Sonographic fatty liver in overweight and obese children, a cross sectional study in Isfahan.
ABSTRACT Children's obesity is a known health problem in the world and is a strong predictor of obesity in adulthood which increases the incidence of related diseases such as metabolic syndrome. According to the MONIKA project by the World Health Organization (WHO), Iran is one of the seven countries with a high rate of child obesity. Fatty liver is an abnormality related to metabolic syndrome, with higher prevalence in obese children according to some previous studies. This study investigates the presence of Sonographic Fatty Liver (SFL) in Iranian obese children in comparison with normal and overweight children.
This was a cross-sectional study on 962 randomly selected children between the ages of 6 to 18 years. The subjects were divided into three groups of normal, overweight and obese based on body mass index (BMI). A questionnaire including demographic and anthropometric characteristics was filled for each one. To detect the presence of SFL all the subjects underwent assessments with ultrasonography by radiologist who was not aware of their BMI. The incidence of SFL was determined based on the ultrasonographic diagnosis criteria.
The average age of the children in the study was 12.59 +/- 3.25 years. The mean of the liver span in the normal, overweight and obese groups were 111.36 +/- 18.73, 121.18 +/- 16.63 and 118.21 +/- 19.15 respectively. The prevalence of SFL in obese children was 54.4%, which was significantly higher than overweight (10.5%) and normal ones (1%). According to present results, there was no significant difference in prevalence of SFL between sexes.
The high rate of detected SFL in obese children in this study suggests that Iranian obese children are at risk of metabolic syndrome. Moreover, the WHO indicated Iran as one of the countries with high rate of obese children. Based on this information, we can conclude that the prevalence of metabolic syndrome and its related non-communicable diseases will be increasing future in . Therefore, it is necessary to develop some plan to control overweight problem including teaching healthy lifestyle in schools and kindergartens as well as mass media.
- SourceAvailable from: Forough Saki[Show abstract] [Hide abstract]
ABSTRACT: Obesity is a global epidemic and its morbidities such as metabolic syndrome, insulin resistance, and fatty liver leads to a spectrum of psycho-social and medical consequences.Iranian Red Crescent medical journal. 05/2014; 16(5):e6656.
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ABSTRACT: Predictors of quantitative evaluation of hepatic steatosis and liver fat content (LFC) using clinical and laboratory variables available in the general practice in the obese children are poorly identified.Pediatric Obesity 06/2014; · 2.42 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is rapidly increasing in the Asia-Pacific and affects up to 30 % of the general population. In younger children, prevalence has been reported to be between 2.1 and 4.5 %. The prevalence of NAFLD increases with increasing age. NAFLD is more prevalent in men than women, but this trend fades in older age group. NAFLD is one of the most common causes of raised serum ALT levels and the latter is closely related to the presence of features of metabolic syndrome. NAFLD may contribute to metabolic syndrome in a similar way as visceral adiposity and can be an early predictor of metabolic disorders. NAFLD increases the risk of developing diabetes mellitus and is closely related to degree of glucose intolerance. A significant proportion of patients with NAFLD have impaired glucose tolerance or diabetes mellitus but with normal fasting blood glucose, highlighting the importance of oral glucose tolerance test in NAFLD patients with normal fasting blood glucose. Besides liver-related complications, NAFLD has been associated with cardiovascular complications, hyperuricemia, gout, chronic kidney disease, gallstone disease, colorectal adenomatous polyp, and polycystic ovarian syndrome. NAFLD seems to be related to host metabolic factors rather than viral factors and does not seem to affect severity of the liver disease in patients with chronic hepatitis B. On the other hand, hepatic steatosis may be related to both host metabolic and viral factors in patients with chronic hepatitis C and seems to adversely impact on the severity of liver disease and possibly response to antiviral therapy.Hepatology International 03/2012; 7(1). · 2.47 Impact Factor
