Hindawi Publishing CorporationJournal of ObesityVolume 2010, Article ID 831901, 6 pagesdoi:10.1155/2010/831901
Long-Term Effects of Metformin and Lifestyle Modification onNonalcoholic Fatty Liver Disease Obese Adolescents
Lian Tock,1 Ana R. Dˆamaso,1, 2 Aline de Piano,1 June Carnier,1 Priscila L. Sanches,1Henrique Manoel Lederman,3 Regina M. Y. Ernandes,4 Marco T ´ulio de Mello,4, 5and S´ergio Tufik4, 5
1 Post Graduate Program of Nutrition, Paulista Medicine School, Federal University of S˜ao Paulo, UNIFESP-EPM,
2 Department of Biosciences, Paulista Medicine School, Federal University of S˜ao Paulo, UNIFESP-EPM, 04020-060 S˜ao Paulo, Brazil3 Imaging Diagnostic, Paulista Medicine School, Federal University of S˜ao Paulo, UNIFESP-EPM, 04020-060 S˜ao Paulo, Brazil4 Association Found of Incentive to Physicobiology, Paulista Medicine School, Federal University of S˜ao Paulo, UNIFESP-EPM,
5 Department of Psychobiology, Paulista Medicine School, Federal University of S˜ao Paulo, UNIFESP-EPM,
Correspondence should be addressed to Lian Tock, firstname.lastname@example.org and Aline de Piano, email@example.com
Received 26 August 2009; Revised 2 December 2009; Accepted 15 December 2009
Copyright 2010 Lian Tock et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
. To assess the long-term effects of metformin in combination with lifestyle intervention and its association betweeninsulin levels and the degree of steatosis at ultrasonography (US) in obese adolescents. Methods
. Thirty-five postpubertal obese boyswere randomized into two groups: one receiving metformin in combination with a multidisciplinary lifestyle intervention versusa placebo group, which also received the same intervention. The visceral, subcutaneous fat and degree of steatosis were measuredby ultrasonography. Fasting blood samples were collected to analyze glucose, insulin, insulin resistance, and aminotransferases.
Repeated ANOVA measures were used to compare changes over time and between groups, and Spearman’s correlations were usedto identify an association between insulin and the degree of steatosis at US. Results
. There was a positive correlation between thedegree of steatosis at US with insulin concentrations and HOMA-IR. Long-term therapy plus metformin significantly reducedbody weight, body mass index, insulin, HOMA-IR, and visceral fat. Conclusions
. Metformin was more effective than the placeboin improving clinical parameters associated with obesity and steatosis.
severe manifestations of NAFLD . It is important to notethat adipose tissue is recently considered endocrine organ
Nonalcoholic Fatty Liver Disease (NAFLD) affects 10% to
strictly related to several comorbidities. The expansion of
39% of the world population, 50% of diabetic patients,
visceral fat is a determinant risk factor for the development
57% to 74% of obese people, and up to 90% of the people
of NAFLD in obese individuals . Moreover, a new study
with morbid obesity. Its prevalence in obese adolescents is
reported that the extent of hepatic inflammation and fibrosis
between 22.5% and 52.8% [1, 2]. When not appropriately
is augmented incrementally with increases in visceral fat.
treated, NAFLD can progress to cirrhosis [1, 2]. Thus,
For each 1% increase in visceral fat, the odds ratios for
treatment of NAFLD is a relevant issue in clinical hepatology,
increasing liver inflammation and fibrosis were 2.4 and 3.5,
and several therapeutic approaches have been tested in
respectively. Visceral fat remained an independent predictor
uncontrolled and controlled pilot studies .
of advanced steatohepatitis and fibrosis even when the
Obesity and type 2 diabetes are considered the most
model controlled for insulin resistance and hepatic steatosis
powerful predisposing risk factors for the development of
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