Metabolic-associated steatotic liver disease in children: diagnostic and treatment options
Authors: Kryuchko T. O. , Bubyr L. M. , Poda O. A. , Kolenko I. O. , Ivanytskyi I. V. , Kovalenko L. A. , Cherevko I. G. 
Published: December 2024

According to the latest statistical reports, metabolic‑associated fatty liver disease (MAFLD) can affect about 7% of children and adolescents in the general paediatric population of Western countries, one‑third of children with verified obesity and may threaten to transform into more severe forms of liver damage in both childhood and adulthood, with the development of steatohepatitis and/or liver failure. The timely verification of steatotic disease of the liver and pancreas in children remains difficult due to the lack of specific clinical manifestations of the disease and insufficient screening of liver function disorders in paediatric patients with diagnosed obesity.
Objective —  to investigate the therapeutic efficacy of a combination drug based on carnitine, betaine and arginine in children with metabolically unhealthy obesity and concomitant comorbid conditions.
Materials and methods. The study involved 30 patients aged 6 to 18 years who were diagnosed with obesity and were under observation in paediatric departments in Poltava. Depending on the comorbidity, obese patients were divided into three groups of 10 children each. Group 1 included children with steatotic liver disease, group 2 — children with insulin resistance, and group 3 — children with metabolically healthy obesity without signs of steatotic liver damage and carbohydrate metabolism disorders. Anthropometric measurements (waist and hip circumference) and body mass index (BMI) were performed, basic hepatic biochemical parameters were determined, lipid and carbohydrate metabolism was assessed, and liver stiffness was investigated by shear wave elastometry. Children with metabolically unhealthy obesity were treated with carnitine betaine arginine complex for 3 months in addition to the protocol recommendations. After 3 months, clinical, laboratory and instrumental changes in all patients were reassessed.
Results. All the examined patients involved in the study were stratified by age and gender. In the groups of patients who took carnitine‑betaine‑arginine complex in addition to recommendations for lifestyle modification, dietary behaviour and increased physical activity, there was a tendency to reduce body weight and a statistically significant decrease in BMI in children with obesity associated with steatosis and insulin resistance. A significant indicator of positive clinical dynamics in patients with metabolically unhealthy obesity was a decrease in waist circumference compared with children with metabolically healthy obesity. The study of liver transaminase levels against the background of drug correction among the examined children with steatotic liver disease demonstrated a significant decrease in alanine aminotransferase levels. Evaluation of lipid metabolism parameters against the background of the proposed therapy allowed us to verify a significant (p <0.01) decrease in triglyceride levels in patients with metabolically associated fatty liver disease and a positive effect on the dynamics of changes in the glycaemic profile of patients with insulin resistance. According to our observation, one of the most significant diagnostic values is the results of dynamic changes in elastometry in patients with MAFLD, which is confirmed by a statistically significant decrease in the range of liver stiffness values in patients of this group after therapy.
Conclusions. Taking into account the complex pathogenetic mechanisms of metabolic changes in obese children, it is advisable to organise multidisciplinary support at the outpatient stage of observation of all overweight and obese patients for the purpose of early detection of pathological comorbidities. According to the results of our study, a dietary supplement based on carnitine‑betaine‑arginine complex improved metabolic processes in the liver and pancreas due to the positive hepatoprotective, antioxidant, anti‑inflammatory, antifibrotic and lipolytic properties of its molecules, which determines the further possibilities of using this drug in the complex recommendations for patients with obesity and metabolic dysfunctions.