PRACE ORYGINALNE/ORIGINAL PAPERS
Endokrynologia Polska/Polish Journal of Endocrinology
Tom/Volume 60; Numer/Number 1/2009
Atoosa Adibi M.D., Ph.D., Isfahan University of Medical Scienses Radiology Isfahan, Iran, e-mail: firstname.lastname@example.org
Sonographic fatty liver in overweight and obese children,
a cross sectional study in Isfahan
Ultrasonograficznie rozpoznane stłuszczenie wątroby u dzieci z nadwagą
oraz otyłych — badanie przekrojowe przeprowadzone w Isfahanie
Atoosa Adibi1, Roya Kelishadi2, Abolfazl Beihaghi1, Hamidreza Salehi1, Mohammad Talaei3
1Isfahan University of Medical Scienses Radiology Isfahan, Iran
2Isfahan University of Medical Sciences Cardiovascular Research Center Isfahan, Iran
3Isfahan University of Medical Scienses COX Research Company, Poursina Hakim Institute Isfahan, Iran
Introduction: Children’s obesity is a known health problem in the world and is a strong predictor of obesity in adulthood which increases
the incidence of related diseases such as metabolic syndrome. According to the MONIKA project by the World Health Organization
(WHO), Iran is one of the seven countries with a high rate of child obesity. Fatty liver is an abnormality related to metabolic syndrome,
with higher prevalence in obese children according to some previous studies. This study investigates the presence of Sonographic Fatty
Liver (SFL) in Iranian obese children in comparison with normal and overweight children.
Material and methods: This was a cross-sectional study on 962 randomly selected children between the ages of 6 to 18 years. The subjects
were divided into three groups of normal, overweight and obese based on body mass index (BMI). A questionnaire including demogra-
phic and anthropometric characteristics was filled for each one. To detect the presence of SFL all the subjects underwent assessments with
ultrasonography by radiologist who was not aware of their BMI. The incidence of SFL was determined based on the ultrasonographic
Results: The average age of the children in the study was 12.59 ± 3.25 years. The mean of the liver span in the normal, overweight and
obese groups were 111.36 ± 18.73, 121.18 ± 16.63 and 118.21 ± 19.15 respectively. The prevalence of SFL in obese children was 54.4%,
which was significantly higher than overweight (10.5%) and normal ones (1%). According to present results, there was no significant
difference in prevalence of SFL between sexes.
Conclusions: The high rate of detected SFL in obese children in this study suggests that Iranian obese children are at risk of metabolic
syndrome. Moreover, the WHO indicated Iran as one of the countries with high rate of obese children. Based on this information, we can
conclude that the prevalence of metabolic syndrome and its related non-communicable diseases will be increasing future in . Therefore, it
is necessary to develop some plan to control overweight problem including teaching healthy lifestyle in schools and kindergartens as well
as mass media. (Pol J Endocrinol 2009; 60 (1): 14–19)
Key words: sonography, child, obesity, fatty liver, overweight
Wstęp: Otyłość u dzieci jest znanym na świecie problemem zdrowotnym oraz silnym czynnikiem prognostycznym wystąpienia otyłości
w wieku dorosłym, która zwiększa częstość chorób jej towarzyszących, takich jak zespół metaboliczny. Według projektu Światowej Orga-
nizacji Zdrowia (WHO, World Health Organization) MONIKA Iran jest jednym z siedmiu krajów o dużym odsetku dzieci otyłych. Stłusz-
czenie wątroby jest zaburzeniem towarzyszącym zespołowi metabolicznemu, zgodnie z wynikami niektórych wcześniejszych badań,
często występującym u otyłych dzieci. W niniejszej pracy badano obecność ultrasonograficznie rozpoznanego stłuszczenia wątroby (SFL)
w populacji otyłych dzieci irańskich w porównaniu z grupą dzieci z nadwagą i prawidłową masą ciała.
