Reinehr T, Schmidt C, Toschke A M, Andler W
Vestische Hospital for Children and Adolescents, University of Witten-Herdecke, Datteln, Germany.
Arch Dis Child. 2009 Jun;94(6):437-42. doi: 10.1136/adc.2008.143594. Epub 2009 Feb 17.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in obese youth. Lifestyle intervention was demonstrated to improve NAFLD but follow-up studies after end of intervention are lacking. Furthermore the necessary degree of overweight reduction for improvement of NAFLD remains unknown.
We examined standard deviation score of body mass index (SDS-BMI) and transaminases in 152 obese children with NAFLD diagnosed by ultrasound at baseline, at the end of a 1-year intervention and 2 years after baseline. Within-subject changes of these parameters were compared by participation in the intervention based on physical activity, nutrition education and behaviour therapy.
In contrast to 43 children without lifestyle intervention, participation in lifestyle intervention (n = 109) was associated with a significant decrease of transaminases and overweight 1 and 2 years after baseline (1 year: alanine transaminase (ALT) -10 U/l (-14 to -6); aspartate transaminase (AST) -5 U/l (-7 to -3); SDS-BMI -0.23 (-0.30 to -0.16); 2 years: ALT -9 U/l (-12 to -6); AST -6 U/l (-7 to -4); SDS-BMI -0.30 (-0.37 to -0.22); data as mean changes and 95% confidence interval compared to baseline). Any degree of overweight reduction was associated with a significant decrease of NAFLD prevalence. The greatest decrease of NAFLD prevalence (1 year: -89% (95% CI -72% to -100%); 2 years: -94% (95% CI -83% to -100%)) was observed in children with the greatest overweight reduction (SDS-BMI decrease >0.5).
Multidisciplinary lifestyle intervention is effective to improve NAFLD even in the 1-year follow-up after the end of intervention. A minimal reduction of overweight led to an improvement of NAFLD.
NCT00435734.
非酒精性脂肪性肝病（NAFLD）是肥胖青少年肝病最常见的病因。生活方式干预已被证明可改善NAFLD，但干预结束后的随访研究尚缺。此外，改善NAFLD所需的体重减轻程度仍不清楚。
我们检测了152名经超声诊断为NAFLD的肥胖儿童在基线、1年干预结束时及基线后2年的体重指数标准差评分（SDS-BMI）和转氨酶水平。通过参与基于体育活动、营养教育和行为疗法的干预，比较这些参数的个体内变化。
与43名未进行生活方式干预的儿童相比，参与生活方式干预（n = 109）的儿童在基线后1年和2年时转氨酶水平和超重情况显著下降（1年：丙氨酸转氨酶（ALT）-10 U/L（-14至-6）；天冬氨酸转氨酶（AST）-5 U/L（-7至-3）；SDS-BMI -0.23（-0.30至-0.16）；2年：ALT -9 U/L（-12至-6）；AST -6 U/L（-7至-4）；SDS-BMI -0.30（-0.37至-0.22）；数据为与基线相比的平均变化及95%置信区间）。任何程度的体重减轻都与NAFLD患病率的显著降低相关。在体重减轻最多（SDS-BMI下降>0.5）的儿童中，观察到NAFLD患病率下降幅度最大（1年：-89%（95%CI -72%至-100%）；2年：-94%（95%CI -83%至-100%））。
多学科生活方式干预即使在干预结束后的1年随访中对改善NAFLD也是有效的。体重的最小程度减轻也能改善NAFLD。
NCT00435734。
