Treatment Strategies for Metabolic Associated Fatty Liver Disease (MAFLD) in Childhood: A Systematic Review

Introduction: Obesity is associated with various metabolic conditions, but the impact differs between children and adults. Our previous research has demonstrated that children may exhibit reversibility in biochemical features, while experiencing less response in terms of anatomical damage. Metabolic Associated Fatty Liver Disease (MAFLD) is a condition that necessitates urgent treatment during childhood to mitigate future complications, such as worsening chronic inflammation and increased predisposition to diabetes, hypertension, or endothelial damage. In this study, we aim to evaluate the main clinical interventions (including drugs, behavioral treatments, nutrition programs, and traditional medicine) that effectively reduce MAFLD in children with obesity.Methods: To conduct this study, we formed an international collaboration group comprising researchers from UTRGV and thirteen institutions in Mexico. The study was registered in Prospero (CRD42023393952). We conducted comprehensive searches in PubMed, Ovid MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, resulting in a total of 1106 registered papers (258=Cochrane, 448=OVID Medline and 400=Web of Science). We analyzed the eligibility criteria for randomized controlled trials (RCTs), assessed the quality of the papers using the Jadad scale, and extracted relevant data. The final analysis includes 28 studies categorized based on the type of intervention performed.Results: Three papers analyzed the effects of metformin and vitamin E (n=359), reporting changes in metabolic variables, with only one study finding improvement in liver condition through ultrasound assessment. Twenty-two papers examined the use of supplements (n=1,378) combined with lifestyle interventions or hypocaloric diets. The commonly studied supplements included vitamin E, probiotics, and polyunsaturated fats. Most of these studies demonstrated improvements in metabolic conditions and liver ultrasound findings. Additionally, four studies focused on lifestyle interventions (n=262), incorporating strategies such as physical activity, diet modifications, and psychological counseling. These interventions also resulted in improved metabolic conditions, and some studies reported changes in liver condition based on ultrasound assessments. Four studies investigated the effects of dietary interventions alone (n=202), three of which showed positive changes in metabolic variables and liver ultrasound findings. Furthermore, a year-long study involving physical activity (n=28) demonstrated improvements in metabolic variables.Conclusion: This systematic review highlights the effectiveness of treatment strategies for children with MAFLD, as evidenced by improvements in biochemical variables and beneficial effects on liver anatomy. Our next step will involve conducting a meta-analysis to further analyze the data and provide comprehensive conclusions.