title: Nonalcoholic fatty liver disease and cardiovascular risk in children with obesity.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) has been recognized as an independent risk factor for cardiovascular disease in adults. It has not been established whether NAFLD is related to early atherosclerotic changes in children.
  
  
  METHODS
  In a cross-sectional study, 78 non diabetic, non smoking children with severe obesity were evaluated for NAFLD. Proton magnetic resonance spectroscopy was used to detect liver steatosis and serum ALT was used as a surrogate marker for steatohepatitis. Carotid intima-media thickness (CIMT) and arterial wall stiffness were measured using ultrasound.
  
  
  RESULTS
  Steatosis was present in 41 (53%) of subjects. Of these children, 26 out of 41 (63%) had elevated ALT levels. No differences in CIMT and arterial wall stiffness were observed between those without and with steatosis and those with steatosis plus elevated ALT levels [CIMT = 0.47 (±0.06), 0.48 (±0.06) and 0.48 (±0.07) mm, respectively; stiffness = 2.78 (±0.50), 3.00 (±0.81), and 2.90 (±0.78), respectively]. Steatosis and ALT were not correlated to CIMT (r = -0.02 and -0.14, respectively) or arterial wall stiffness (r = 0.13 and -0.11, respectively).
  
  
  CONCLUSIONS
  In this study, no relationship between NAFLD and early atherosclerotic changes in children was observed. An atherogenic effect of steatohepatitis (NASH) on pediatric age and long-term atherogenic consequences of simple steatosis cannot be excluded based on this study.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bart G P
authors.initials: BG
authors.lastname: Koot
authors.affiliation: Department of Cardiology and Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.|Imagelabonline and Cardiovascular, Matrix II, Science Park, Amsterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: de Groot
authors.affiliation: Childhood Obesity Center Heideheuvel, Hilversum, The Netherlands.
authors.forename: Olga H
authors.initials: OH
authors.lastname: van der Baan-Slootweg
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anneloes E
authors.initials: AE
authors.lastname: Bohte
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Nederveen
authors.affiliation: Department of Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Peter L M
authors.initials: PL
authors.lastname: Jansen
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000209:etiology* / Q000473:pathology; D002318:Cardiovascular Diseases / Q000175:diagnosis; D059168:Carotid Intima-Media Thickness; D002648:Child; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000473:pathology; D009765:Obesity / Q000150:complications*; D063766:Pediatric Obesity / Q000150:complications* / Q000473:pathology; D066244:Proton Magnetic Resonance Spectroscopy; D012307:Risk Factors; D059289:Vascular Stiffness