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A Multidisciplinary Clinical Program Is Effective in Stabilizing BMI and Reducing Transaminase Levels in Pediatric Patients With NAFLD

DeVore, Stephanie; Kohli, Rohit; Lake, Kathleen; Nicholas, Lynda; Dietrich, Kim; Balistreri, William F.; Xanthakos, Stavra A.

Journal of Pediatric Gastroenterology and Nutrition: July 2013 - Volume 57 - Issue 1 - p 119–123
doi: 10.1097/MPG.0b013e318290d138
Original Articles: Hepatology and Nutrition

Background and Aim: Weight loss is an effective treatment for children with nonalcoholic fatty liver disease (NAFLD), but it is extremely difficult to achieve outside of an intensive weight management program. We hypothesized that one can achieve success in improving NAFLD and weight-related outcomes in a structured and focused multidisciplinary clinical program feasible to implement in a gastroenterology clinic.

Methods: We prospectively tracked the clinical status of our patients enrolled in a multidisciplinary program of dietary and exercise advice through an institutional review board–approved NAFLD registry. Each patient met with a gastroenterologist and dietitian every 3 months for 30 minutes to set individualized goals and monitor progress.

Results: A total of 108 children have been enrolled in the registry, and of the 83 that were eligible for 1-year follow-up and included in the analysis, 39 patients returned, resulting in a 47% follow-up rate. These 39 patients showed statistically significant improvements in mean BMI z score (−0.1 U, P < 0.05), total (−11 mg/dL, P < 0.05) and low-density lipoprotein (9 mg/dL, P < 0.05) cholesterol, and serum alanine aminotransferase levels (−36 U/L) and aspartate aminotransferase levels (−22 U/L) levels.

Conclusions: A clinically feasible multidisciplinary program for obese pediatric patients with NAFLD stabilized BMI z score and significantly improved aminotransferase levels at 1-year follow-up.

Supplemental Digital Content is available in the text

Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Rohit Kohli, MBBS, MS, Cincinnati Children's Steatohepatitis Center, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229 (e-mail:

Received 5 July, 2012

Accepted 26 February, 2013

Drs DeVore and Kohli participated equally in this study.

This study received funding from NASH CRN (S.D.): U01 DK61732; K23 (S.A.X.): K23 DK080888; K08 (RK): K08 DK84310. Digestive Health Center: P30 DK078392; Institutional CTSA NIH/NCRR: 1UL1RR026314-01.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,