Differentiated approach to the prevention and management to metabolically associated fatty liver disease in overweight and obese children

Obesity is one of the most important public health issues worldwide, affecting people of all age groups. Aim - to assess the impact of a differentiated approach to the prevention and management of metabolic-associated fatty liver disease (MAFLD) in overweight and obese children, taking into account the presence of vitamin D deficiency. Materials and methods. The study included 298 overweight and obese children aged 6 to 16 years. A clinical and laboratory examination was conducted. 45 children with MAFLD and vitamin D deficiency were selected and included into the main group. The factor analysis of vitamin D deficiency on the occurrence and course of MAFLD was conducted. Counseling was provided. Vitamin D supplementation was recommended to children with deficiency. Treatment results were assessed based on liver function markers, metabolic parameters, and vitamin D levels. Results. The frequency of MAFLD in the study cohort reached 27%, vitamin D deficiency was detected in 37% of children. MAFLD and insufficient serum vitamin D levels were identified in 15% of children. Intrauterine growth retardation, excessive consumption of easily digestible carbohydrates and trans fats, sedentary lifestyle and lack of exercise, obesity, prehypertension and prediabetes and specific changes in liver ultrasound as factors associated with MAFLD are likely to occur more often in combination with vitamin D deficiency. Children from main group got supplementation with vitamin D at a dose of 2000 IU for 3 months. Children with overweight/obesity and MAFLD had shown good dynamics of laboratory indicators of alanineaminotransferase level, carbohydrate and lipid profiles. At the same time, obese children had a lower average level of vitamin D (29.3±5.0 ng/l) in blood serum after treatment than overweight children (40.8±4.6 ng/l). Conclusions. Vitamin D supplementation in children with MAFLD in combination with a standard treatment regimen significantly improved liver function, lipid and carbohydrate metabolism. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local institutional ethics committee. Informed consent was obtained from the patients (or from the parents or legal guardians of the children) prior to participation. The authors declare no conflict of interest.