Systematic Review: Nutrition and Physical Activity in the Management of Paediatric Non-alcoholic Fatty Liver Disease

To evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric non-alcoholic fatty liver disease (NAFLD). The prevalence of paediatric NAFLD continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first-line treatment, although supplementation of specific dietary components may be beneficial. Medline, CINAHL, EMBASE, Scopus and Cochrane Libraries were systematically searched to identify randomised controlled trials (RCTs) assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist. Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega-3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No RCTs examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, while omega-3 fatty acids decreased hepatic fat content. Probiotics gave mixed results while reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist. The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first-line treatment until high quality evidence emerges that support specific interventions that offer additional clinical benefit.