Objective To investigate the effects of different levels of weight loss on body fat, blood lipids, blood glucose, liver function, and liver morphology in obese children and adolescents with non-alcoholic fatty liver disease (NAFLD). Methods From July to September 2023, seventy obese children and adolescents with NAFLD were recruited from a closed weight loss camp and underwent a 4-week weight loss intervention. Various test indicators were collected from the participants one day before the intervention and four weeks after the intervention. Based on the percentage of weight loss (WL) and clinical guideline recommendations, the participants were divided into a low WL group (WL<5%), a moderate WL group (5%≤WL<7%), and a high WL group (WL≥7%). The paired-sample t-test was used to compare changes in indicators within groups, one-way ANOVA was used to compare differences in improvement effects between groups, and a generalized regression model was used to analyze the relationship between weight change and blood glucose, blood lipids, and liver enzymes. Results A total of 61 participants were included in the analysis. After the 4-week weight loss intervention, there were significant decreases in body fat (BF) (t=6.471, 9.991, 13.351) and fat percentage (FP) (t=6.240, 5.549, 7.616) in the three NAFLD groups (P<0.05). Low-density lipoprotein cholesterol (LDL-C) significantly improved in all three groups (t=3.403, 9.218, 7.844, P<0.05), and the decrease in serum total cholesterol (TC) was statistically significant only in the 5%≤WL<7% and WL≥7% groups (t=7.114, 6.735,P<0.05). Serum gamma-glutamyltransferase (GGT) (t=5.082, 4.275, 5.003) and serum cholinesterase (ChE) (t=6.708, 9.254, 10.941) were significantly reduced (P<0.05). Alkaline phosphatase (ALP) (t=3.842, 4.584) and lactate dehydrogenase (LDH) (t=3.065, 3.869, P<0.05) decreased significantly in the 5%≤WL<7% and WL≥7% groups, and aspartate aminotransferase (AST) decreased significantly in the WL≥7% group (t=2.115, P<0.05). Using the percentage of weight change as the independent variable and a generalized linear regression model for trend testing, it was found that serum TC, ALP, LDL-C, TG, and ChE exhibited a linear trend across weight change groups (P<0.05). Conclusion Weight loss intervention can significantly improve glucose and lipid metabolism and liver function in obese children and adolescents with NAFLD, and with increasing amounts of weight loss, there is a trend of increased improvement in NAFLD liver enzymes.
Key words
children and adolescents /
non-alcoholic fatty liver disease /
weight loss /
obesity
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Calcaterra V, Magenes VC, Vandoni M, et al. Benefits of physical exercise as approach to prevention and reversion of non-alcoholic fatty liver disease in children and adolescents with obesity[J]. Children, 2022, 9(8): 1174.
[2] Nobili V, Alisi A, Newton KP, et al. Comparison of the phenotype and approach to pediatric vs adult patients with nonalcoholic fatty liver disease[J]. Gastroenterology, 2016, 150(8): 1798-1810.
[3] Crespo M, Lappe S, Feldstein AE, et al. Similarities and differences between pediatric and adult nonalcoholic fatty liver disease[J]. Metabolism, 2016, 65(8): 1161-1171.
[4] Ahmed IA, Mikail MA, Mustafa MR, et al. Lifestyle interventions for non-alcoholic fatty liver disease[J]. Saudi J Biol Sci, 2019, 26(7): 1519-1524.
[5] 周雪莲,傅君芬.儿童非酒精性脂肪肝病诊断与治疗专家共识[J].中国实用儿科杂志,2018,33(7):487-492.
Zhou XL, Fu XF. Expert consensus on diagnosis and treatment of nonalcoholic fatty liver disease in children[J]. Chin J Pract Pediatr, 2018, 33(7): 487-492. (in Chinese)
[6] Koutoukidis DA, Astbury NM, Tudor KE, et al. Association of weight loss interventions with changes in biomarkers of nonalcoholic fatty liver disease: A systematic review and meta-analysis[J]. JAMA Intern Med, 2019, 179(9): 1262-1271.
[7] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南(2018更新版)[J].传染病信息,2018,31(5):393-402,420.
Fatty Liver and Alcoholic Liver Disease Group, Chinese Medical Association Hepatology Branch, Fatty Liver Disease Expert Committee, Chinese Medical Doctor Association. Guidelines for the prevention and treatment of non-alcoholic fatty liver disease (2018 Update)[J]. Infect Dis Inf, 2018, 31(5): 393-402,420. (in Chinese)
[8] 鲁旭娟,张慧萍.非酒精性脂肪肝患者血脂、血糖和肝功能联合检测及其临床意义[J].贵州医药,2023,47(6):896-897.
Lu XJ, Zhang HP. Combined detection of blood lipid, blood glucose and liver function in patients with nonalcoholic fatty liver disease and its clinical significance[J]. Guizhou Medical Journal, 2023, 47(6): 896-897. (in Chinese)
[9] 王海燕,牟晓雯.肝功能与血脂血清学指标水平检验在脂肪肝诊断中的效果观察[J].中国实用医药,2023,18(19):70-72.
Wang HY, Mou XW. Observation on the effect of liver function and blood lipid of serology test in the diagnosis of fatty liver[J]. China Pract Med, 2023, 18(19): 70-72. (in Chinese)
[10] 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].中华肝脏病杂志,2006,14(3):161-163.
