Treatment of Nonalcoholic Fatty Liver Disease in Children: A Systematic Review

Context: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver illness that results from exceeding fat cumulating in the liver. NAFLD can result in progressive fibrosis, which leads to end-stage liver disease. It has rapidly evolved into the most common liver disease seen in the pediatric and adolescent population, being an increasingly common indication for liver transplant even in youths. Best practices in the management of pediatric NAFLD have not been clearly defined. Objectives: Due to increasing prevalence and the nature of the disease as well as importance of treatment plans and efficacy of each mode of treatment, all studies for pediatric fatty liver disease have been investigated for introducing definite or potential therapies. Data Sources: This systematic review aimed to include and analyze all studies descry the effectiveness of lifestyle modification, pharmacological, non-pharmacological, and dietary supplement treatments in children suffered from fatty liver, NAFLD, or NASH. The PUBMED/MEDLINE for Controlled Trials, Scopus, and OVID databases were searched for articles published up to and including December 2016. Study Selection, Data Extraction: All study in the pediatric group with diagnosis of fatty liver spectrum were included in this review. Adult studies were excluded. The results extracted and expanded. Results: A total of 27 randomized controlled trials were identified after the complete search, deletion of duplicates, removal of irrelevant studies, and final assessment of studies. Treatment plans of interest in these pediatrics articles included: lifestyle modifications, fish oil, and omega-3 fatty acids, including docosahexaenoic acid (DHA), probiotics, vitamin E, metformin, ursodeoxycholic acid, vitamin D, and bariatric surgery. Conclusions: Lifestyle modification is the only approved treatment modality for which evidence-based studies have documented benefits. Omega-3 fatty acids, particularly DHA, are probably effective. Probiotics likely have therapeutic effects in cases of fatty liver; however, further research is needed. Vitamin E and metformin have equivocal results. Ursodeoxycholic acid is recommended as an adjuvant; however, the data are insufficient for vitamin D. Bariatric surgery is not an acceptable plan in pediatric patients. Research of fatty liver diseases in children in all aspects of treatments is urgently needed.