School Nutrition Program; Prevention of Obesity and Fatty Liver in Children

Nonalcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease in the pediatric population in the last few decades[1,2]. In Western countries, the prevalence of NAFLD is estimated up to 10% of children. In Iran fatty liver was diagnosed by ultrasound in 7.1% of children aged 7-18 years[1]. Increased prevalence of this form of liver disease runs parallel with the dramatic rise in childhood obesity and diabetes mellitus over the past 2 decades. Most of children with NAFLD are low active and obese, and suffer from metabolic impairments (including increased baseline waist circumference, hypertension and high insulin level) and dyslipidemia[3]. There was a strong relationship between NAFLD and the abnormal metabolic variables in children[4]. Higher age, higher fasting insulin, abnormality in total cholesterol, LDL cholesterol and triglycerides is linked with higher risk of NAFLD[1]. Pediatric NAFLD is not a benign condition, and it can be a predictive of cardiovascular disease and diabetes mellitus in adulthood and some times it can progress to severe liver diseases[4]. The mechanisms leading to NAFLD in children is the same as in adults and include genetic background, epigenetics and environmental factors (i.e. high caloric intake, daily consumption of junk food and soft drinks, low level of physical activity, and beyond average weight) all of which concur during development and progression of the disease[5]. Obesity is the circle between the risk factors showing that 70% of NAFLD in pediatric group is associated with obesity[6]. Faghih et al found a tremendous trend toward over-weight and obesity with a 3-fold increase of obesity among adolescent girl students in Ahvaz between 1997 and 2006. The data showed that there was a significant relation between BMI and food habits including number of meals and missing the breakfast. The authors recommend, regarding the harmful ramifications of obesity, to encourage healthy eating patterns and increased physical activity among adolescent girls[7].