The effect of a multicomponent intervention on hepatic steatosis is partially mediated by the reduction of intermuscular abdominal adipose tissue in children with overweight or obesity; the EFIGRO project
In adults, there is evidence that the improvement of metabolic associated fatty liver disease (MAFLD) depends on the reduction of myoesteatosis. In children, where the prevalence of MAFLD is alarming, this muscle-liver crosstalk has not been tested. Therefore, we aimed to explore whether the effects of a multicomponent intervention on hepatic fat were mediated by changes on intermuscular abdominal adipose tissue (IMAAT) in children with overweight/obesity.
Research design and methods
A total of 116 children with overweight/obesity were allocated to a 22-week family-based lifestyle and psychoeducational intervention (control group, N=57), or the same plus supervised exercise (exercise group, N=59). Hepatic fat percentage and IMAAT were acquired by magnetic resonance imaging at baseline and at the end of the intervention.
Changes in IMAAT explained the 20.7% of the improvements in hepatic steatosis (P<0.05). Only children who meaningfully reduced their IMAAT (i.e., responders), improved hepatic steatosis at the end of the intervention (within-group analysis; responders: -20%, P=0.005 vs. non-responders: -1.5%, P=0.803). Between-group analysis showed greater reductions in favour to the IMAAT responders compared to the non-responders (18.3% vs. 0.6%, P=0.018) regardless of overall abdominal fat loss.
The reduction of IMAAT has a relevant role over the improvement of hepatic steatosis after a multicomponent intervention in children with overweight/obesity. Indeed, only those children who achieved a meaningful reduction in IMAAT at the end of the intervention reduced their percentage hepatic fat independently of abdominal fat loss. Our findings suggest that abdominal muscle fatty infiltration could be a therapeutic target for the treatment of MAFLD at childhood.