Omega-3 fatty acids for the treatment of nonalcoholic fatty liver disease in children and adolescents

Evaluation of: Janczyk W, Socha P, Lebensztejn D et al. Omega-3 fatty acids for treatment of non-alcoholic fatty liver disease: design and rationale of randomized controlled trial. BMC Pediatrics 13(23), 85-94 (2013). This article discusses the design and rationale of a randomized, multicenter, double-blind, placebo-controlled trial of omega-3 fatty acids (450-1300 mg of docosahexaenoic acid + eicosapentaenoic acid daily) for the treatment of nonalcoholic fatty liver disease (NAFLD) in children, adolescents and young adults (5-19 years of age) in comparison with placebo. The primary end point of the trial is the number of patients who experience a decrease in alanine aminotransferase activity >30% of the upper limit of normal. The main secondary end points are improvement in the biochemical liver tests, liver steatosis on ultrasound, markers of insulin resistance and difference in fat/lean body mass composition after 24 weeks of intervention. There is evidence that long-chain omega-3 fatty acids improve the lipid profile by lowering triglycerides, as well as decreasing insulin resistance and cytokine synthesis, thus tackling the mechanisms involved in the pathogenesis of NAFLD. There is evidence that long-chain omega-3 fatty acids are effective at normalizing metabolic syndrome-related aberrations, even in adolescents. Hence, long-chain omega-3 fatty acids may be a promising option for the treatment of NAFLD, even in children and adolescents. However, other aspects and measures should be considered.