Materiał i metody: Niniejsze badanie przekrojowe przeprowadzono w grupie 962 losowo wybranych dzieci w wieku 6–18 lat. Badani
zostali podzieleni według wskaźnika masy ciała (BMI) na trzy grupy: o prawidłowej masie ciała, z nadwagą i na grupę dzieci otyłych.
W przypadku każdego uczestnika wypełniano kwestionariusz zawierający charakterystykę demograficzną i antropometryczną. U wszyst-
kich uczestników dla wykrycia SFL wykonywano badanie ultrasonograficzne przeprowadzane przez radiologa, który nie znał BMI bada-
nych. Częstość SFL ustalano na podstawie ultrasonograficznych kryteriów diagnostycznych.
Wyniki: Średni wiek dzieci uczestniczących w badaniu wynosił 12,59 ± 3,25 roku. Średnie wymiary pionowe wątroby wynosiły: 111,36 ±
± 18,73, 121,18 ± 16,63 i 118,21 ± 19,15 mm odpowiednio w grupach dzieci z prawidłową masą ciała, z nadwagą i otyłych. Częstość
występowania SFL u dzieci otyłych wynosiła 54,4%, co było wartością istotnie wyższą w porównaniu z grupą dzieci z nadwagą (10,5%)
i prawidłową masą ciała (1%). Według wyników tego badania nie było znamiennych różnic w częstości występowania SFL między płciami.
Wnioski: Duży odsetek SFL wykrywanego u dzieci otyłych w tym badaniu sugeruje, że irańskie otyłe dzieci obciążone są ryzykiem
wystąpienia zespołu metabolicznego. Co więcej, WHO określa Iran jako jeden z krajów o dużym odsetku dzieci otyłych. Opierając się na
Endokrynologia Polska/Polish Journal of Endocrinology 2009; 60 (1)
Metabolic syndrome, first defined in 1988, is characte-
rized by insulin resistance, hypertension, dyslipidaemia,
type 2 diabetes and other metabolic disorders related
to cardiovascular disease in adults . According to the
criteria of the Third National Health and Nutrition Exa-
mination Survey (NHANES III), about 25% of Ameri-
can adults and 21.9% of Iranian adults have metabolic
syndrome [2, 3]. Children may also have metabolic syn-
drome and studies have shown that overweight chil-
dren are at a higher risk of metabolic syndrome [4–6].
A strong predictor of metabolic syndrome is fatty liver
disease, which is the build-up of fat in the liver cells so
that more than 5% of the liver weight becomes fat .
Most patients with fatty liver have other disorders rela-
ted to the metabolic syndrome, including obesity,
diabetes mellitus, and some forms of hyperlipidaemia
and hypertension . Given the global increase in the
prevalence of overweight and obesity in children, some
studies highlight the possibility of other changes simi-
lar to fatty liver in these children .
Fatty liver is one of the chronic disorders associated
with lipid accumulation in hepatic steatosis. This dise-
ase describes a range of conditions involving the liver.
The mildest type is simple fatty liver (steatosis), but
a potentially serious type is non-alcoholic steatohepatitis
(NASH), which is associated with liver-damaging in-
flammation and, sometimes, the formation of fibrosis.
A more serious type is progressive fibrosis and cirrho-
sis. Simple fatty liver is often a silent disease and only
shows itself occasionally in increasing liver enzymes.
The only visible signs of the disease occur in cirrhosis
or hepatic failure complications .
Today childhood obesity is a global problem .
It is a strong predictor of obesity in adulthood and in-
creases the risk factors for cardiovascular diseases such
as hypertension, diabetes and dyslipidaemia ). Abo-
ut 80% of obese adolescents will grow to obese adults,
and overweight adolescents are at greater risk of serio-
us diseases. The prevalence of overweight and obesity
is increasing worldwide at an alarming rate in both de-
veloping and developed countries [13–14]. Body mass
index (BMI) with its divisions based on percentiles is
normally used to measure obesity in children [15, 16].
