The effect of weight loss on pediatric nonalcoholic Fatty liver disease. ISRN Gastroenterol. 2013;2013:398297. [PMID: 23781345 DOI: 10.1155/2013/398297]

Association between BMI Change, Transaminases, and Other Metabolic Parameters in Children with Nonalcoholic Fatty Liver Disease

Background

Weight loss and lifestyle interventions are the mainstay of treatment in pediatric NAFLD. There are gaps in the literature on the objective improvement in BMI to meaningfully impact NAFLD in children.

Aim

To determine the decrease in BMI associated with a significant decline in ALT and other metabolic parameters.

Methods

Retrospective chart review of pediatric patients with the diagnosis of NAFLD. Data were collected at the baseline and 6 and 12 months. A linear regression model was used to assess the percent change in BMI predictive of change in ALT and other metabolic parameters.

Results

281 charts were included. 71% of patients who had up to a 2.5% loss in BMI at 6 months had a decrease in ALT of up to 10 U/L compared to 43% patients who did not have a decrease in BMI up to 2.5% loss at the same time period (P=0.01). The linear regression model showed that 6-month and 12-month percent changes in BMI are predictive of 6-month and 12-month ALT changes (P=0.01 and 0.02), respectively. ALT normalization was achieved on 12% of patients with a ≥2.5% decrease in BMI at 6 months compared to 1% of patients that had no decrease of ≥2.5% decrease in BMI at 6 months (P=0.01). The mean BMI Z-score decline was 0.18 (P=0.001) in the group with a ≥2.5% decrease in BMI at 6 months.

Conclusions

BMI loss of up to 2.5% and the mean BMI Z-score 0.18 are associated with a significant decrease in ALT of up to 10 U/L. BMI percent change at 6 months and 12 months is predictive of changes in ALT. These results should help guide providers in clinical practice set objective goals for the management of children with NAFLD resulting from obesity.

Impact of Weight Reduction on Thyroid Function and Nonalcoholic Fatty Liver among Egyptian Adolescents with Obesity

BACKGROUND

The prevalence of childhood obesity has been increasing worldwide. This may explain the emergence of nonalcoholic fatty liver as the leading cause of liver disease. Several previous studies have addressed the association between thyroid function and nonalcoholic fatty liver disease.

OBJECTIVES

To study the impact of weight reduction through lifestyle modifications in adolescents with obesity.

METHODS

A prospective cohort study was done on 61 adolescents with obesity. Patients were evaluated at the first visit by the full history, clinical examination, and investigations (thyroid profile, lipid profile, liver function tests, HbA1c, and liver ultrasonography) as basal information. The intervention program included a dietary program, increasing physical activity, and decreasing sedentary activity. A postintervention evaluation was done at the end of six months which included anthropometric measures, laboratory results, and ultrasonographic estimation.

RESULTS

It was shown that the mean BMI of the participants had significantly decreased after lifestyle modification from (32.05 ± 3.36 kg/m2) to (28.1 ± 2.77 kg/m2) (P < 0.001). It also showed that the percentage of studied adolescents with elevated TSH decreased from 47.5% to 19.7% after the weight reduction program. Improvement was also achieved in the lipid profile and liver functions. The percentage of studied adolescents with ultrasound appearance of NAFLD decreased from 31.1% to 26.2% after weight reduction.

CONCLUSIONS

Lifestyle modification positively influences the metabolic derangement in obesity without medical treatment. ΔTSH is a significant predictor of the change in BMI z-score. It is also possible that hepatic steatosis affects thyroid function rather than the other way around.

Metabolic syndrome and chronic liver diseases

Drastic changes in diet and lifestyle as well as rapid population aging in China have made the morbidity of metabolic syndrome (MetS) quite close to the levels of industrialized countries. MetS is one of the highest risk factors for cardiovascular diseases; accumulating epidemiological data also show that MetS is an independent risk factor of the development of chronic liver cirrhosis and hepatocellular carcinoma. The synergism between MetS and HBV infection is considered to robustly increase the morbidity and mortality of end-stage liver diseases, and this needs particular attention because of the huge HBV-positive population in China. The purpose of this review is to disucss the association between MetS and the development of end-stage liver diseases.