الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
NAFLD has recently emerged as the leading cause of chronic liver disease in children and liver related morbidity and mortality worldwide. Moreover, over the past three decades, NAFLD has been considered one of the most common causes of liver disease in adults and children. The increasing incidence of NAFLD is a mirror of the worldwide annual increment of obese individuals.
NAFLD affects 9.6% of children and adolescents, and this figure increases up to 38% among obese children.In Egypt,few studies evaluated the prevalence of NAFLD; a study conducted in Cairo, reported that the prevalence of NAFLD was 38.5% in obese Egyptian children and adolescents. However,in a cross sectional, nested case control study conducted in Alexandria- Egypt, NAFLD was detected in 15.8% and increased significantly with age.
The natural history and prognosis of NAFLD in children is still uncertain as published data with long-term follow up is scanty. It has been reported that, in susceptible individuals, NAFLD can evolve to cirrhosis and hepatocellular carcinoma (HCC), with the consequent need for liver transplantation.
A wide range of conditions can increase the risk ofNAFLD including: IR, metabolic syndrome and type2 DM, obesity, dyslipidaemia, environmental factors; ethnic differences, diet, smoking, exercise and genetic factors), polycystic ovarian syndrome, sleep apnea, protein energy malnutrition, essential fatty acid deficiency, hypothyroidism and hypopituitarism.
Regarding the diagnostic tools of NAFLD in children; Serum transaminases may vary from normal to high values in children with NAFLD. Ultrasonography is the only imaging technique used for NAFLD screening in children because it is safe, non-invasive, widely available, relatively inexpensive, and can detect evidence of portal hypertension. Liver biopsy is also not recommended as a screening procedure due to its invasive nature and high cost.
Various potential therapeutic approachesfor paediatric NAFLD have been investigated in the past two decades. The lifestyle intervention (dietary modification and physical activity) should be the first line of treatment. In children with poor adherence to lifestyle changes, pharmacological interventions and dietary supplementations, including antioxidants (vitamin E), insulin sensitizers (metoformin), UDCA, omega-3 PUFA, and probiotics could be customized according to the case.
The aim of this study was to assess the efficacy of 12 months lifestyle intervention (dietary modification, weight loss and physical activity)and supplementation of omega-3 PUFA in the treatment of children with NAFLD.
The current study is a Randomized Controlled Trial which was conducted in the Liver Clinic, Nutrition and Obesity Management Clinic in Alexandria, Egypt. 90 Children aged from 5 to18 years who had been diagnosed with NAFLDwere enrolled and randomly classified into two groups (lifestyle intervention group and lifestyle intervention combined with omega-3 PUFA supplementation group).Each group consisted of 45 children who were followed up for a period of 12 months.
The main results of the study included:
• At baseline, both studied groups were matched regarding age, sex, residence, educational level of patients and parents, family history, present and past medical history.
• At baseline, there was no significant difference between the two studied groups regarding lifestyle and dietary habits pattern.
• At baseline all the studied children with NAFLD were either obese (97.78%) or overweight (2.22%). Elevated ALT was detected in 18.88% of cases in both groups and elevated AST was detected only in 10% of cases in both groups. Elevated cholesterol and LDL were detected in 21.11% of cases in both groups, elevated TG was found in 27.77% of patients in both groups, and decreased HDL was detected in 50% in both groups. There was no significant difference between the two groups regarding anthropometric measurements and laboratory parameters at baseline.
• There was evident decrease among the two studied groups regarding BMI during the different periods of follow-up (3, 6, 9, 12 months), with no significant difference between them.
• There was evident decrease in AST& ALT levels among the two studied groups with no significant difference between them during different periods of measurements and at the end of the study.
• There was evident decrease in cholesterol and LDL levels among the two studied groups with no significant difference between them during different periods of measurements and at the end of the study.
• There was evident decrease in TG levels among the two studied groups with more evident decrease in the lifestyle modification combined with omega-3 PUFA group, a statistically significant difference between the two groups at 3, 6, 9 months and at the end of the study was found.
• HDL level had got an evident increase among the two studied groups with evident increase in the omega-3 PUFA group at the 9th month and at the end of the study with a statistically significant difference between the two groups.
• Regarding the changes in ultrasound findings; at the end of study, there were 36 cases (80%) that had an improvement in liver steatosis compared to baseline in the omega-3 PUFA group; however there were only 16 cases (35.56%) that had an improvement in the lifestyle intervention only group. There was a statistically significant difference between the two groups regarding the change in the ultrasound findings at the end of the study.