According to the MONICA project (monitoring of
cardiovascular diseases) carried out in 1998 by the World
Health Organization (WHO), Iran is one of seven co-
untries with a high prevalence of obesity among chil-
dren . Since the 1990s there has been a rapid incre-
ase in BMI and overweight and obesity have become
prevalent in Iran owing to rapid changes in eating ha-
bits on the one hand and lack of physical exercise on
the other [18, 19]. As a result, between 1993 and 1999
overweight and obesity among Iranian children do-
ubled . This study aimed to investigate the preva-
lence of sonographic fatty liver among overweight ado-
lescent Iranians in comparison with those of normal
Material and methods
This was a cross-sectional study carried out in 2006–2007
in Khorshid Hospital, Isfahan. The subjects were cho-
sen from healthy children aged from 6 to 18 years from
Isfahan schools, who had been randomly selected for
the Isfahan Healthy Heart Program (IHHP), a national
project in the Isfahan Cardiovascular Research Centre.
The children were divided into three groups on the basis
of their BMI: 408 subjects (42.9%) in the normal group
(BMI equal to or lower than the 86th percentile),
314 (33%) in the overweight group (BMI between the
85th and the 94th percentile) and 230 (24.2%) in the obese
group (BMI equal to or higher than the 95th percentile).
The groups were matched according to gender and
The selected students entered the study of their own
will and with their parents’ permission. If a student was
unwilling to participate, he/she was replaced by ano-
ther student fulfilling the same criteria. All the children
were examined by a specialist. Data concerning age,
gender, educational level and history of previous dia-
betes, liver disease and endocrine disorders were col-
lected by means of a questionnaire. Those treated with
chronic medication, those with a history of diabetes or
metabolic diseases and those suffering from mental di-
sabilities, chronic medical diseases, genetic syndromes
or symptoms, symptoms of liver disorders or endocri-
ne diseases were excluded from the study.
The body weight and height of the subjects were
calculated by a Seca scale, and the BMI was calculated
by dividing the weight in kilograms by the square of
the height in metres. Then, on the basis of the BMI per-
centile for the age of the subjects, they were divided
tych informacjach, można wysunąć wniosek, że częstość występowania zespołu metabolicznego i związanych z nim chorób niezakaź-
nych będzie się zwiększać w przyszłości. Dlatego konieczne jest opracowanie określonego planu dla kontroli problemu nadwagi, uwzględ-
niającego nauczanie zdrowego stylu życia w szkołach, przedszkolach i środkach masowego przekazu.
(Endokrynol Pol 2009; 60 (1): 14–19)
Słowa kluczowe: ultrasonografia, dziecko, otyłość, stłuszczenie wątroby, nadwaga
Fatty liver and obesity in children Atoosa Adibi et al.
into three groups: normal, overweight and obese .
All the subjects underwent ultrasound examination by
two radiologists synchronously who knew the purpo-
se of the study but did not know the subjects’ BMI or
the related grouping. An ultrasound multi-frequency
curvilinear 3.5–5 MHZ probe by Siemens Company (So-
noline G50 series, model number 7474922) was used for
the liver ultrasound to check for sonographic fatty liver
(SFL) and other sonographic criteria.
To perform the ultrasound examination the liver’s
superior and inferior contours were found by calcula-
ting the span along the midclavicular line, the distance
being measured by a standard ruler. The liver paren-
chyma was then viewed from subcostal windows in the
RUQ and alongside the axial lines in the coronal area.
The presence of SFL was defined as increased echoge-
nicity of the liver parenchyma to the extent that it was
reported by ultrasound and disturbed the visibility of
the portal vein and liver artery . Then, in deep in-
spiration, the diameter of the portal vein and common
bile duct (CBD) were measured . The data collected
were recorded using Epi Info™ software, and the Stati-
stical Package for the Social Sciences (SPSS) version 15
(SPSS Inc., Chicago, IL, USA) was used to analyze data.
