title: Association of nonalcoholic fatty liver disease with cardiovascular risk factors in obese adolescents: the role of interdisciplinary therapy.
abstract: BACKGROUND
  Obesity is associated with several cardiovascular risk factors, including nonalcoholic fatty liver disease (NAFLD). These risk factors can induce changes in the arteries such as an increase in the carotid intima-media thickness (cIMT), which contributes to the early development of atherosclerosis.
  
  
  OBJECTIVE
  To determine whether NAFLD is associated with an atherogenic lipid profile, inflammatory markers, or cIMT in obese adolescents and to compare the effects of therapeutic lifestyle changes in NAFLD and non-NAFLD groups.
  
  
  METHODS
  A total of 79 obese adolescents were divided into two groups: 33 NAFLD and 46 non-NAFLD. They were submitted to an interdisciplinary therapy involving diet exercise and psychological support during the course of 1 year. The cIMT and estimates of fat mass (liver, intra-abdominal, and subcutaneous) were determined ultrasonographically. Body composition, glucose, lipid profile, and adipokines were analyzed before and after the therapy.
  
  
  RESULTS
  At baseline, only in the NAFLD group was the homeostasis model assessment of insulin resistance positively correlated with cIMT and triglyceride/high-density lipoprotein cholesterol ratio. Therapy was associated with an increase in adiponectin concentrations and reduced visceral fat, cIMT, leptin, and plasminogen activator inhibitor-1 concentrations, as well as the ratios of total cholesterol/high-density lipoprotein cholesterol and triglycerides/high-density lipoprotein cholesterol in both groups. Only in the non-NAFLD group did therapy result in a reduction in the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and increased high-density lipoprotein cholesterol concentration.
  
  
  CONCLUSIONS
  In obese adolescents, NAFLD is associated with cardiovascular risk factors and inflammatory markers of atherosclerosis that were positively correlated with cIMT only in the NAFLD group. Nevertheless, the strength of the present study is that the interdisciplinary therapy effectively improved cIMT and other proinflammatory adipokines in both groups.
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil. Electronic address: ana.damaso@unifesp.br.
authors.forename: Priscila L
authors.initials: PL
authors.lastname: Sanches
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: de Piano
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil.
authors.forename: Raquel M S
authors.initials: RM
authors.lastname: Campos
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil.
authors.forename: June
authors.initials: J
authors.lastname: Carnier
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil; Psychobiology Department, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Marco T
authors.initials: MT
authors.lastname: de Mello
authors.affiliation: Association Fund of Incentive to Research, São Paulo, Brazil.
authors.forename: Natália
authors.initials: N
authors.lastname: Elias
authors.affiliation: Cardiology Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Francisco A H
authors.initials: FA
authors.lastname: Fonseca
authors.affiliation: Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo/Santos, São Paulo, Brazil.
authors.forename: Deborah C L
authors.initials: DC
authors.lastname: Masquio
authors.affiliation: Universidade Federal de Goiás, Goiânia, Brazil.
authors.forename: Patrícia L
authors.initials: PL
authors.lastname: da Silva
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil.
authors.forename: Flavia C
authors.initials: FC
authors.lastname: Corgosinho
authors.affiliation: Weight Science, Rua Teodoro Sampaio, 744 - Pinheiros, São Paulo, Brazil.
authors.forename: Lian
authors.initials: L
authors.lastname: Tock
authors.affiliation: Physiology Department, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Lila M
authors.initials: LM
authors.lastname: Oyama
authors.affiliation: Psychobiology Department, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Post Graduate Program of Nutrition, Universidade Federal de São Paulo, Rua Marselhesa, 650 - Vila Clementino, São Paulo 04020-050, Brazil; Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo/Santos, São Paulo, Brazil; Biosciences Department, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Dâmaso
mesh_terms: D052242:Adiponectin / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000453:epidemiology*; D015992:Body Mass Index; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D004035:Diet Therapy; D005081:Exercise Therapy; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008055:Lipids / Q000097:blood; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012944:Social Support; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D008055:Lipids
keywords: Cardiovascular risk factors; Interdisciplinary intervention; Non-alcoholic fatty liver disease; Obesity