Lifestyle Intervention and Antioxidant Therapy in Children with Nonalcoholic Fatty Liver Disease: A Randomized, Controlled Trial

No proven treatment exists for nonalcoholic fatty liver disease (NAFLD) in children and adolescents. We sought to determine the efficacy of lifestyle intervention with or without antioxidant therapy in pediatric NAFLD. A total of 53 patients (age 5.7-18.8 years, 37 boys) were included. Lifestyle intervention consisting of a diet tailored to the patient’s calorie needs, and increased physical activity was prescribed in all. Patients were concomitantly randomized to alpha-tocopherol 600 IU/day plus ascorbic acid 500 mg/day (n 25) or placebo (n 28), and treated for 24 months. The study was an extension of a previous study aimed at evaluating the effect of 12-month lifestyle intervention and antioxidant therapy on serum levels of aminotransferases. The primary end point of the present study was change in liver histology on repeated biopsy at 24 months. Secondary end points were changes in body weight, liver enzymes, and insulin sensitivity indices on 2-hour oral glucose tolerance test. The amount of weight lost at 24 months was similar in the placebo and antioxidant groups (4.75 [range, 16-4.0] versus 5.5 [range, 12.2-0.4] kg, respectively, P 0.9). A significant improvement occurred in the grade of steatosis, lobular inflammation, and he-patocyte ballooning, and in the NAFLD activity score in both groups. Levels of aminotrans