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Walking program improves liver enzymes and BMI in children with PKU and NAFLD

Walking program improves liver enzymes and BMI in children with PKU and NAFLD
Photo by Aziz Acharki / Unsplash
Key Takeaway
Consider walking as a potential adjunct in children with PKU/NAFLD, but evidence is preliminary.

A randomized controlled trial evaluated an 8-week free walking program versus waitlist control in 40 overweight/obese children aged 9-12 years with phenylketonuria (PKU) and non-alcoholic fatty liver disease (NAFLD). The study duration was 8 weeks. The primary outcome was not reported.

The main finding was a significant enhancement (improvement) in the exercise group only across multiple secondary outcomes: BMI, ALT, GGT, ALP, AST, and TG. The abstract reports the direction of effect as improvement but does not provide specific numerical results, effect sizes, p-values, or confidence intervals. The comparator was a waitlist control group.

Safety and tolerability data, including adverse events, serious adverse events, and discontinuations, were not reported in the abstract. Key limitations include the small sample size (n=40), short 8-week follow-up period, and lack of reported statistical measures and effect sizes. Funding sources and conflicts of interest were not reported.

For clinical practice, this single, small RCT suggests a walking intervention may benefit metabolic and liver parameters in this specific pediatric population over 8 weeks. However, the absence of numerical data and statistical measures precludes assessment of the magnitude of effect. These findings should be interpreted as preliminary evidence requiring validation in larger, longer-duration studies with complete outcome reporting before considering changes to clinical management.

Study Details

Study typeRct
Sample sizen = 20
EvidenceLevel 2
Follow-up1.8 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Phenylketonuria (PKU), the inherited metabolic autosomal recessive disorder, is a prevalent disorder in Arabic countries (1 in 6000 babies are affected by this disorder) due to the high prevalence of consanguinity. In children with PKU, excess body weight and its associated complications - such as non-alcoholic fatty liver disease (NAFLD) - are highly reported due to the sedentary lifestyle, low physical activity, and restriction of the consumption of most important natural dietary proteins that can pose a potential risk of overconsumption of carbohydrates, sugars, and fats to meet children's energy needs. Investigating the effect of an 8-week walking exercise program on liver enzymes in children with PKU and NAFLD was the aim of this randomized controlled trial. METHODS: This PKU trial is a randomized controlled trial in children. Forty overweight/obese children with PKU and NAFLD who were aged 9-12 years old were included. Children were randomly assigned into an exercise group (n=20) that received an 8-week free walking program or control group (waitlist group, n=20). Serum alanine transaminase (ALT), body mass index (BMI), serum gamma-glutamyl transferase (GGT), serum triglycerides (TG), serum alkaline phosphatase (ALP), and serum aspartate transaminase (AST) were assessed in both groups. RESULTS: A significant enhancement (improvement) in BMI, ALT, GGT, ALP, AST, and TG was reported in the exercise group only. CONCLUSION: Participation in an 8-week free walking program significantly improves BMI, AST, ALP, ALT, GGT, and TG in children with NAFLD and PKU.
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