Intensive lifestyle treatment for non-alcoholic fatty liver disease in children with severe obesity: inpatient versus ambulatory treatment.

BACKGROUND/AIMS: Lifestyle intervention is the only established therapy for non-alcoholic fatty liver disease (NAFLD). The optimal treatment schedule and predictors of response of this treatment have not been established in children. We aimed to evaluate the 2-year efficacy of an inpatient versus ambulatory intensive lifestyle intervention for treating NAFLD in children with severe obesity. METHODS: A cohort study of 51 severely obese non-diabetic children (mean age 14.7 (±2.4) years; BMI-z-score 3.5 (±0.5)) with liver steatosis were non-randomly allocated to inpatient treatment (2 or 6 months), ambulatory treatment or usual care. Proton Magnetic Resonance Spectroscopy determined liver steatosis and serum alanine aminotransferase (ALT) at 6 months were the primary outcome measures. Baseline variables were evaluated as predictors of treatment response. RESULTS: Liver steatosis had disappeared in 43, 29 and 22% and serum ALT normalized in 41, 33 and 6% at the end of 6 months in the inpatient, ambulatory or usual care treatment groups, respectively. Only the proportions of ALT normalization in inpatient and ambulatory treatment compared with usual care were significantly higher. Treatment effects of inpatient and ambulatory treatment were sustained at 1.5 years follow-up. No baseline characteristic, including PNPLA3 polymorphism or leptin, was consistently predictive for treatment response. CONCLUSIONS: A 6-month intensive inpatient and ambulatory lifestyle treatment in children with severe obesity reverses NAFLD in a minority of patients. This study suggests that inpatient compared with ambulatory intensive treatment does not importantly increase treatment success. Further efforts to optimize and individualize lifestyle interventions and additional treatments options are needed particular for children with severe obesity resistant to conventional lifestyle interventions.

Ultrasonography is not more reliable than anthropometry for assessing visceral fat in obese children.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Visceral fat accumulation is a risk factor for obesity-related complications. Waist circumference is used in clinical practice to assess visceral adiposity. WHAT THIS STUDY ADDS: Ultrasound is not superior to waist circumference for assessing visceral obesity in obese children. The optimal site for measuring waist circumference in obese children is at the smallest body circumference between xiphisternum and umbilicus. OBJECTIVE: Visceral fat accumulation is a well-established risk factor for obesity-related complications. In children, it has not been determined whether ultrasonography is superior to waist measurement for assessing visceral fat. Moreover, the optimal site for waist measurement has not been determined. DESIGN: In a prospective cohort of 92 severely obese children and adolescents (age 13.9 ± 2.2 years, body mass index z-score 3.29 ± 0.33), we evaluated the performance of ultrasonography and two different methods of waist circumference measurement, using magnetic resonance imaging as the reference standard. RESULTS: Waist circumference, defined as the smallest body circumference between xiphisternum and umbilicus had the strongest correlation with visceral fat quantity (r = 0.69 all, r = 0.68 girls, r = 0.64 boys). It was not outperformed by ultrasonography (r = 0.60 all, r = 0.62 girls, r = 0.50 boys) and correlated significantly better than the World Health Organization standard for waist measurement, midway between lower margin of the last rib and the crest of the ilium, (r = 0.51 all, r = 0.39 girls, r = 0.46 boys). CONCLUSIONS: Waist circumference measurement, defined as the smallest body circumference between xiphisternum and umbilicus, is the preferred non-invasive technique for daily clinical practice to assess visceral fat accumulation in severely obese children and adolescents. There is no place for ultrasonography for the quantification of visceral fat in this group.

Gain in lung function after weight reduction in severely obese children.

AIM: The primary objective of this prospective cohort study was to determine the effect of weight loss on pulmonary function values in extremely obese children. METHODS: Obese children participated in a 26-week in-hospital or outpatient multidisciplinary treatment programme. Waist circumference was measured and pulmonary function tests were performed at enrolment and after 6 months. RESULTS: The data of 112 children were analysed. The children had a mean age of 14.4 (range 8.5-18.9) years and 62.5% were girls. The mean SD score-body mass index (SDS-BMI) was +3.38 at baseline and +2.91 after the intervention. Lung function improved significantly: functional vital capacity increased by 3.08% (95% CI 1.16% to 5.00%) of the predicted value, forced expiratory volume in 1 s (FEV(1)) by 2.91% (95% CI 1.11% to 4.71%) of the predicted value, total lung capacity by 2.27% (95% CI 1.16% to 5.00%) of the predicted value, and expiratory reserve volume (ERV) by 14.8% (95% CI 8.66% to 20.88%) of the predicted value. The increase in ERV correlated with the reduction in SDS-BMI and with the reduction in waist circumference. FEV(1) did not correlate with the reduction in either SDS-BMI or waist circumference. CONCLUSIONS: Weight loss in severely obese children correlated with an improvement in lung function, especially ERV. The improvement in ERV correlated with the decrease in SDS-BMI and waist circumference.

Comparison of handling and acceptability of two spacer devices in young children with asthma.

UNLABELLED: This study compared parents' preference for two spacer devices, NebuChamber and Babyhaler for the treatment of young children with asthma. In this open, cross-over study 141 patients (aged 5-57 mo) who used inhaled steroids via a spacer device were randomized to budesonide via NebuChamber or beclomethasone dipropionate via Babyhaler. Both treatments were given by the parents twice daily for 2 wk. At the final visit parents completed a questionnaire on preference in general and for a given set of features. Acceptability and handling were scored in a diary. Diary scores on acceptability by the child and handling of both spacer devices were comparable. In the preference questionnaire, 68% of parents preferred NebuChamber [95% confidence interval (CI) 60-76] and 25% Babyhaler (95% CI 18-33). The preference was independent of the type of spacer used before the study and was also apparent in the different features: acceptability by child, carrying around, cleaning, close fitting of face mask, assembling and disassembling, damage resistance and size. These differences were statistically significant for all features, except for acceptability by the child. CONCLUSION: Two-thirds of parents prefer NebuChamber over Babyhaler for the treatment of their young asthmatic children.