title: Arterial function and structure after a 1-year lifestyle intervention in children with nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics and Child Neuropsichiatry, Sapienza University of Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pacifico
authors.forename: M
authors.initials: M
authors.lastname: Arca
authors.forename: C
authors.initials: C
authors.lastname: Anania
authors.forename: V
authors.initials: V
authors.lastname: Cantisani
authors.forename: M
authors.initials: M
authors.lastname: Di Martino
authors.forename: C
authors.initials: C
authors.lastname: Chiesa
mesh_terms: D050154:Adiposity; D001158:Arteries / Q000473:pathology / Q000503:physiopathology*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D059168:Carotid Intima-Media Thickness; D002648:Child; D002652:Child Behavior; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004038:Diet, Reducing; D015444:Exercise; D005234:Fatty Liver / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology / Q000517:prevention & control; D050152:Intra-Abdominal Fat / Q000473:pathology; D007558:Italy / Q000453:epidemiology; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000178:diet therapy / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D014664:Vasodilation