The c² test was used to compare SFL in the three gro-
ups of normal, overweight and obese children. Analy-
sis of variance (ANOVA) was used to compare the ages
of the three groups. Including age as a covariate, analy-
sis of covariance (ANOVA) was used to compare the
groups for liver span, splenic size and portal vein and
common bile duct diameters. Results with P values less
than 0.05 were considered statically significant.
The study was conducted on 952 students of 6 to 18
years old, their mean age being 12.59 ± 3.25 years. The
subjects were divided into three groups on the basis of
their BMI: 408 subjects (42.9%) in the normal group, 314
(33%) in overweight group and 230 (24.2%) in the obe-
se group. The mean value for BMI in the normal group
was 16.84 ± 3.04, in the overweight group 22.94 ± 3.35
and in the obese group 27.04 ± 3.93. The mean age in
the three groups was 12.18 ± 3.44, 13.23 ± 3.09 and 12.45
± 2.98 respectively (P < 0.001). The average age for the
overweight group was higher than for the normal group
(mean difference = 1.04; P < 0.001) and the obese gro-
up (mean difference = 0.77; P = 0.016), but the age va-
riable did not show any significant difference between
the normal and obese groups. Of the 952 subjects 537
were girls (56.4%) and 415 were boys (43.6%), and the-
re was no significant gender difference between the
groups (P = 0.344). The ultrasound showed that 161 of
all the subjects (16.9%) had SFL and the gender varia-
ble showed no significant difference (P = 0.65).
Table I shows the frequency distribution of SFL and
the ultrasound indices of the three groups. The frequ-
ency of SFL increased from the normal group to the
overweight and obese groups. The normal group had
significantly smaller livers than the other two groups,
and the largest livers were found in the overweight gro-
up, although the difference between the overweight
and obese groups was not significant (P = 0.138). The
situation was exactly the same for the splenic span. The
difference in the CBD diameter was significant only
between the normal and obese groups (P = 0.011). Ho-
wever, there was no significant difference between the
groups in portal vein diameter (P = 0.911).
Table II presents a comparison of the age and sono-
graphic indices for fatty liver in the three groups on the
basis of gender. There was no significant difference be-
tween girls and boys regarding age and fatty liver. Ho-
wever, in each group both genders followed the same
pattern as that found in the whole sample. The boys
had significantly larger livers, spleen spans and CBD
diameters than girls, but their portal veins were smaller
in size. The difference between the liver size of boys in
the obese and overweight groups was not significant
Table I. Fatty liver-related indicators in three groups of adolescents: normal, overweight and obese (mean ± SD)
Tabela I. Wskaźniki związane ze stłuszczeniem wątroby w trzech grupach dzieci: z prawidłową masą ciała, z nadwagą
i otyłych (średnia ± SD)
Normal (408)Over weight (314) Obese (230) P value
Fatty liver (%)
Liver span [mm]
Splenic span [mm]
CBD diameter [mm]
Portal vein diameter [mm]
P values are reported between the first and third columns
Endokrynologia Polska/Polish Journal of Endocrinology 2009; 60 (1)
(0.924), but in both the liver was significantly larger than
in the normal group (P < 0.001). The largest liver size in
girls was found in the overweight group (P < 0.001 in
comparison with the normal group and P = 0.004 com-
pared with the obese group), but there was no diffe-
rence in liver size between the obese and normal gro-
ups (P = 0.687). The size of the spleen was significantly
smaller for both genders in the normal group compa-
red to the two other groups (P < 0.001), but there was
no significant difference between the obese and over-
weight groups (P = 0.329 for boys and P = 0.757 for
girls). There was no difference in CBD diameter betwe-
en the boys in the three groups, but this index was signi-
ficantly higher in normal than in overweight (P = 0.023)
and obese girls (P < 0.001). There was no significant
difference in portal vein diameter between the three
Table III sets out the differences in age and measu-
red sonographic indices for girls and boys separately.
