The course of metabolic-associated steatohepatitis in obese children

Objective. To study the course of metabolic-associated steatohepatitis (MASH) in children with simple obesity on the background of long-term non-drug therapy. Patients and methods. 57 children aged 12 [11; 17] years (38.6% girls) with MASH and obesity were included in a singlecenter retrospective study. The children were under outpatient follow-up and followed the recommendations for nutritional and physical activity correction. The duration of follow-up was 12 [6; 24] months (3 months to 7 years). We monitored nutritional status (anthropometry, assessment of fat and fat-free components of body composition by bioimpedance analysis with calculation of MFR/muscle-to-fat ratio index), indicators of cytolysis (ALT, AST), cardiometabolic markers of MASH (triglycerides, HDL cholesterol, glucose), and ultrasound examination of the liver. At the end of the follow-up, the outcome of obesity was evaluated based on the dynamics of body mass index (BMI) SDS compared to baseline. An increase in BMI SDS ≥0.1 was considered as obesity progression, BMI SDS ±0.1 as stabilization, and a decrease of ≥0.1 as favorable outcome of obesity. Results. Symptoms of MASH were eliminated in the follow-up in 32 children (56.1%) regardless of the duration of follow-up: in 3–12 months MASH resolved in 50%, after 1–2 years – in 59%, after 3 or more years – in 63.6% of children. No significant increase in ALT level and cardiometabolic criteria was observed in the group of MASH persistence. Children with MASH resolve had significantly decreased fat mass (43.9% [38.1; 46.3] and 39.9% [34.4; 45.5] at the beginning and end of the study, p = 0.002) and increased MFR index (0.70 [0.66; 0.94] and 0.83 [0.61; 1.01], respectively, p = 0.02). Decrease in SDS BMI did not fully determine the dynamics of MASH: when SDS BMI decreased, cytolysis syndrome was relieved in 70.3% of children, when it stabilized – in 22.2%, and when obesity progressed – in 36.4%. Conclusion. Non-drug therapy of MASH in children has sufficiently high efficacy. In order to stop MASH, it is necessary to change the body composition – decrease in fat mass and increase in muscle mass. Such a result can be achieved by combining optimized nutrition with physical activity in aerobic and resistance modes. Key words: obesity, children, metabolically associated steatohepatitis, metabolically associated fatty liver disease