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OBJECTIVES: To evaluate whether a 1-year nutrition-behavior intervention based on normocaloric balanced diet and physical exercise may reduce liver fat in obese children. PATIENTS AND METHODS: Twenty-six obese children (11 boys and 15 girls), aged 6 to 14 years, underwent anthropometric, nutritional, metabolic, and liver magnetic resonance imaging (MRI) examinations at baseline and after a 1-year nutrition-behavior intervention. Anthropometry included weight, height, waist and hip circumference, and total upper arm area. Body mass index z scores were calculated. Biochemistry included serum aminotransferases, lipid profile, glucose, and insulin. Liver steatosis was judged as hepatic fat fraction (FF) by MRI and was > or =9%. RESULTS: Prevalence of steatosis was 34.6% at baseline and declined to 7.7% after intervention (P < 0.0001). Mean (95% CI) reduction of liver FF was 8.0% (4.0%-12.0%). In 77.8% of children with liver steatosis at baseline, the FF declined lower than 9% at the end of intervention, going from a mean (SD) of 18.7% (9.1) to 1.3% (4.1), (P < 0.0001). At the end of the intervention, children showed a mean reduction in body mass index z score of 0.26 (0.11-0.41) and waist circumference of 1.46 (0.34-2.60) cm. Triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B, ApoA1/ApoB ratio, and gamma-glutamyltransferase plasma values in plasma decreased at the end of intervention (P < 0.05). CONCLUSIONS: The results suggest that in obese children nutritional-behavior interventions may reduce the liver fat.

To assess a relationship between longitudinal changes in liver fat content and biochemical parameters in obese children after 1-year nutritional intervention.Forty-six obese children, 21 males and 25 females, aged 6-14 years, underwent metabolic measurements, liver ultrasonography (US) and chemical-shift magnetic resonance imaging (MRI) examinations at baseline and after 1-year nutritional intervention. A child was defined obese if her/his body mass index (BMI) was above the age- and sex-adjusted BMI Cole's curve passing through the cut-off of 30 kg/m(2) at 18 years. BMI Z scores were calculated and adjusted for age and gender by using the Cole's LMS-method and Italian reference data. Biochemistry included serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Abdominal US and chemical-shift MRI were performed according to a randomized sequence. The same radiologist performed US by a GE Logiq 9 (General Electric Healthcare Medical Systems, Milwaukee, WI, United States) using a 3.5-MHz convex array transducer. Liver echogenicity was evaluated independently on videotape by 3 radiologists unaware of the child and MRI outcomes, and a consensus was established. Another experienced radiologist, unaware of the child and US data, performed the abdominal chemical-shift MRI with a 1-t system NT-Intera (Philips Medical Systems, Best, The Netherlands) and a phased-array coil. Liver fat fraction (FF) on MRI was judged elevated when greater than 9%. A FF18% was considered expressing more severe cases of fatty liver according to Fishbein. A nutritional-behavioral intervention was recommended to promote a normocaloric balanced diet and active lifestyle based on the Italian guidelines for treatment of childhood obesity.Compared to baseline, at the end of intervention children showed lower intakes of energy (mean ± SD: 2549 ± 1238 Kcal vs 1770 ± 622 Kcal, P0.0001), total fat (90 ± 47 g vs 52 ± 23 g, P0.0001), carbohydrates (356 ± 174 g vs 241 ± 111 g, P = 0.001), and protein (99 ± 48 g vs 75 ± 23 g, P = 0.006) intakes. Prevalence of FF ≥ 9% declined from 34.8% to 8.7% (P0.01), with a mean reduction of 7.8% (95%CI: 5.0-10.6). At baseline, FF was associated with liver biochemical parameters (maximum P0.001). At the end of the intervention association was found with AST (P = 0.017). Change of FF was associated with change in AST (P = 0.027) and ALT (P = 0.024). Rate of increased liver echogenicity declined from 45.6% to 21.7% (P0.0001). Liver echogenicity was associated with ALT at baseline only (P0.001). An age- and sex- adjusted multiple regression analysis showed that FF change was independently associated with change in serum AST (adjusted regression coefficient 0.348, P = 0.048).The results suggest that in obese children longitudinal changes in liver fat content based on MRI may be associated with change in serum transaminases suggesting novelty in monitoring nonalcoholic fatty liver disease.

Background and Aims Despite the potential clinical and practical relevance, there is lack of studies in current literature assessing the relationship of longitudinal change of liver fat content with liver biochemical parameters in paediatric age. The aim of the present study was to assess whether any association may exist of change in liver fat content based on MRI with change in liver biochemical parameters in obese children who underwent a one-year nutritional intervention. Methods Fourthy six obese children, aged 6–14 years, underwent metabolic measurements, liver ultrasonography (US) and chemical-shift MRI examinations at baseline and after an one-year nutritional intervention. Biochemistry included serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Liver fat fraction (FF) on MRI was judged elevated as it was 39%. Results Prevalence of FF³ 9% declined from 34.8% to 8.7% ( P P P =0.017). Change of FF was associated with change in AST ( P =0.027) and ALT( P =0.024). Liver echogenicity was associated with ALT at baseline (P P =0.048). Conclusions The results suggest that in obese children undergoing nutritional interventions longitudinal changes in liver fat content may be associated with change in serum transaminases suggesting novelty in monitoring NAFLD in childhood obesity.