treatment or usual care. Proton Magnetic Resonance Spectroscopy determined liver steatosis and serum alanine aminotransferase (ALT) at 6 months were the primary outcome measures. Baseline variables were evaluated as predictors of treatment response.
Liver steatosis had disappeared in 43, 29 and 22% and serum ALT normalized in 41, 33 and 6% at the end of 6 months in the inpatient, ambulatory or usual care treatment groups, respectively. Only the proportions of ALT normalization in inpatient and ambulatory treatment compared with usual care were significantly higher. Treatment effects of inpatient and ambulatory treatment were sustained at 1.5 years follow-up. No baseline characteristic, including PNPLA3 polymorphism or leptin, was consistently predictive for treatment response.
A 6-month intensive inpatient and ambulatory lifestyle treatment in children with severe obesity reverses NAFLD in a minority of patients. This study suggests that inpatient compared with ambulatory intensive treatment does not importantly increase treatment success. Further efforts to optimize and individualize lifestyle interventions and additional treatments options are needed particular for children with severe obesity resistant to conventional lifestyle interventions.
背景/目的：生活方式干预是唯一已确立的非酒精性脂肪性肝病（NAFLD）治疗方法。儿童NAFLD的最佳治疗方案及该治疗反应的预测因素尚未确定。我们旨在评估住院与门诊强化生活方式干预对重度肥胖儿童NAFLD的2年疗效。
对51例患有肝脂肪变性的重度肥胖非糖尿病儿童（平均年龄14.7（±2.4）岁；BMI-z评分3.5（±0.5））进行队列研究，将其非随机分配至住院治疗（2或6个月）、门诊治疗或常规护理。质子磁共振波谱法测定肝脂肪变性情况，6个月时血清丙氨酸氨基转移酶（ALT）为主要结局指标。评估基线变量作为治疗反应的预测因素。
住院、门诊或常规护理治疗组在6个月末肝脂肪变性消失的比例分别为43%、29%和22%，血清ALT恢复正常的比例分别为41%、33%和6%。仅住院和门诊治疗组ALT恢复正常的比例与常规护理相比显著更高。住院和门诊治疗的效果在1.5年随访时得以维持。没有基线特征，包括PNPLA3基因多态性或瘦素，能始终如一地预测治疗反应。
对重度肥胖儿童进行6个月的强化住院和门诊生活方式治疗可使少数患者的NAFLD得到逆转。本研究表明，与门诊强化治疗相比，住院治疗并未显著提高治疗成功率。需要进一步努力优化和个性化生活方式干预及增加其他治疗选择，尤其是对于对传统生活方式干预有抵抗的重度肥胖儿童。
