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de Cuevillas B, Lubrecht J, Navas-Carretero S, Vreugdenhil A, Martinez JA. Sleep duration is associated with liver steatosis in children depending on body adiposity. Eur J Pediatr 2024; 183:779-789. [PMID: 38001309 PMCID: PMC10912132 DOI: 10.1007/s00431-023-05332-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Sleep is a factor associated with overweight/obesity risk, wherein interactions with fatty liver should be ascertained. The aim of this cross-sectional study was to analyze the possible relationships of sleep with liver health and whether this interplay is related to body adiposity distribution in children and adolescents. Anthropometric, clinical, and biochemical measurements were performed in children and adolescents (2-18 years old) with overweight/obesity (n = 854). Body fat distribution was clinically assessed, and several hepatic markers, including hepatic steatosis index, were calculated. Sleep time mediation (hours/day) in the relationship between the hepatic steatosis index and body fat distribution was investigated. Differences among diverse fatty liver disease scores were found between children with overweight or obesity (p < 0.05). Linear regression models showed associations between hepatic steatosis index and lifestyle markers (p < 0.001). Hepatic steatosis index was higher (about + 15%) in children with obesity compared to overweight (p < 0.001). Pear-shaped body fat distribution may seemingly play a more detrimental role on liver fat deposition. The association between sleep time and hepatic steatosis index was dependent on body mass index z-score. Post hoc analyses showed that 39% of the relationship of body fat distribution on hepatic steatosis index may be explained by sleep time. Conclusion: An association of sleep time in the relationship between body fat distribution and hepatic steatosis index was observed in children and adolescents with overweight/obesity, which can be relevant in the prevention and treatment of excessive adiposity between 2 and 18 years old. CLINICAL TRIAL NCT04805762. Import: As part of a healthy lifestyle, sleep duration might be a modifiable factor in the management of fatty liver disease in children. WHAT IS KNOWN • Sleep is an influential factor of overweight and obesity in children. • Excessive adiposity is associated with liver status in children and adolescents. WHAT IS NEW • Sleep time plays a role in the relationship between body fat distribution and liver disease. • Monitoring sleep pattern may be beneficial in the treatment of hepatic steatosis in children with excessive body weight.
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Affiliation(s)
- Begoña de Cuevillas
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, School of Pharmacy and Nutrition, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain.
| | - Judith Lubrecht
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Santiago Navas-Carretero
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, School of Pharmacy and Nutrition, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- IdiSNA, Health Research Institute of Navarra, Pamplona, Spain
| | - Anita Vreugdenhil
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - J Alfredo Martinez
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, School of Pharmacy and Nutrition, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Precision Nutrition Program, Research Institute On Food and Health Sciences IMDEA Food, CSIC-UAM, Madrid, Spain
- Centro de Medicina y Endocrinología, Universidad de Valladolid, Valladolid, Spain
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Choi YH, Lee JY, Moon KW. Exposure to volatile organic compounds and polycyclic aromatic hydrocarbons is associated with the risk of non-alcoholic fatty liver disease in Korean adolescents: Korea National Environmental Health Survey (KoNEHS) 2015-2017. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 251:114508. [PMID: 36621033 DOI: 10.1016/j.ecoenv.2023.114508] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent liver diseases among adolescents. Several animal studies have suggested that volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) increase NAFLD risk. However, few epidemiological studies have confirmed the association between VOCs, PAHs and NAFLD in the general adolescent population. Therefore, we analyzed 798 adolescents from the Korean National Environmental Health Survey (KoNEHS), 2015-2017, to examine the associations of urinary metabolites of VOCs and PAHs with serum alanine aminotransferase (ALT) activity and NAFLD prevalence. We performed linear regression, logistic regression, and Bayesian kernel machine regression (BKMR) to evaluate the association of urinary VOCs and PAHs metabolites with ALT levels and NAFLD prevalence. After adjusting for all covariates, urinary benzylmercapturic acid and 2-hydroxyfluorene levels were found to increase ALT activity and NAFLD prevalence. Additionally, the BKMR analyses showed a significantly positive overall effect on ALT activity and NAFLD prevalence with urinary concentrations of VOCs and PAHs metabolites, with 2-hydroxyfluorene as the biggest contributor. Our study suggests that exposure to low-level VOCs and PAHs may have a detrimental effect on NAFLD risk in adolescents. Given the increasing prevalence of NAFLD in adolescents, future cohort studies are confirmed to comprehend the effect of these chemicals on NAFLD risk.
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Affiliation(s)
- Yun-Hee Choi
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea; BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea
| | - Ju-Yeon Lee
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea; BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea
| | - Kyong Whan Moon
- BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea; Department of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea.
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Benefits of Physical Exercise as Approach to Prevention and Reversion of Non-Alcoholic Fatty Liver Disease in Children and Adolescents with Obesity. CHILDREN 2022; 9:children9081174. [PMID: 36010064 PMCID: PMC9406958 DOI: 10.3390/children9081174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an important health concern during childhood; indeed, it is the most frequent cause of chronic liver diseases in obese children. No valid pharmacological therapies for children affected by this condition are available, and the recommended treatment is lifestyle modification, usually including nutrition and exercise interventions. In this narrative review, we summarized up-to-date information on the benefits of physical exercise on NAFLD in children and adolescents with obesity. The role of exercise as non-pharmacological treatment was emphasized in order to provide recent advances on this topic for clinicians not deeply involved in the field. Several studies on obese children and adults confirm the positive role of physical activity (PA) in the treatment of NAFLD, but to date, there are no pediatric randomized clinical trials on exercise versus usual care. Among the pathogenic mechanisms involved in the PA effects on NAFLD, the main players seem to be insulin resistance and related inflammation, oxidative stress, and gut dysbiosis, but further evaluations are necessary to deeply understand whether these factors are correlated and how they synergistically act. Thus, a deeper research on this theme is needed, and it would be extremely interesting.
