title: Psychosocial outcomes for children with nonalcoholic fatty liver disease over time and compared with obese controls.
abstract: OBJECTIVE
  Children with nonalcoholic fatty liver disease (NAFLD) experience compromised quality of life (QOL) akin to those with other chronic disease. Our objectives were to examine the association between NAFLD and QOL as well as other psychosocial outcomes, to compare psychosocial outcomes to obese children without known NAFLD, and to determine whether present standard care for NAFLD results in weight loss and improvement in psychosocial outcomes longitudinally.
  
  
  METHODS
  Children with NAFLD between 8 and 18 years and obese control children without known NAFLD were consented to complete a brief psychosocial battery examining depression (Children's Depression Inventory), QOL (Pediatric Quality of Life Inventory; PedsQL), and effect of weight on self-esteem (Body-Esteem Scale for Adolescents and Adults) at baseline; and additionally for the NAFLD group after at least 6 months.
  
  
  RESULTS
  A total of 48 children with NAFLD and 40 obese control children were enrolled. The PedsQL scores were not significantly different but the CDI total score and subscales of negative mood, ineffectiveness, and negative self-esteem as well as all of the 3 subscales of BESAA, appearance, attribution, and weight were worse in the NAFLD group compared with obese controls. The PedsQL scores also did not change after standard care in the 33 patients with NAFLD who completed the follow-up evaluations, but the CDI score differed between those whose body mass index improved or not.
  
  
  CONCLUSIONS
  Children with NAFLD have higher levels of depression than obese controls. Outcomes did not improve with standard care. Larger longitudinal studies and appropriate interventions are required in this area.
authors.affiliation: Division of Pediatric Hepatology and Recanati Miller Transplant Institute, Mount Sinai Medical Center, New York 10029, USA. nanda.kerkar@mountsinai.org
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.forename: Christine
authors.initials: C
authors.lastname: D'Urso
authors.forename: Kelsey
authors.initials: K
authors.lastname: Van Nostrand
authors.forename: Israel
authors.initials: I
authors.lastname: Kochin
authors.forename: Allison
authors.initials: A
authors.lastname: Gault
authors.forename: Frederick
authors.initials: F
authors.lastname: Suchy
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Jaime
authors.initials: J
authors.lastname: Chu
authors.forename: Rachel
authors.initials: R
authors.lastname: Annunziato
mesh_terms: D000293:Adolescent; D000339:Affect; D001828:Body Image; D001835:Body Weight; D002648:Child; D005234:Fatty Liver / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000523:psychology*; D011788:Quality of Life; D012649:Self Concept; D020377:Self Efficacy