Comorbidities: Non alcoholic fatty liver in childhood obesity

Obesity poses increasing challenges to most healthcare systems worldwide (Wang and Lobstein 2006). The growing epidemic of overweight and obesity in childhood and adolescence has raised global concern among experts, as the numbers of affected children and adolescents steadily increased over time. The increase in prevalence of childhood obesity due to obesogenic environmental conditions (i.e., increased consumption of processed food including fructose containing juices and sweets, physical inactivity) results in a risingprevalence of metabolic syndrome (Weiss et al. 2004; Baranowski et al. 2006) and type 2 diabetes in populations other than minority groups (Wiegand et al. 2004; I’Allemandet al.2008). The major diagnostic and therapeutic challenges posed by obesity comorbidities have been a constant focus of the pediatric discourse, since obese children and adolescents present numerous comorbidities. Commonly psychosocial (poor self-esteem, depression, eating disorders), neurological (pseudotumour cerebri), pulmonary (sleep apnoea, exercise intolerance), cardiovascular (dyslipidemia, hypertension), endocrine (type 2 diabetes, precocious puberty, polycystic ovary syndrome in girls, and hypogonadism in boys), musculoskeletal (slipped capital femoral epiphysis, flat feet), renal (glomerulonephritis), and gastrointestinal (gallstones) comorbidities are among those most frequently observed (Ebbeling et al. 2002). The majority of the examples above belong to the subgroup of metabolic comorbidities with the metabolic syndrome as a risk cluster for the development of cardiovascular diseases. This chapter will put an emphasis on the hepatic manifestation of the metabolic syndrome, namely, the Nonalcoholic Fatty Liver Disease.