Childhood Obesity for Pediatric Gastroenterologists

Abstract

Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology.

Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions

“…Dietary interventions are still not based on precise evidence-based guidelines: in childhood however diets must be balanced to allow a healthy and harmonic growth [12]. The ESPGHAN Committee on Nutrition [13] suggests that energy intake should be individually determined, and slowly rather than rapidly absorbed carbohydrates should be preferred.…”

“…Recent pharmacological studies in NAFLD animal models and in adult humans focusing on the effect of oral treatment with ω-3 fatty acids, demonstrate that they have both anti-inflammatory and insulin sensitizing properties, suggesting a potential role in treatment of NAFLD [47]. In NAFLD children ω3-docosahexaenoic acid treatment for 6 months improved ultrasonographic fatty liver and insulin sensitivity [12]. Because this treatment is well tolerated in pediatric population, DHA deserve further studies in the management of children with NAFLD.…”

The Full Spectrum of Hepatic Steatosis in Children

“…With this, there is a growing recognition of metabolic syndrome-related NAFLD in children, reported to affect nearly 11% of adolescents and one-half of obese males 6 ; it is also the most common cause of liver disease in children. 7,8 However, there are many other recognized causes of liver steatosis 9 that often need to be ruled out before a diagnosis of NAFLD can be given. These include inborn errors of metabolism, 10,11 viral hepatitis, 12 Wilson disease, 13 medications, 14 parenteral nutrition (PN) use, 15 alcohol consumption, 16 and pregnancy-related fatty liver.…”

Performance of fibrosis prediction scores in paediatric non‐alcoholic fatty liver disease

“…Screening recommendations for NAFLD in children include measuring serum alanine transaminase (ALT) and aspartate transaminase (AST) levels biannually in overweight and obese children, beginning when they are 10 years of age . There is little guidance for diagnostic workup after the detection of abnormal liver enzyme levels, particularly regarding the optimal timing of a liver biopsy to confirm NAFLD diagnosis . Although liver biopsies are the diagnostic gold standard for NASH and fibrosis, the procedure is risky and costly .…”