This study evaluated the effect of weight loss on pediatric nonalcoholic fatty liver disease (NAFLD). Subjects included 81 overweight NAFLD patients referred to two pediatric gastroenterologists from 2000 to 2010. Data on subjects were obtained from review of medical charts. The effect of weight loss was assessed at 1–4？months, 5–8？months, 9–12？months, and beyond one year as the change in weight, BMI -score (for age-and-sex), and alanine aminotransferase and the relationship between the change in body weight and BMI -score, and the change in alanine aminotransferase. Subjects were mostly obese (99%), male (86%), and Asian (63%) and had median age of 14.1 (11.2–16.2)？years and alanine aminotransferase of 105 (78–153) U/L at referral. Alanine aminotransferase decreased 32？±？66 ( ), 30？±？65 ( ), 37？±？75 ( ), and 45？±？69 ( ) for subjects with follow-up data at 1–4？months ( ), 5–8？months ( ), 9–12 months ( ), and beyond one year ( ), respectively. During these time periods, neither was body weight (？0.2 to +7.1？kg) or BMI -score (？0.12 to ？0.05) significantly reduced, nor were changes in these variables associated with the change in alanine aminotransferase. These findings suggest that weight and BMI -score may not be sufficient indicators of treatment response in pediatric NAFLD patients. 1. Introduction Nonalcoholic fatty liver disease (NAFLD) is a common complication of pediatric obesity characterized by the inappropriate accumulation of fat in hepatocytes in the absence of other known causes of steatosis [1–3]. Hepatic steatosis is closely related to metabolic syndrome and may contribute to the pathogenesis of other obesity-related conditions [4–7]. Prior investigation of children diagnosed with metabolic syndrome in Hawai’i found that approximately two-thirds had elevated serum alanine aminotransferase (ALT) values suggestive of NAFLD [8]. The majority of children with NAFLD suffer from psychological, physical, and pain-related symptoms, which contribute to a lower physical and psychosocial health, and reduced quality of life [9]. When compared to obese controls, pediatric NAFLD patients were found to have greater depression and influence of body weight on self-esteem [10]. Moreover, hepatic steatosis may be accompanied by inflammation and/or fibrosis, which can progress to liver cirrhosis requiring transplantation [1, 11–13]. Along with this, children with NAFLD were found to have reduced age- and sex-standardized survival free of liver transplantation [13]. Similar to other obesity-related conditions, weight loss is the primary treatment strategy for
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