Non-alcoholic fatty liver disease in obese children: long-term effects of a lifestyle intervention. Follow-up study of a cohort

In February 2008, a study protocol titled *Non-alcoholic fatty liver disease in
obese children: measuring liver steatosis by MR Spectroscopy* (MEC number
07/141) was started. In that study, 50 children with non-alcoholic fatty liver
disease (NAFLD) are being identified from a cohort of severely obese children
and the effects of 6 months of lifestyle intervention on NAFLD are evaluated.
Proton magnetic resonance spectroscopy (1H-MRS) is used in that study to
non-invasively and accurately measure liver steatosis.
Even more important than short term effects is the sustainability of the
effects of lifestyle interventions on NAFLD. In the presently proposed
follow-up study protocol, the sustainability of the effects of lifestyle
interventions on NAFLD are investigated. Only one paediatric study into the
long term efficacy has been published. In that study, ultrasonography and serum
transaminases are used which are inaccurate diagnostic tools to determine
NAFLD.

To determine the 1 year sustainability of the effects of a lifestyle
intervention on NAFLD in severely obese children and determine the relation
between long term changes in liver steatosis and other clinical and biochemical
parameters. Finally, to determine whether long term changes in liver steatosis
are related to changes in signs of atherosclerosis.

In a previously identified cohort of obese children with NAFLD, we will measure
liver steatosis using 1H-MRS, measure body fat distribution using conventional
MR imaging, perform ultrasound of the carotid arteries for signs of
arthrosclerosis and collect clinical and biochemical data one year after these
children participated in a lifestyle intervention program.

Participants in this study have all been identified as suffering from NAFLD in
the previous study. It is standard clinical care that NAFLD is followed up by
imaging and blood sampling every 6-12 months in order to identify deterioration
of liver function. In the previous study permission was asked to contact
patients for future studies. When a patient is included in the study all
examinations will be performed during one visit to the AMC hospital. 1H-MRS and
MR body fat distribution imaging together is a non-invasive, non-ionizing 30
minute examination in the MRI scanner. Ultrasound of carotid arteries takes
about 15-20 minutes and is safe, non-invasive, and subject friendly. Blood
sampling will be performed after an overnight fast. History taking and physical
examination will take place in the paediatric outpatient clinic of the AMC
hospital and will take 15 minutes.