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Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents.
Pediatr Diabetes. 2009 Feb; 10(1):5-13.PD

Abstract

The presence of fatty liver per ultrasound and liver-associated enzymes were measured in a select cohort of youth with both obesity and insulin resistance, and the effect of metformin on these parameters evaluated. Fifty obese, multiethnic, insulin-resistant adolescents (mean age 15.1 yr, mean body mass index 39.8 kg/m2) were randomized to receive lifestyle recommendations plus either twice per day doses of 850 mg of metformin or placebo. Fasting and post-glucose challenge biochemistries and liver ultrasounds were compared at baseline and 6 months. The prevalence of fatty liver was 74%, elevated alanine aminotransferase (ALT) 14%, aspartate aminotransferase (AST) 14%, and gamma-glutamyl transferase (GGT) 17%. Fatty liver was mild in 23%, moderate in 31%, and severe in 46%. Fatty liver was more common in male and Hispanic subjects and elevated ALT more common in Hispanic subjects. Subjects with fatty liver appeared more insulin resistant (higher fasting insulin and triglycerides, lower high-density lipoprotein cholesterol) and had higher ALT and AST. At 6 months, mean ALT, GGT, and fasting insulin improved significantly in all subjects. Fatty liver prevalence (p < 0.04), severity (p < 0.04), and fasting insulin (p < 0.025) improved significantly with metformin compared to placebo. Non-alcoholic fatty liver disease (NAFLD) occurs with a high prevalence and severity in obese, insulin-resistant adolescents. While metformin plus lifestyle intervention appears promising, defining NAFLD therapies capable of preventing fibrosis and cirrhosis requires further study.

Authors+Show Affiliations

Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA. nadeaukj@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18721166

Citation

Nadeau, Kristen J., et al. "Treatment of Non-alcoholic Fatty Liver Disease With Metformin Versus Lifestyle Intervention in Insulin-resistant Adolescents." Pediatric Diabetes, vol. 10, no. 1, 2009, pp. 5-13.
Nadeau KJ, Ehlers LB, Zeitler PS, et al. Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents. Pediatr Diabetes. 2009;10(1):5-13.
Nadeau, K. J., Ehlers, L. B., Zeitler, P. S., & Love-Osborne, K. (2009). Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents. Pediatric Diabetes, 10(1), 5-13. https://doi.org/10.1111/j.1399-5448.2008.00450.x
Nadeau KJ, et al. Treatment of Non-alcoholic Fatty Liver Disease With Metformin Versus Lifestyle Intervention in Insulin-resistant Adolescents. Pediatr Diabetes. 2009;10(1):5-13. PubMed PMID: 18721166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents. AU - Nadeau,Kristen J, AU - Ehlers,Lindsay B, AU - Zeitler,Philip S, AU - Love-Osborne,Kathy, Y1 - 2008/08/20/ PY - 2008/8/30/pubmed PY - 2009/5/16/medline PY - 2008/8/30/entrez SP - 5 EP - 13 JF - Pediatric diabetes JO - Pediatr Diabetes VL - 10 IS - 1 N2 - The presence of fatty liver per ultrasound and liver-associated enzymes were measured in a select cohort of youth with both obesity and insulin resistance, and the effect of metformin on these parameters evaluated. Fifty obese, multiethnic, insulin-resistant adolescents (mean age 15.1 yr, mean body mass index 39.8 kg/m2) were randomized to receive lifestyle recommendations plus either twice per day doses of 850 mg of metformin or placebo. Fasting and post-glucose challenge biochemistries and liver ultrasounds were compared at baseline and 6 months. The prevalence of fatty liver was 74%, elevated alanine aminotransferase (ALT) 14%, aspartate aminotransferase (AST) 14%, and gamma-glutamyl transferase (GGT) 17%. Fatty liver was mild in 23%, moderate in 31%, and severe in 46%. Fatty liver was more common in male and Hispanic subjects and elevated ALT more common in Hispanic subjects. Subjects with fatty liver appeared more insulin resistant (higher fasting insulin and triglycerides, lower high-density lipoprotein cholesterol) and had higher ALT and AST. At 6 months, mean ALT, GGT, and fasting insulin improved significantly in all subjects. Fatty liver prevalence (p < 0.04), severity (p < 0.04), and fasting insulin (p < 0.025) improved significantly with metformin compared to placebo. Non-alcoholic fatty liver disease (NAFLD) occurs with a high prevalence and severity in obese, insulin-resistant adolescents. While metformin plus lifestyle intervention appears promising, defining NAFLD therapies capable of preventing fibrosis and cirrhosis requires further study. SN - 1399-5448 UR - https://www.unboundmedicine.com/medline/citation/18721166/Treatment_of_non_alcoholic_fatty_liver_disease_with_metformin_versus_lifestyle_intervention_in_insulin_resistant_adolescents_ L2 - https://doi.org/10.1111/j.1399-5448.2008.00450.x DB - PRIME DP - Unbound Medicine ER -