Pediatric Obesity Clinic and Wellness Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico.
Laboratorio de Biologia Molecular, Universidad Autónoma de Tamaulipas, Tamaulipas, Mexico.
BMC Med. 2024 Nov 21;22(1):548. doi: 10.1186/s12916-024-03744-x.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is a prevalent hepatic condition linked to metabolic alterations. It gradually causes liver damage and potentially progresses to cirrhosis. Despite its significance, research, especially in the pediatric population, is limited, leading to contradictory findings in diagnosis and treatment. This meta-analysis aims to synthesize existing literature on therapeutic interventions for MASLD in children and adolescents.
A comprehensive search of randomized controlled clinical trials yielded 634 entries from PubMed, Scopus, and Web of Science up to 2023. Interventions included medications, behavioral modifications, dietary changes, probiotics, supplements, surgical procedures, or combinations. The analysis focused on studies with treatment duration of at least 3 months, employing a random-effects REML meta-analysis model. Treatment effects on anthropometric measurements and biochemical components were examined and adjusted for heterogeneity factors analysis. A bibliometric analysis for insights into research contributors was performed.
The systematic review incorporated 31 clinical trials, with 24 meeting criteria for meta-analysis. These comprised 3 medication studies, 20 with supplements, 4 focusing on lifestyle, and 4 centered on diets. Significant overall treatment effects were observed for ALT, AST, BMI, and HOMA-IR mainly by supplements and lifestyle. Meta-regression identified age, BMI changes, and treatment duration as factors modifying ALT concentrations. Bibliometric analysis involving 31 linked studies highlighted contributions from 13 countries, with the USA, Spain, and Chile being the most influential.
We conclude that supplementation and lifestyle changes can effectively impact ALT and AST levels, which can help address liver issues in obese children. However, the evaluation of risk bias, the high heterogeneity, and the bibliometric analysis emphasize the need for more high-quality studies and broader inclusion of diverse child populations to provide better therapeutic recommendations.
PROSPERO, CRD42023393952. Registered on January 25, 2023.
代谢功能障碍相关脂肪性肝病（MASLD），以前称为非酒精性脂肪性肝病（NAFLD），是一种与代谢改变相关的常见肝脏疾病。它逐渐导致肝损伤，并可能进展为肝硬化。尽管其意义重大，但研究，特别是在儿科人群中的研究，有限，导致在诊断和治疗方面存在矛盾的发现。本荟萃分析旨在综合现有的关于儿童和青少年 MASLD 治疗干预的文献。
对 PubMed、Scopus 和 Web of Science 进行全面检索，截至 2023 年共获得 634 项随机对照临床试验。干预措施包括药物、行为改变、饮食改变、益生菌、补充剂、手术或联合治疗。分析重点是治疗持续时间至少为 3 个月的研究，采用随机效应 REML 荟萃分析模型。检查了治疗对人体测量学和生化成分的影响，并对异质性因素分析进行了调整。还进行了文献计量分析，以了解研究贡献者的情况。
系统综述纳入了 31 项临床试验，其中 24 项符合荟萃分析标准。这些研究包括 3 项药物研究、20 项补充剂研究、4 项生活方式研究和 4 项饮食研究。补充剂和生活方式主要对 ALT、AST、BMI 和 HOMA-IR 有显著的总体治疗效果。元回归分析确定年龄、BMI 变化和治疗持续时间是影响 ALT 浓度的因素。涉及 31 项相关研究的文献计量分析突出了来自 13 个国家的贡献，其中美国、西班牙和智利的贡献最大。
我们的结论是，补充剂和生活方式的改变可以有效地影响 ALT 和 AST 水平，这有助于解决肥胖儿童的肝脏问题。然而，风险偏倚的评估、高度异质性以及文献计量分析强调需要更多高质量的研究，并更广泛地纳入不同的儿童人群，以提供更好的治疗建议。
PROSPERO，CRD42023393952。注册于 2023 年 1 月 25 日。
