Dietitian-led lifestyle modification programme for obese Chinese adolescents with non-alcoholic fatty liver disease: a randomized controlled study

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The prevalence of non-alcoholic fatty liver disease (NAFLD) in children is increasing. This study evaluated the efficacy of a dietitian-led lifestyle modification programme (D-LMP) to reduce NAFLD in obese adolescents.


Subjects with intra-hepatic triglyceride content (IHTC) equal to or greater than 5% diagnosed by proton-magnetic resonance spectroscopy (1H-MRS) were enroled and randomly assigned to either the D-LMP intervention or conventional paediatrician-led consultation (P-CON) group. Subjects in the P-CON group received usual care consisting of a consultation by a paediatrician with the child and parents every 16 weeks. Intention-to-treat analysis was used for data analysis.


Fifty-two subjects were recruited, with 26 in each group. After the initiation phase (at week-16), there was a greater difference in the change in the IHTC and BMI z-score in the D-LMP group (P = 0.029 and <0.001, respectively) and there was a decrease in dietary intake of fat content (P = 0.019). After 52 weeks of the maintenance phase, both groups had reductions of IHTC to 2–3% and there was no intergroup difference in the rate of reduction. During the maintenance phase, parents’ involvement was minimal in the D-LMP group, with only three parents accompanying their children to attend the dietitian sessions. In contrast, over 90% of the parents in the P-CON group regularly accompanied their children to attend the consultations suggesting the possibility that regular parental and paediatrician involvement may contribute to increasing awareness on fatty liver complications. Multivariate analysis showed that only reduction in body fat remained as an independent factor associated with remission of NAFLD at the end of both study phases.


A dietitian-led lifestyle modification intervention reduced IHTC, BMI z-score and body fat in obese Chinese adolescents with NAFLD. To sustain the effect of this intervention, regular parental and paediatrician involvement may be important.

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The project was funded by a grant from the Health and Medical Research Fund, Food and Health Bureau, Hong Kong SAR Government (Ref. no: 11122981) and the Direct Grant for Research (Ref. no: 2014.1.065). The authors thank all the subjects and their parents who participated in the study.

Author contributions

D.F.Y.C. contributed to the study hypothesis, study design and analyses, writing of the manuscript and sharing of scientific discussion. H.K.S. carried out the data analysis and wrote the first draft of the manuscript. S.C.N.H. and W.C.W.C. contributed to the design of 1H-MRS imaging, analysis of IHCT and AAT volume. E.A.S.N. and R.S.M.C. made significant contribution to the conceptual development and review of the manuscript. All authors were involved in the interpretation of the results, revised the manuscript, and read and approved the final version.

Author information


  1. Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China

    • D. F. Y. Chan
    • , A. M. Li
    •  & E. A. S. Nelson
  2. Department of Paediatrics and Adolescent Medicine, , The University of Hong Kong, Hong Kong, China

    • H. K. So
  3. Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China

    • S. C. N. Hui
    •  & W. C. W. Chu
  4. Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China

    • R. S. M. Chan
    • , M. M. Sea
    •  & J. Woo
  5. Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, China

    • M. Chan


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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to D. F. Y. Chan.