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Iraji H, Minasian V, Kelishadi R. Changes in Liver Enzymes and Metabolic Profile in Adolescents with Fatty Liver following Exercise Interventions. Pediatr Gastroenterol Hepatol Nutr 2021; 24:54-64. [PMID: 33505894 PMCID: PMC7813572 DOI: 10.5223/pghn.2021.24.1.54] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/23/2020] [Accepted: 08/06/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Nonalcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver diseases in both adults and children with obesity. The aim of this study was to compare the changes in liver enzymes and metabolic profile in adolescents with fatty liver following selected school-based exercise (SBE) and high-intensity interval training (HIIT) interventions. METHODS In a semi-experimental study, 34 obese male adolescents with clinically defined NAFLD were divided into the HIIT (n=11, age=12.81±1.02 years, body mass index [BMI]=26.68 ±2.32 kg/m2), selected SBE (n=11, age=13.39±0.95 years, BMI=26.47±1.74 kg/m2), and control (n=12, age=13.14±1.49 years, BMI=26.45±2.21 kg/m2) groups. The ultrasonography NAFLD grade, peak oxygen uptake (VO2peak), lipid profile, insulin resistance, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of the participants were measured before and after the exercise interventions. RESULTS The BMI, waist-to-hip ratio, and body fat percentage of the participants decreased, and a significant increase in VO2peak was observed after the intervention; however, the HIIT group showed a significant improvement compared with the SBE group (p<0.01). Significant reductions were observed in the levels of insulin resistance, triglyceride, total cholesterol, ALT, and AST in both groups, although high-density lipoprotein levels decreased only in the HIIT group (p<0.01). Further, a significant reduction in low-density lipoprotein level was observed in the training groups (p<0.01), but this decrease was not significant compared with the control group (p>0.01). CONCLUSION HIIT and SBE are equally effective in improving health parameters in obese children and adolescents.
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Affiliation(s)
- Hamdollah Iraji
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Vazgen Minasian
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Effects of Dietary and Lifestyle Interventions on Liver, Clinical and Metabolic Parameters in Children and Adolescents with Non-Alcoholic Fatty Liver Disease: A Systematic Review. Nutrients 2020; 12:nu12092864. [PMID: 32961669 PMCID: PMC7551480 DOI: 10.3390/nu12092864] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) affects 5.5–10.3% of children worldwide, while in obese individuals, it increases to almost 34%. Pediatric NAFLD is consistently associated with metabolic syndrome and insulin resistance. As no pharmacological agents exist for the treatment of NAFLD, lifestyle modifications remain the only therapy. However, as not all overweight/obese children have NAFLD, high-quality data, focused exclusively on NAFLD population are needed. Therefore, the present systematic review assessed the efficacy of lifestyle (diet or exercise) based on randomized controlled clinical trials (RCTs) on liver, anthropometric, glucose, and lipid parameters in children, with imaging or biopsy-proven NAFLD. In general, the results were inconclusive and therefore no specific recommendations could be drawn. In most studies, differences were derived from within group comparisons, which are known to be highly misleading. However, both low-carbohydrate and low-fat diets could benefit liver outcomes, as long as weight loss is achieved, but not necessary glucose and lipid parameters. No RCTs were found on exercise alone, as compared to no intervention on pediatric NAFLD. Concerning diet plus exercise interventions, all studies led to improvements in liver outcomes accompanied with weight loss. Resolution of NAFLD was found in considerably high percentages, while improvements were also seen in glucose but were modest in lipid parameters.
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Abstract
Fatty liver is a growing health problem worldwide. It might evolve to nonalcoholic steatohepatitis, cirrhosis and cause hepatocellular carcinoma. This disease, which has increased because of eating habits, changes in food content and lifestyle, affects people from childhood. The most important risk factors are obesity and insulin resistance. Besides these factors, gender, ethnicity, genetic predisposition and some medical problems are also important. Cirrhosis in children is rare but is reported. Nonalcoholic fatty liver disease (NAFLD) has no specific symptoms or signs but should be considered in obese children. NAFLD does not have a proven treatment. Weight loss with family based treatments is the most acceptable management. Exercise and an applicable diet with low glycemic index and appropriate calorie intake are preferred. Drugs are promising but not sufficient in children for today.
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Elsheikh E, Henry LL, Younossi ZM. Current management of patients with nonalcoholic fatty liver disease. Expert Rev Endocrinol Metab 2013; 8:549-558. [PMID: 30736139 DOI: 10.1586/17446651.2013.846212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH) are the most common causes of chronic liver disease in industrialized countries. NAFLD has also been strongly associated with type II diabetes and cardiovascular diseases. This study was a multipurposed review, which included discussion of recent studies investigating the cellular and genetic basis of these diseases, the pathogenesis of NAFLD and the current treatment and management of nonalcoholic steatohepatitis. Currently, maintaining a healthy weight through dietary changes and exercise, the use of insulin-modulating pharmacologic agents for diabetes control and the use of lipid-lowering, anti-oxidants have been the most widely recommended treatments. Inclusion of pathogenic mechanisms in treatment design will allow future therapies to target-specific pathways involved in NAFLD pathogenesis.
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Affiliation(s)
- Elzafir Elsheikh
- a Department of Medicine, Inova Fairfax Hospital, Center for Liver Diseases, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Linda L Henry
- a Department of Medicine, Inova Fairfax Hospital, Center for Liver Diseases, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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