The most frequent pediatric chronic liver disease is Nonalcoholic fatty liver disease (NAFLD). But its outcomes in recognized youth are unclear.

A study compared paired liver biopsies from children with NAFLD, receiving placebo and standard of care lifestyle advice in 2 double-blind, randomized clinical trials.  The histological changes from baseline and longitudinal change in clinical variables using regression analysis were assessed.

The results found that-

During enrollment-

• 31% of the children had definite NASH, 
• 34% had borderline zone 1 NASH, 
• 13% had borderline zone 3 NASH,
• 21% had fatty liver but not NASH. 

After 1.6 ± 0.4 years (mean)- 

• 29% of the children showed resolution of borderline or definite NASH 18% of the children with fatty liver or borderline NASH developed definite NASH. 
• 34% of the children demonstrated an improvement in Fibrosis
• 23% of the children demonstrated worsening of Fibrosis. 
• At baseline, any progression to definite NASH and/or fibrosis was related to adolescent age, and higher waist circumference, levels of alanine or aspartate aminotransferase, total and low-density lipoprotein cholesterol. 
• Over follow-up time, any progression to definite NASH and/or in fibrosis was related to an increasing level of alanine aminotransferase, haemoglobin A1C.

Reduced odds of any improvement was noted with an increasing level of gamma-glutamyl transferase

Thus it was concluded that 33% of children with NAFLD enrolled in placebo groups of clinical trials demonstrates histologic features of progression within 2 years, with increasing obesity and serum levels of aminotransferases and loss of glucose homeostasis.

Source: Gastroenterology. 2020 Nov;159(5):1731-1751.e10. doi: 10.1053/j.gastro.2020.07.034. Epub 2020 Jul 23. PMID: 32712103; PMCID: PMC7680281.