Assessment and Treatment of Dietary and Mental Health Concerns in Youth With NAFLD

fatty liver disease
Fatty liver disease and hepatic steatosis body part as a medical health care concept of the digestive system anatomy and vital organ for digestion functions in a 3D illustration style.
Investigators assessed the presence of unhealthy eating behaviors in adolescents with obesity undergoing bariatric surgery, with or without nonalcoholic fatty liver disease.

Adolescents with nonalcoholic fatty liver disease (NAFLD) often present with emotional and behavioral concerns associated with their disease; assessment and treatment of these dietary and mental health concerns is vital, according to a study published in the Journal of Pediatric Gastroenterology and Nutrition.

While unhealthy eating behaviors (UEB) and NAFLD have been associated with psychopathology symptoms, the relationships among these variables have not been explored in adolescents presenting for bariatric surgery. As diet plays a role in the development and persistence of NAFLD, researchers evaluated the prevalence of UEB, whether these behaviors varied by NAFLD or nonalcoholic steatohepatitis (NASH) disease status, and the association of psychopathology with NAFLD.

In total, 159 adolescents (mean age, 16.4 years; mean body mass index [BMI], 53.7 kg/m2; 73% girls; 62.3% White) self-reported the presence or absence of 10 UEBs prior to undergoing metabolic and bariatric surgery (MBS). The presence of NAFLD and NASH was assessed by intraoperative liver biopsy. A medical comorbidity index was created to assess the presence of prediabetes/diabetes, dyslipidemia, and elevated blood pressure in participants. Psychopathology was assessed in a subgroup of 98 adolescents that completed the Youth Self-Report: a validated tool used to assess adolescent symptomatology over a period of 6 months.

The researchers found that symptoms of binge eating disorder were associated with higher odds of NAFLD, while frequent eating out (eating outside the home for ≥1 meal ≥3 times per week) was associated with lower odds of NAFLD.

Roughly 37% of patients with NAFLD had borderline or confirmed NASH. Among those with NAFLD, frequent eating out was associated with higher odds of borderline or confirmed NASH; eating at night was associated with lower odds of NASH.

Patients with a greater number of comorbidities were associated with higher odds of NAFLD.

 This study was limited by the lack of diversity among the patient cohort, reducing its generalizability. Further studies should be conducted in more diverse populations.

“Taken together, it would be beneficial to screen adolescents with severe obesity and NAFLD for frequent eating out, nocturnal eating, internalizing disorders, and BED and refer for adjunctive care whenever indicated,” the researchers concluded.


Ley SL, Zeller MH, Reiter-Purtill J, Kleiner DE, Dixon J, Xanthakos S, for the Teen View Study Group and in collaboration with the Teen-LABS Consortium. Unhealthy eating, psychopathology, and nonalcoholic fatty liver disease in youth presenting for bariatric surgery. JPGN. 2021;73(6):670-676. doi: 10.1097/MPG.0000000000003253