Smith Martha R, Yu Elizabeth L, Malki Ghattas J, Newton Kimberly P, Goyal Nidhi P, Heskett Karen M, Schwimmer Jeffrey B
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, United States of America.
Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States of America.
PLoS One. 2024 Dec 10;19(12):e0314542. doi: 10.1371/journal.pone.0314542. eCollection 2024.
BACKGROUND & AIMS: Steatotic liver disease affects approximately 1 in 10 children in the U.S. and increases the risk of cirrhosis, diabetes, and cardiovascular disease. Lifestyle modification centered on increased physical activity and dietary improvement is the primary management approach. However, significant gaps in the literature hinder the establishment of exercise as a targeted therapeutic strategy for pediatric metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD). We performed a systematic review of studies assessing the impact of exercise interventions on validated hepatic outcomes in children with NAFLD.
We searched CENTRAL, PubMed, Embase, Web of Science, CINAHL, and Google Scholar on June 5 and 6, 2023, for studies in English involving children aged 0 to 19 years diagnosed with NAFLD or at increased risk for NAFLD due to overweight or obesity. We updated the search on August 8, 2024. Eligible studies were required to examine the impact of exercise interventions on hepatic steatosis or liver chemistry. The risk of bias was assessed with RoB2 and ROBINS-I. Data extraction was performed by two independent reviewers.
After screening 1578 unique records, 16 studies involving 998 children were included. This comprised seven studies comparing exercise intervention with non-exercising controls, three uncontrolled studies of exercise intervention, two studies comparing exercise plus lifestyle interventions with lifestyle interventions alone, and nine studies comparing different types of exercise interventions. Five of the 11 studies that evaluated hepatic steatosis reported an absolute decrease of 1% to 3%. In the nine studies that evaluated liver chemistry, no significant changes were observed.
Evidence supporting exercise intervention for the treatment of pediatric MASLD is limited. Existing studies were constrained by their methodological approaches; thus, there is a pressing need for high-quality future research. This will enable the development of precise, evidence-based exercise guidelines crucial for the effective clinical management of this condition.
在美国，脂肪性肝病影响着约十分之一的儿童，并增加了肝硬化、糖尿病和心血管疾病的风险。以增加身体活动和改善饮食为核心的生活方式改变是主要的管理方法。然而，文献中的重大空白阻碍了将运动确立为治疗小儿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））的靶向治疗策略。我们对评估运动干预对NAFLD儿童经过验证的肝脏结局的影响的研究进行了系统评价。
我们于2023年6月5日和6日在CENTRAL、PubMed、Embase、Web of Science、CINAHL和谷歌学术上搜索了涉及0至19岁被诊断为NAFLD或因超重或肥胖而患NAFLD风险增加的儿童的英文研究。我们于2024年8月8日更新了搜索。符合条件的研究需考察运动干预对肝脂肪变性或肝脏生化指标的影响。采用RoB2和ROBINS - I评估偏倚风险。由两名独立的评审员进行数据提取。
在筛选了1578条独特记录后，纳入了16项涉及998名儿童的研究。其中包括7项比较运动干预与非运动对照组的研究、3项运动干预的非对照研究、2项比较运动加生活方式干预与单纯生活方式干预的研究以及9项比较不同类型运动干预的研究。在评估肝脂肪变性的11项研究中，有5项报告绝对下降了1%至3%。在评估肝脏生化指标的9项研究中，未观察到显著变化。
支持运动干预治疗小儿MASLD的证据有限。现有研究受到其方法学的限制；因此，迫切需要未来开展高质量的研究。这将有助于制定精确的、基于证据的运动指南，这对于有效临床管理这种疾病至关重要。
