Evidence-based review of the nutritional treatment of obesity and metabolic dysfunction-associated steatotic liver disease in children and adolescents

Abstract

The growing pediatric obesity epidemic has paralleled the surge in metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis. It develops due to nutritional imbalances, microbiome dysbiosis, gene regulation, hormonal changes, and environmental factors like food deserts, low activity level, and an unhealthy lifestyle. The prevalence of MASLD and obesity is rising every year. Lifestyle changes remain the mainstay treatment for obesity and MASLD. Per the 2023 American Association for the Study of Liver Diseases Practice Guidance on MASLD, achieving ≥5% weight loss can reduce hepatic steatosis, ≥7% weight loss can reduce hepatic inflammation, and ≥10% weight loss can reduce liver fibrosis. Therefore, nutritional interventions can be a powerful tool to help correct metabolic dysfunction and promote healthy weight loss. Current endorsed nutritional interventions for weight loss or MASLD include the Mediterranean diet, low glycemic/low carbohydrate diet, plant-based diet/anti-inflammatory diet, ketogenic diet, and intermittent fasting. This review provides evidence-based insights into current nutritional interventions for children and adolescents with obesity and MASLD to help guide pediatric gastroenterologists in making the best dietary-based recommendations in clinical practice.

Keywords: Mediterranean diet; intermittent fasting; ketogenic diet; low‐carbohydrate diet; plant‐based diet.