Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
J Pediatr Gastroenterol Nutr. 2013 Jul;57(1):119-23. doi: 10.1097/MPG.0b013e318290d138.
Weight loss is an effective treatment for children with nonalcoholic fatty liver disease (NAFLD), but it is extremely difficult to achieve outside of an intensive weight management program. We hypothesized that one can achieve success in improving NAFLD and weight-related outcomes in a structured and focused multidisciplinary clinical program feasible to implement in a gastroenterology clinic.
We prospectively tracked the clinical status of our patients enrolled in a multidisciplinary program of dietary and exercise advice through an institutional review board-approved NAFLD registry. Each patient met with a gastroenterologist and dietitian every 3 months for 30 minutes to set individualized goals and monitor progress.
A total of 108 children have been enrolled in the registry, and of the 83 that were eligible for 1-year follow-up and included in the analysis, 39 patients returned, resulting in a 47% follow-up rate. These 39 patients showed statistically significant improvements in mean BMI z score (-0.1 U, P < 0.05), total (-11 mg/dL, P < 0.05) and low-density lipoprotein (9 mg/dL, P < 0.05) cholesterol, and serum alanine aminotransferase levels (-36 U/L) and aspartate aminotransferase levels (-22 U/L) levels.
A clinically feasible multidisciplinary program for obese pediatric patients with NAFLD stabilized BMI z score and significantly improved aminotransferase levels at 1-year follow-up.
减肥是治疗非酒精性脂肪性肝病（NAFLD）儿童的有效方法，但在强化体重管理方案之外，减肥非常困难。我们假设，通过一种可行的、以结构化和集中为特点的多学科临床方案，可以在改善 NAFLD 和与体重相关的结果方面取得成功。
我们通过机构审查委员会批准的 NAFLD 注册中心，前瞻性地跟踪了参加多学科饮食和运动建议方案的患者的临床状况。每位患者每 3 个月与胃肠病学家和营养师会面 30 分钟，以制定个性化目标并监测进展。
共有 108 名儿童被纳入该注册中心，其中 83 名符合 1 年随访条件并纳入分析，39 名患者返回，随访率为 47%。这些 39 名患者的 BMI z 评分（-0.1 U，P < 0.05）、总胆固醇（-11 mg/dL，P < 0.05）和低密度脂蛋白胆固醇（-9 mg/dL，P < 0.05）以及血清丙氨酸氨基转移酶水平（-36 U/L）和天冬氨酸氨基转移酶水平（-22 U/L）均有统计学显著改善。
对于肥胖的 NAFLD 儿科患者，一种可行的临床多学科方案可稳定 BMI z 评分，并在 1 年随访时显著改善转氨酶水平。
