Effect of weight loss interventions on liver-related health in children and adolescents with obesity

The present systematic review and meta-analysis explores the effect of weight loss interventions, depending on their modality (lifestyle, bariatric surgery or anti-obesity medication), on circulating, imagery-related and histology-related liver parameters in children and adolescents with obesity (aged 5–18 years). After consulting the main databases (MEDLINE, EMBASE, Web of Science and Google Scholar and the Cochrane Controlled Register of Trials), 145 studies were included, gathering 18609 participants (10539 included in the meta-analysis) allocated to 257 experimental arms (26 diet, 24 medication, 96 multidisciplinary, 39 controls, 16 physical activity, 41 supplementation and 15 surgery). Circulating levels of liver enzymes were found improved in the majority of the studies, with multidisciplinary treatments showing the most significant effects. However, physical activity programs had no positive effect. Sixty-seven percent of the intervention arms found significant improvements in hepatic fat, with bariatric surgery appearing to be the only modality to improve histology-related parameters. According to the meta-regression, improvements in the Non-alcoholic fatty liver disease Activity Score are associated with the degree of weight loss and BMI reduction. The results indicate improved overall liver status in response to weight loss interventions in this population, highlighting the need for adapted and appropriate dietary and multidisciplinary interventions as first-line strategies, particularly in the context of obesity medication.