Benefits of Physical Exercise as Approach to Prevention and Reversion of Non-Alcoholic Fatty Liver Disease in Children and Adolescents with Obesity

Abstract

Non-alcoholic fatty liver disease (NAFLD) is an important health concern during childhood; indeed, it is the most frequent cause of chronic liver diseases in obese children. No valid pharmacological therapies for children affected by this condition are available, and the recommended treatment is lifestyle modification, usually including nutrition and exercise interventions. In this narrative review, we summarized up-to-date information on the benefits of physical exercise on NAFLD in children and adolescents with obesity. The role of exercise as non-pharmacological treatment was emphasized in order to provide recent advances on this topic for clinicians not deeply involved in the field. Several studies on obese children and adults confirm the positive role of physical activity (PA) in the treatment of NAFLD, but to date, there are no pediatric randomized clinical trials on exercise versus usual care. Among the pathogenic mechanisms involved in the PA effects on NAFLD, the main players seem to be insulin resistance and related inflammation, oxidative stress, and gut dysbiosis, but further evaluations are necessary to deeply understand whether these factors are correlated and how they synergistically act. Thus, a deeper research on this theme is needed, and it would be extremely interesting.

Accelerometer-based sedentary time and physical activity with MASLD and liver cirrhosis in 2684 British adolescents

“…In the present cohort, the prevalence of ultrasound-measured advanced liver stiffness in adolescence is <1%, and transient elastography-measured severe liver steatosis is ~10% in young adulthood. Inflammation partly mediated the association of ST with severe liver steatosis and cirrhosis 28 , while triglyceride and insulin resistance had no significant mediating effect in contrast with previous evidence 3,4,21,28 . Although ST may independently increase fat mass, fat mass suppressed the relationship between ST and severe liver steatosis and fibrosis, suggesting that fat mass in an apparently healthy cohort may not be deleterious to liver health, akin to a report on vascular health 12,14,29 .…”

“…In the largest and longest follow-up study to date, accelerometermeasured cumulative ST, LPA and MVPA from childhood through young adulthood were independently but differently related to the various liver indices and enzymes during growth from adolescence to There is a scarcity of longitudinal studies in children and adolescents that have examined the relationships between accelerometer-measured ST and liver steatosis and fibrosis 3,11,20,21 . A recent cross-sectional study of 667 middle-aged adults from the Netherlands with a MASLD prevalence of 34.3% reported that accelerometer-measured ST was not associated with higher odds of ultrasound-assessed liver steatosis after full adjustment for cardiometabolic factors 26 .…”

“…Several emerging longitudinal studies are reporting that LPA might yield more significant health benefits than MVPA, such as reducing systolic blood pressure, dyslipidaemia, fat mass obesity, insulin resistance, inflammation and vascular stiffness [12][13][14][15][16]30 . Longitudinal studies of accelerometer-based LPA and liver indices in the young population are scarce 3,[8][9][10][11]19,21 . In the present study, although LPA decreased from 6 h/day to 3 h/day, it was cumulatively associated with a 1-11 in 1000 decreased odds of advanced liver stiffness and liver steatosis in adolescence and liver cirrhosis in young adulthood.…”

“…A recent longitudinal study of 50-year-old adults reported that questionnaire-based self-reported vigorous PA but not moderate PA was associated with reduced risk of MASLD 19 . However, studies on long-term patterns of accelerometer-based movement behaviours, such as ST, light PA (LPA) and moderate-to-vigorous PA (MVPA), in relation to MASLD and liver fibrosis in the young population are lacking 3,8,10,11,20,21 .…”

Sex Hormone-Binding Globulin (SHBG) Reduction: The Alarm Bell for the Risk of Non-Alcoholic Fatty Liver Disease in Adolescents with Polycystic Ovary Syndrome

“…NAFLD represents a spectrum of progressive liver damage that progressively evolves from mild fatty liver to severe fibrosis. In the initial stages, NAFLD can be reversible, so accurate screening of subjects with risk factors is mandatory to avoid irreversible damages [ 30 ]. NAFLD is an important health issue in PCOS subjects, but to date is still little studied, especially in adolescents.…”