All ETDs from UAB

Advisory Committee Chair

Kevin R Fontaine

Advisory Committee Members

Ambika P Ashraf

Jeffrey A Engler

Amy M Goss

Suzanne E Judd

Gregory Pavela

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder among children in the developed world and can progress to cirrhosis, hepatocellular carcinoma, and liver failure. Objectives: The primary objectives of this dissertation were to (1) review advances in the field of pediatric NAFLD, (2) describe the demographic, anthropometric and metabolic characteristics of children with NAFLD and evaluate whether differences existed based on ethnicity and diagnostic method, and (3) compare the effect of a carbohydrate restricted diet vs fat reduced diet on improvement in hepatic steatosis over an 8-week period among overweight and obese children diagnosed with NAFLD. Methods: To characterize children with NAFLD, a retrospective electronic medical record (EMR) chart review was conducted on a random sample of 309 subjects identified with the condition. Subjects were included in this study if had the following criteria: (1) diagnosis of NAFLD confirmed through radiological testing, needle biopsy, or suspected by a clinician; (2) age at diagnosis < 19 years of age; and (3) seen at a Children’s of Alabama clinic. To evaluate the effects of macronutrient composition on hepatic fat content, a two-arm, parallel design randomized controlled trial was conducted in which 40 participants ages 9 to 18 were randomized to a carbohydrate (CHO) restricted diet (n= 20) or control, fat restricted diet (n=20). This family-based diet intervention included groceries specific to the assigned diet and extensive education on diet implementation through biweekly, diet specific group and individualized counselling sessions led by a registered dietitian. Results: Significant cardiometabolic derangements existed in children with NAFLD that differed in severity based on ethnicity, but not diagnostic method. This retrospective study also found that serum triglyceride and non-high density lipoprotein cholesterol (non-HDL-C) were significantly associated to indicators of liver dysfunction and cardiometabolic variables. Discussion: Cardiometabolic disease is highly prevalent in children with NAFLD and should be managed appropriately. These findings also suggest a potential role of TG and non-HDL-C in the pathophysiology of pediatric NAFLD, and indicate that managing dyslipidemia may curtail the progression of the disease.

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