Welcome to the ESPGHAN 2023 Interactive Programme
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ESGE Session - 
THE TRIPLE INTERACTION: DIET, MICROBIOTA AND EPIGENETICS IN THE ONSET OF OBESITY AND COMORBIDITIES (ID 1607)
METABOLOMICS AND LIPIDOMICS SIGNATURES OF NAFLD IN CHILDREN: POTENTIAL APPLICATIONS (ID 1609)
N-O015 - THE EFFECTS OF WEIGHT LOSS INTERVENTIONS ON CHILDREN AND ADOLESCENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD): A SYSTEMATIC REVIEW AND META-ANALYSIS (ID 488)
Abstract
Objectives and Study
As lifestyle interventions are the main therapeutic strategy for pediatric NAFLD, there is a clear necessity for science-based weight loss recommendations and well-founded interventions for NAFLD patients. Most of the previous studies assess the efficiency of such kinds of weight loss interventions on some biochemical and anthropometric parameters in children and adolescents with NAFLD in isolation and there is no review on them. Therefore, the present systematic review and meta-analysis, based on clinical trials, aimed to investigate the effects of weight loss interventions on several NAFLD-related parameters in children and adolescents with NAFLD.
Methods
Original databases were searched using standard keywords to identify all controlled trials investigating the effects of weight loss interventions among NAFLD children and adolescents. Pooled weighted mean difference and 95% confidence intervals were achieved by random-effects model analysis.
Results
Eighteen eligible clinical trials were included in this systematic review and meta-analysis. The pooled findings showed that especially more intense weight loss interventions significantly reduced the glucose (P= 0.007), insulin (P= 0.002), homeostatic model assessment-insulin resistance (HOMA-IR) (P= 0.003), weight (P= 0.025), body mass index (BMI) (P= 0.003), BMI z-score (P< 0.001), waist circumference (WC) (P= 0.013), triglyceride (TG) (P= 0.001), and aspartate transaminase (AST) (P= 0.027). However, no significant changes were found in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), alanine transaminase (ALT), and hepatic steatosis grades (all P> 0.05) following weight loss interventions.
Conclusions
In general, the present meta-analysis demonstrated that weight loss interventions may be able to significantly improve glycemic parameters, TG, and AST levels and are associated with a trend towards reduced anthropometric parameters in children and adolescents with NAFLD. The beneficial effect seemed greatest in those trials with more intense weight loss interventions. Continuous and multidimensional lifestyle intervention for NAFLD patients might optimize the therapeutic effect of weight loss.
PHARMACOLOGICAL TREATMENT OF ADIPOSITY - CHALLENGES AND OPPORTUNITIES (ID 1611)
H-O015 - PEDIATRICIANS’ PRACTICES AND KNOWLEDGE OF NON-ALCOHOLIC FATTY LIVER DISEASE – A MULTINATIONAL SURVEY (ID 264)
Abstract
Objectives and Study
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children and adolescents. It is associated with significant extrahepatic comorbidity. There is no consensus in current guidelines on screening, diagnosis and treatment of NAFLD in children. This potentially results in a variety of practices among pediatricians and may lead to underdiagnosing and/or insufficient treatment of NAFLD in children. The increasing prevalence of NAFLD and associated long-term health risks demand adequate clinical management and consensus in guidelines. This study aims to evaluate the daily practices of pediatricians in screening, diagnosis and treatment of NAFLD in children.
Methods
An online survey with 41 questions (single and multiple response options) was sent to practicing pediatricians (with and without subspecialty) in Europe and Israel, via members of the ESPGHAN Fatty Liver Special Interest Group, between June-November 2022. 454 pediatricians were included in this study.
Results
51% of pediatricians indicated using any guideline for diagnosis and treatment of NAFLD, with 68% stating they follow recommendations only partially. The ESPGHAN guideline (2012) is utilized most frequently. The majority of pediatricians (63%) is of the opinion that guidelines should be revised. 62% of pediatricians indicate they screen for NAFLD in children with overweight/obesity. Liver function tests and abdominal ultrasound are the most reported screening instruments. When asked how often pediatricians perform or request a liver biopsy in children with NAFLD, only 17% indicates they perform or request a liver biopsy in more than 10% of cases. A large variety of treatment options is utilized by pediatricians, including lifestyle changes, supplement and probiotic use, with a notable 34% of pediatricians prescribing some form of pharmacotherapy.
Conclusions
There is insufficient awareness and considerable variation in screening, diagnosis and treatment practices among European pediatricians, and a clear demand for new, uniform guidelines for NAFLD in children.
DIETARY TREATMENTS OF FATTY LIVER DISEASE: INTERVENTIONS, IDEALS AND INSIGHT. (ID 1613)
H-O002 - EARLY CHILDHOOD ADIPOSITY, LIFESTYLE, AND GUT MICROBIOME ARE LINKED TO NON-ALCOHOLIC FATTY LIVER DISEASE DEVELOPMENT IN ADOLESCENTS (ID 1037)
Abstract
Objectives and Study
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children worldwide but etiology and possible role for intestinal microbes remain unclear. Early adiposity and lifestyle could modulate the gut microbiota composition and contribute to the development of NAFLD. Therefore, we aimed to investigate associations between adiposity during early childhood, lifestyle, and gut microbiome, and the risk of developing NAFLD in adolescence.
Methods
Population-based cross-sectional analysis of the “Growth and Obesity Chilean Cohort Study” (GOCS) included 69 children (14–17 years old) with NAFLD confirmed by ultrasonography (case group) and 69 matched children without NAFLD (control group). Anthropometric data throughout early childhood and lifestyle parameters (habitual dietary intake and physical activity) were evaluated. Fecal samples were collected, and microbiome composition and function were assessed using 16S ribosomal RNA amplicon sequencing.
Results
Principal component analysis plots demonstrated distinctions in dietary intake (p = 0.017, PERMANOVA) and childhood adiposity (p = 0.049) between the case and control groups. Higher levels of daily fibre intake and lower childhood adiposity (triceps skinfold at 5 years of age, suprailiac skinfold at 8 and 11 years of age, and waist-to-hip ratio at 4–9 years of age) were associated with lower odds of developing NAFLD during adolescence. NAFLD was associated with a lower abundance of certain microbial species. Interestingly, we observed a lower abundance of Bacteroides vulgatus in the case group than in the control group (control/case abundance ratio=18.71). Bacteroides vulgatus abundance positively correlated with dietary fibre intake (Spearman rs = 0.31, p = 0.014) and inversely correlated with childhood adiposity.
Conclusions
Adiposity in early childhood, dietary fibre intake, and alterations to the intestinal microbiome may contribute to the pathogenesis of NAFLD during adolescence and could be used as early disease markers and targets for intervention.