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Publications

Journal Article Systematic Review Ahead of print

PubMed: 42420603 DOI: 10.1038/s41366-026-02144-w

Effect of weight loss interventions on liver-related health in children and adolescents with obesity: a systematic review and meta-analyses.

Int J Obes (Lond)

Authors: Alexis Couret, Duane Beraud, Gabriel Torbahn, Julia Lischka, Valérie Julian V, Bruno Pereira, James A King, Armand Abergel, Daniel Weghuber, David Thivel, Gaël Ennequin

Affiliations

  • Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH, Clermont Auvergne Universit, Clermont-Ferrand, France.
  • Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria.
  • Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria.
  • Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany.
  • Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France.
  • Unit of Biostatistics (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
  • National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK. NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
  • Digestive and Hepatobiliary Medicine Department, Hôpital Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
  • International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France.
  • Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH, Clermont Auvergne Universit, Clermont-Ferrand, France.
  • International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France.

Abstract

BACKGROUND

Metabolically-dysfunction-associated steatotic liver disease is today rising in prevalence among 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).

METHODS

After consultation of 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).

RESULTS

Circulating levels of liver enzymes were found improved in the large majority of the studies (most of them relying on multidisciplinary treatments), with however a lack of positive effect of physical activity programs. Sixty-seven percent of the intervention arms found significant improvements in hepatic fat, with no effect of physical activity interventions according to the meta-analysis. Bariatric Surgery appears as 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 Body Mass Index reduction.

CONCLUSIONS

The present results indicate improved overall liver status in response to weight loss interventions in this population, further studies remain however needed to clarify the effects of physical activity alone. Importantly, results also suggest the necessity to provide adapted and appropriate dietary and multidisciplinary interventions as first line strategies for liver-related health, especially in the context of obesity medication.

MeSH

Liver Diseases, Exercise, Liver, Diet, Adolescent, Histology, Obesity, Weight Loss, Child