The age variable showed no significant difference be-
tween girls and boys in the healthy and fatty liver gro-
ups. Liver span, splenic span and portal vein diameter
were significantly higher in SFL cases than in normal
subjects of either sex, but CBD diameter showed no gen-
der-related difference between the two groups.
The results of the study clearly show that the prevalen-
ce of fatty liver in obese children is higher than in those
Table II. Fatty liver-related indicators according to sex in three groups of adolescents: normal, overweight and obese (mean ± SD)
Tabela II. Wskaźniki związane ze stłuszczeniem wątroby według płci w trzech grupach dzieci: z prawidłową masą ciała,
z nadwagą i otyłych (średnia ± SD)
BMI P value Total
BMI P valueTotal
Age (year) 12.36
Fatty liver (%) < 0.001< 0.001
Liver span [mm]§
Splenic span [mm]§
< 0.001< 0.001
CBD diameter [mm]*
Portal vein diameter*
Between sex P-value: *< 0.01 §< 0.001
Table III. Sonographic indicators in normal and fatty liver groups according to sex (mean ± SD)
Tabela III. Wskaźniki ultrasonograficzne w grupach ze stłuszczeniem wątroby i bez stłuszczenia według płci (średnia ± SD)
Fatty liver (n = 161)Normal (n = 788)
Girl (n = 80)Boy (n = 81)P valueGirl (n = 454)Boy (n = 334)P value
Liver span [mm]§
Splenic span [mm]§
CBD diameter [mm]*
Portal vein diameter*
Between sex P-value: *< 0.01 §< 0.001
Fatty liver and obesity in children Atoosa Adibi et al.
of normal weight. In addition, the results show that the
incidence of fatty liver is not related to gender in this
Fatty liver disease was recognized in the 1970s as
the prevalence of obesity increased among adults, but
it took several decades to determine its prevalence
among children. In 1983 for the first time Moran et al.
reported three 10-year-old obese children with severe
hepatitis and liver fibrosis .
In an epidemiological study in 2002, Schwimmer
et al.  determined the prevalence of paediatric fatty
liver as diagnosed by histology in a population-based
sample of children who had an autopsy performed by
a county medical examiner. The prevalence on autop-
sy of fatty liver in children aged 2 to 19 was 9.6%. On
the assumption that the rate was the same in other sta-
tes, they concluded that probably 6.5 million children
and adolescents in the United States were at risk of fat-
ty liver .
In one study on 84 obese Chinese children ultraso-
und showed that fatty liver was present in 77% of the
subjects. The subjects underwent further examinations
to determine liver transferases. The results of the exa-
minations showed the presence of fatty liver in a total
of 24% of the subjects . The differences between the
reported prevalence of fatty liver and liver disorders in
overweight and obese children are the result of using
different diagnosing methods . In an Italian multi-
centre study on liver damage in paediatric obesity, obese
children were screened for abnormal serum aminotrans-
ferases, which indicated a prevalence of 10–25% .
In another study in Italy sonographic liver steatosis was
present in 42% of the subjects . A review of the stu-
dies shows that the variation in the prevalence of fatty
liver in obese children is related to the diagnosing me-
thodology. The number ranges from 9.6%, on the basis
of autopsy in the United States, to 77%, on the basis of
sonographic indices in China.
The present study is one of the first to evaluate the
prevalence of fatty liver in obese children in Iran. In
this study only sonographic methods were used to dia-
gnose the fatty liver. As shown by the results, the pre-
valence is 57%, which is lower than the result of the
study in China (77%), also obtained by sonography. It
should be mentioned that the mean BMI in that study
was larger than in ours (30.3 vs. 27), which may explain
the difference. Moreover, our sample size was larger,
but the mean age was the same in both studies.
