Department of Pediatrics and Child Neuropsichiatry, Sapienza University of Rome, Italy.
Nutr Metab Cardiovasc Dis. 2013 Oct;23(10):1010-6. doi: 10.1016/j.numecd.2012.08.003. Epub 2012 Sep 24.
Lifestyle modification has been the mainstay of controlling childhood obesity and has proved to be effective in reducing cardiovascular risk factors. However, it is currently unknown whether the subclinical atherosclerotic changes associated with nonalcoholic fatty liver disease (NAFLD) in such population are reversible.
We analyzed changes of brachial flow-mediated dilation (FMD), carotid intima-media thickness (cIMT), clinical, laboratory, and imaging data in 120 obese children with NAFLD, at the end of a 1-year intervention program with diet and physical exercise. The lifestyle intervention led to a significant mean decrease of body mass index (BMI)-standard deviation score (SDS), waist circumference (WC) and fat mass, along with diastolic blood pressure, triglycerides, liver enzymes, insulin, insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR), and high-sensitivity C-reactive protein. At the end of the study, FMD improved (P < 0.0001), while cIMT did not change significantly (P = 0.20). A significant decrease in hepatic fat content as measured by magnetic resonance imaging was also observed. Changes in FMD were inversely associated with changes in BMI-SDS, WC, total cholesterol, non-HDL cholesterol, liver enzymes, HOMA-IR, physical activity, and hepatic fat content. After including in the model all the significant variables as well as age, gender, pubertal status, and baseline FMD values, changes in FMD were significantly and independently associated with changes in WC and total cholesterol.
Also in obese children with NAFLD arterial function may be restored by improving metabolic risk factors and reducing visceral adiposity following a 1-year lifestyle intervention.
生活方式的改变一直是控制儿童肥胖的主要方法，并且已被证明可以有效降低心血管危险因素。然而，目前尚不清楚这种人群中非酒精性脂肪性肝病（NAFLD）相关的亚临床动脉粥样硬化变化是否可以逆转。
我们分析了 120 名患有 NAFLD 的肥胖儿童在饮食和体育锻炼 1 年干预计划结束时的肱动脉血流介导的扩张（FMD）、颈动脉内膜中层厚度（cIMT）、临床、实验室和影像学数据的变化。生活方式干预导致体重指数（BMI）-标准差评分（SDS）、腰围（WC）和脂肪量的平均显著降低，同时舒张压、甘油三酯、肝酶、胰岛素、胰岛素抵抗（稳态模型评估的胰岛素抵抗，HOMA-IR）和高敏 C 反应蛋白也降低。研究结束时，FMD 改善（P < 0.0001），而 cIMT 无显著变化（P = 0.20）。通过磁共振成像测量的肝脂肪含量也显著降低。FMD 的变化与 BMI-SDS、WC、总胆固醇、非高密度脂蛋白胆固醇、肝酶、HOMA-IR、体力活动和肝脂肪含量的变化呈负相关。在将所有显著变量以及年龄、性别、青春期状态和基线 FMD 值纳入模型后，FMD 的变化与 WC 和总胆固醇的变化显著独立相关。
在患有 NAFLD 的肥胖儿童中，通过改善代谢危险因素和减少内脏脂肪堆积，动脉功能可能在 1 年的生活方式干预后得到恢复。
