Systematic review of exercise for the treatment of pediatric metabolic dysfunction-associated steatotic liver disease.

Elizabeth L Yu, Karen M Heskett, Kimberly P Newton, Nidhi P Goyal, Jeffrey B Schwimmer, Martha R Smith, Ghattas J Malki

Journal: PloS one 2024;19(12):e0314542

PMID: 39656734

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Plain Language Summary

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition affecting about 1 in 10 children in the U.S, which can lead to serious health issues like cirrhosis (severe liver damage), diabetes and heart disease. Management of MASLD involved diet and lifestyle modification. However, it is unclear as to the specific type of exercise that may have the most benefit. This systematic review of 16 studies examined the role of exercise in treating paediatric MASLD. The authors searched multiple databases for studies that looked at the effects of exercise on liver health in children aged 0 to 19 years. They aimed to clarify how physical activity might improve liver outcomes in those diagnosed with MASLD.

The review showed that there is a need for more evidence on how exercise can be effectively used as a treatment, as current literature shows significant gaps in understanding its benefits for children with this condition. Five studies reported a modest decrease in hepatic steatosis ranging from 1-3%. The types of exercise that demonstrated a decrease in liver steatosis included aerobic, resistance and a combination of the two.

It was concluded that there is limited evidence on the effects of exercise in children with MASLD. This study could be used by healthcare professionals to understand the current limitations in research regarding exercise as a treatment for paediatric MASLD.

Abstract

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Copyright: © 2024 Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Address: 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.; Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, United States of America.; Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California, United States of America.; Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, United States of America.; The Library, University of California San Diego, La Jolla, California, United States of America.

DOI: 10.1371/journal.pone.0314542