Non-alcoholic fatty-liver disease in pediatric populations

Long-term effects of metformin and lifestyle modification on nonalcoholic Fatty liver disease obese adolescents

Objective. To assess the long-term effects of metformin in combination with lifestyle intervention and its association between insulin levels and the degree of steatosis at ultrasonography (US) in obese adolescents. Methods. Thirty-five postpubertal obese boys were randomized into two groups: one receiving metformin in combination with a multidisciplinary lifestyle intervention versus a placebo group, which also received the same intervention. The visceral, subcutaneous fat and degree of steatosis were measured by ultrasonography. Fasting blood samples were collected to analyze glucose, insulin, insulin resistance, and aminotransferases. Repeated ANOVA measures were used to compare changes over time and between groups, and Spearman's correlations were used to identify an association between insulin and the degree of steatosis at US. Results. There was a positive correlation between the degree of steatosis at US with insulin concentrations and HOMA-IR. Long-term therapy plus metformin significantly reduced body weight, body mass index, insulin, HOMA-IR, and visceral fat. Conclusions. Metformin was more effective than the placebo in improving clinical parameters associated with obesity and steatosis.

Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgery

This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH and children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress; however, clinical trials focusing on NASH are needed. Heightened physician awareness of NAFLD, NASH, and associated risk factors is important to identify and treat affected children.

Societal aspects in the dietary management of childhood hyperlipidemia

Pediatric hyperlipidemias increasingly require dietary management of overweight and obesity for resolution. Dietary management of inappropriate weight gain may be outside of normal pediatric expertise. This review used scientific statements of expert professional groups, federal program documentation, and selected original articles or opinions to survey dietary techniques and highlight continuing controversies and therapeutic successes. At present, complex societal and environmental factors underlie the current epidemic in pediatric overweight, precluding definitive statements of best practices. Thus, although first-generation professional group recommendations are available, clinicians should expect recommendations to change. However, lack of standardized practices to assess the degree and quality of overweight (central versus peripheral adiposity) limit objective determination of therapeutic need and timely referral to nutrition professionals. Dietary management of insulin-resistant, overweight/obese children with dyslipidemias (metabolic syndrome) requires appropriate laboratory diagnostics to ensure that total fat and energy restrictions do not provoke or exacerbate hypertriglyceridemia or liver fat accumulation. Integrated treatment approaches that combine nutrition education, behavioral modification, and individualized diet instruction are showing success. Diet instructions that include practical translation of nutrition principles to daily eating habits are able to bring about substantial dietary change. The role of the school as a significant component of a child's lifestyle is described, as well as consideration of federally mandated feeding programs as a factor in designing effective dietary management strategies for those likely to be at high risk for overweight and dyslipidemias. The need for coordination among families, and health and school professionals to achieve success is emphasized.