de Piano Aline, Prado Wagner L, Caranti Danielle A, Siqueira Kãli O, Stella Sérgio G, Lofrano Mara, Tock Lian, Cristofalo Dejaldo M J, Lederman Henrique, Tufik Sérgio, de Mello Marco Túlio, Dâmaso Ana R
Federal University of São Paulo, Escola Paulista de Medicina UNIFESP-EPM, São Paulo, Brazil.
J Pediatr Gastroenterol Nutr. 2007 Apr;44(4):446-52. doi: 10.1097/MPG.0b013e31803815d9.
The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing due to its prevalence in obesity, diabetes, and insulin-resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention can improve and prevent it. The aim of the present study was to evaluate the dietary and metabolic profiles of obese adolescents with NAFLD who participated in a multidisciplinary program.
We studied 43 adolescents ages 15 to 19 years (17.18 +/- 1.66 years) with a body mass index (BMI) > or = 30, consisting of 30 patients without NAFLD (BMI = 35.80 +/- 3.44 kg/m2) and 13 with NAFLD (BMI = 33.47 +/- 2.34 kg/m2). The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic aminotransferase levels, and lipid profiles. Insulin resistance was measured by homeostasis model assessment insulin-resistance index (HOMA-IR). The analyses of baseline and postintervention food intake were made by a 3-day inquiry.
At baseline conditions, the patients with NAFLD showed significant differences in body mass, BMI, and visceral and subcutaneous fat. Glucose and visceral and subcutaneous fat presented a significant reduction after treatment in patients with NAFLD. Analyzing the food intake, at baseline we observed a positive correlation between the visceral obesity and lipid consumption only in patients with NAFLD. We also observed significant decrease in energy and cholesterol consumption in patients with NAFLD after the multidisciplinary therapy.
The intervention promoted a decrease in the prevalence of NAFLD, a significant decrease in visceral obesity, and improved HOMA-IR, glycemia, and serum lipid levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.
非酒精性脂肪性肝病（NAFLD）的发病率因在肥胖症、糖尿病和胰岛素抵抗综合征中的普遍存在而不断上升。NAFLD的最佳治疗方案尚未确定。然而，有证据表明运动和营养干预可以改善和预防该病。本研究的目的是评估参与多学科项目的患有NAFLD的肥胖青少年的饮食和代谢状况。
我们研究了43名年龄在15至19岁（平均年龄17.18±1.66岁）、体重指数（BMI）≥30的青少年，其中30名无NAFLD患者（BMI = 35.80±3.44 kg/m2），13名患有NAFLD患者（BMI = 33.47±2.34 kg/m2）。通过超声检查确定NAFLD诊断。采集血样以分析血糖、肝转氨酶水平和血脂谱。通过稳态模型评估胰岛素抵抗指数（HOMA-IR）测量胰岛素抵抗。通过3天饮食询问对干预前后的食物摄入量进行分析。
在基线条件下，患有NAFLD的患者在体重、BMI以及内脏和皮下脂肪方面存在显著差异。NAFLD患者治疗后血糖以及内脏和皮下脂肪显著降低。分析食物摄入量，在基线时我们仅在患有NAFLD的患者中观察到内脏肥胖与脂质消耗之间存在正相关。我们还观察到多学科治疗后NAFLD患者的能量和胆固醇消耗显著降低。
该干预措施使NAFLD的患病率降低，内脏肥胖显著减轻，并改善了HOMA-IR、血糖和血脂水平，而这些都是NAFLD的危险因素。总之，多学科项目对于NAFLD的治疗和预防至关重要。
