American Diabetes Association
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The effect of a multicomponent intervention on hepatic steatosis is partially mediated by the reduction of intermuscular abdominal adipose tissue in children with overweight or obesity; the EFIGRO project

posted on 2022-08-31, 00:10 authored by Cristina Cadenas-Sanchez, Fernando Idoate, Rafael Cabeza, Arantxa Villanueva, Beatriz Rodríguez-Vigil, María Medrano, Maddi Osés, Francisco B. Ortega, Jonatan R. Ruiz, Idoia Labayen



In adults, there is evidence that the improvement of metabolic associated fatty liver disease (MAFLD) depends on the reduction of myoesteatosis. In children, where the prevalence of MAFLD is alarming, this muscle-liver crosstalk has not been tested. Therefore, we aimed to explore whether the effects of a multicomponent intervention on hepatic fat were mediated by changes on intermuscular abdominal adipose tissue (IMAAT) in children with overweight/obesity.

Research design and methods

A total of 116 children with overweight/obesity were allocated to a 22-week family-based lifestyle and psychoeducational intervention (control group, N=57), or the same plus supervised exercise (exercise group, N=59). Hepatic fat percentage and IMAAT were acquired by magnetic resonance imaging at baseline and at the end of the intervention. 


Changes in IMAAT explained the 20.7% of the improvements in hepatic steatosis (P<0.05). Only children who meaningfully reduced their IMAAT (i.e., responders), improved hepatic steatosis at the end of the intervention (within-group analysis; responders: -20%, P=0.005 vs. non-responders: -1.5%, P=0.803). Between-group analysis showed greater reductions in favour to the IMAAT responders compared to the non-responders (18.3% vs. 0.6%, P=0.018) regardless of overall abdominal fat loss. 


The reduction of IMAAT has a relevant role over the improvement of hepatic steatosis after a multicomponent intervention in children with overweight/obesity. Indeed, only those children who achieved a meaningful reduction in IMAAT at the end of the intervention reduced their percentage hepatic fat independently of abdominal fat loss. Our findings suggest that abdominal muscle fatty infiltration could be a therapeutic target for the treatment of MAFLD at childhood. 


This project was funded by the Spanish Ministry of Health's Fondos de Investigación Sanitaria del Instituto de Salud Carlos III (PI13/01335), the Spanish Ministry of the Economy Industry and Competitiveness (DEP2016-78377-R), and by European Regional Development Funds (ERDF): Una Manera de Hacer Europa. Support was also provided by the Regional Government of Navarra's Department of Economic Development (0011-1365-2019-000152 & 0011-1365-2020-000243), co-funded by European Regional Development Funds (ERDF 2014-2020 for Navarra). CC-S is supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I). MM is supported by Junta de Andalucía and European Union (SNGJ Ref-8025). MO is supported by the Spanish Ministry of Economy and Competitiveness (BES-2017-080770). This study was supported by the University of Granada Plan Propio de Investigación 2021 -Excellence actions: Unit of Excellence on Exercise, Nutrition and Health (UCEENS)- and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, European Regional Development Funds (ref. SOMM17/6107/UGR).


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