Fatty Liver and Alcoholic Liver Disease Group, Chinese Society of Hepatology. Guidelines for diagnosis and treatment of nonalcoholic fatty liver diseases[J]. Chin J Hepatol, 2006, 14(3): 161-163. (in Chinese)
[11] 童丽.肝脏彩色多普勒超声在非酒精性脂肪肝病情程度评估中的应用[J].基层医学论坛,2023,27(25):110-112.
Tong L. Application of hepatic color Doppler ultrasound in the evaluation of nonalcoholic fatty liver disease degree[J]. Med Forum, 2023, 27(25): 110-112. (in Chinese)
[12] 杨秀莲.抗阻训练结合健步走对非酒精性脂肪肝干预效果的研究[D].广州:广州体育学院,2017.
Yang XL. Influences of resistance training combined with vigorous walking on nonalcoholic fatty liver disease[D]. Guangzhou: Guangzhou Institute of Physical Education, 2017. (in Chinese)
[13] 郭吟,陈佩杰,陈文鹤.4周有氧运动对肥胖儿童青少年身体形态、血脂和血胰岛素的影响[J].中国运动医学杂志,2011,30(5):426-431.
Guo Y, Chen PJ, Chen WH. Effects of 4-week aerobic exercise on body shape, blood lipid and insulin in obese children and adolescents[J]. Chin J Sports Med, 2011, 30(5): 426-431. (in Chinese)
[14] Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis[J]. Gastroenterology, 2015, 149(2): 367-378.
[15] Arora C, Malhotra A, Ranjan P, et al. Effect of intensive weight-loss intervention on metabolic, ultrasound and anthropometric parameters among patients with obesity and non-alcoholic fatty liver disease: an RCT[J]. Eur J Clin Nutr, 2022, 76(9): 1332-1338.
[16] Lindqvist C, Holmer M, Hagström H, et al. Macronutrient composition and its effect on body composition changes during weight loss therapy in patients with non-alcoholic fatty liver disease: Secondary analysis of a randomized controlled trial[J]. Nutrition, 2023, 110: 111982.
[17] Pouwels S, Sakran N, Graham Y, et al. Non-alcoholic fatty liver disease (NAFLD): A review of pathophysiology, clinical management and effects of weight loss[J]. BMC Endocr Disord, 2022, 22(1): 63.
[18] Rinaldi L, Pafundi PC, Galiero R, et al. Mechanisms of non-alcoholic fatty liver disease in the metabolic syndrome. A narrative review[J]. Antioxidants,2021,10(2): 270.
[19] Shida T, Oshida N, Oh S, et al. Progressive reduction in skeletal muscle mass to visceral fat area ratio is associated with a worsening of the hepatic conditions of non-alcoholic fatty liver disease[J]. Diabetes Metab Syndr Obes, 2019, 12: 495-503.
[20] Mizuno N, Seko Y, Kataoka S, et al. Increase in the skeletal muscle mass to body fat mass ratio predicts the decline in transaminase in patients with nonalcoholic fatty liver disease[J]. J Gastroenterol, 2019, 54(2): 160-170.
[21] Kim G, Lee SE, Lee YB, et al. Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: A 7-year longitudinal study[J]. Hepatology, 2018, 68(5): 1755-1768.
[22] Mccarthy D, Berg A. Weight loss strategies and the risk of skeletal muscle mass loss[J]. Nutrients, 2021, 13(7): 2473.
[23] Schwimmer JB, Ugalde-Nicalo P, Welsh JA, et al. Effect of a low free sugar diet vs usual diet on nonalcoholic fatty liver disease in adolescent boys: A randomized clinical trial[J]. JAMA, 2019, 321(3): 256-265.
[24] Tian YM, Ma N, Jia XJ, et al. The "hyper-triglyceridemic waist phenotype" is a reliable marker for prediction of accumulation of abdominal visceral fat in Chinese adults[J]. Eat Weight Disord, 2020, 25: 719-726.
[25] Seebacher F, Zeigerer A, Kory N, et al. Hepatic lipid droplet homeostasis and fatty liver disease[J]. Semin Cell Dev Biol, 2020, 108: 72-81.
[26] Scorletti E, Carr RM. A new perspective on NAFLD: Focusing on lipid droplets[J]. J Hepatol, 2022, 76(4): 934-945.
[27] Katsagoni CN, Papachristou E, Sidossis A, et al. Effects of dietary and lifestyle interventions on liver, clinical and metabolic parameters in children and adolescents with non-alcoholic fatty liver disease:A systematic review[J]. Nutrients, 2020, 12(9): 2864.
[28] Bondyra-Wis′niewska B, Myszkowska-Ryciak J, Harton A. Impact of lifestyle intervention programs for children and adolescents with overweight or obesity on body weight and selected cardiometabolic factors—A systematic review[J]. Int J Environ Res Public Health, 2021, 18(4): 2061.
[29] Koutoukidis DA, Koshiaris C, Henry JA, et al. The effect of the magnitude of weight loss on non-alcoholic fatty liver disease: A systematic review and meta-analysis[J]. Metabolism, 2021, 115: 154455.
PDF(667 KB)