Another considerable variable in the study is gen-
der. In 2005 in a study by Schwimmer et al. on 127 stu-
dents participating in the CATCH project the presence
of fatty liver in boys was significantly higher than in
girls . In the present study, however, there was no
significant difference related to gender in the prevalence
of fatty liver. This difference may be related to the mean
age, which was lower in our study. As the sexual hor-
mones are not present at lower ages this may have led
to the difference in the results.
The results of this study show that an increase in
BMI significantly increases the prevalence of fatty liver
in both boys and girls, and in both genders the preva-
lence of fatty liver was significantly higher in the obese
group than in the overweight and normal groups.
As shown in Table 3, where the gender variable is
taken into account, all three groups, namely those of
normal, overweight and obese children, are compared
in relation to fatty liver indices. The increase in fatty
liver prevalence in both genders, along with the incre-
ase in BMI, has a direct relationship with the increase
in fatty liver indices, including liver and spleen sizes in
both genders and CBD in girls.
The important point is the significant difference be-
tween the three groups in terms of the age variable,
which can predict an increase in the prevalence of obe-
sity as the children grow up. As they mature, not only
do their hormones change but their lifestyle also chan-
ges and may involve leisure activities that tend away
from active behaviour, such as participation in sport, to
a sedentary life style centred on TV and computer ga-
mes. A factor worth consideration, therefore, is lifestyle
education for adolescents and encouragement in acti-
ve leisure activities.
The study results showed the presence of fatty liver
in 17% of the children, which can be a predictor for
a high rate of type 2 diabetes and metabolic syndrome
in adulthood. According to the result, the overall pre-
valence of fatty liver in the overweight and obese gro-
ups was 28.8%. Assuming that this result can be gene-
ralized to the whole country, and in view of the fact
there are 20 million children and adolescents between
the ages of 2 and 18 years, of whom 21% are overwe-
ight or obese, about 1.2 million Iranian children and
adolescents may have fatty liver [31, 32]. In other words,
about 1.2 million Iranian children are at risk of metabo-
lic syndrome and type 2 diabetes and the relation be-
tween these complications and cardiovascular diseases
suggests that the prevalence of the latter will increase
These results and that of the WHO project, which
defined Iranian society as one of seven countries with
a high rate of childhood obesity, suggest that it is es-
sential to make intervention programmes to prevent
obesity a priority in Iran. Since a high BMI is associated
with fatty liver disease, which can progress to fibrosis/
/cirrhosis , weight loss and obesity control should
be health priorities. BMI can be a useful and non-inva-
sive index for screening fatty liver disorders and provi-
ding community-based interventions for control and
Endokrynologia Polska/Polish Journal of Endocrinology 2009; 60 (1)
protection. Kindergartens and schools are convenient
places to establish contact with children and adole-
scents, where preventive intervention for lifestyle chan-
ges, including eating habits and physical exercise, can
be planned and implemented. These interventions can
be included in health programmes or the physical edu-
cation hours of their current curriculum without any
burden of expense on the public. Moreover, the mass
media, particularly television, have a considerable in-
fluence on children and adolescents, and most of their
lifestyle features and habits are promoted by the me-
dia. The production of television programmes aimed at
encouraging children and adolescents to correct their
lifestyle and maintain a normal weight therefore forms
therefore a valuable contribution. The potential expen-
se involved in weight loss and the treatment of compli-
cations of obesity, such as metabolic syndrome, type 2
diabetes and cardiovascular disease, can be brought to
the attention of children and adolescents and their pa-
rents as an encouragement to weight control. Empha-
sis should be placed on frequent measurement of waist
circumference and body weight as obesity indices, to-
gether with monitoring of blood pressure and blood fat.
These measurements will help them to be aware of the
risk and to start treatment in time. It is expected that
education of this kind in schools and kindergartens and
through the mass media will lead to lifestyle improve-
ment and prevent disorders such as fatty liver and non-
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