Association of nonalcoholic fatty liver disease with cardiovascular risk factors in obese adolescents: The role of interdisciplinary therapy Priscila L. Sanches, PhD * , Aline de Piano, PhD, Raquel M. S. Campos, MS, June Carnier, PhD, Marco T. de Mello, PhD, Nat  alia Elias, MD, Francisco A. H. Fonseca, MD, Deborah C. L. Masquio, MS, Patr  ıcia L. da Silva, PhD, Flavia C. Corgosinho, MS, Lian Tock, MD, Lila M. Oyama, PhD, Sergio Tufik, MD, Ana R. D ^ amaso, PhD * Post Graduate Program of Nutrition, Universidade Federal de S~ ao Paulo, Rua Marselhesa, 650 – Vila Clementino, S~ ao Paulo 04020–050, Brazil (Drs. Sanches, de Piano, Carnier, de Mello, and D^ amaso and Ms. Campos and Ms. Corgosinho); Psychobiology Department, Universidade Federal de S~ ao Paulo, S~ ao Paulo, Brazil (Drs. de Mello and Tufik); Association Fund of Incentive to Research, S~ ao Paulo, Brazil (Drs. Elias and Tufik); Cardiology Division, Department of Medicine, Universidade Federal de S~ ao Paulo, S~ ao Paulo, Brazil (Dr. Fonseca); Physiology Department, Universidade Federal de S~ ao Paulo, S~ ao Paulo, Brazil (Dr. Oyama); Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de S~ ao Paulo/Santos, S~ ao Paulo, Brazil (Ms. Masquio and Dr. D^ amaso); Biosciences Department, Universidade Federal de S~ ao Paulo, S~ ao Paulo, Brazil (Dr. D^ amaso); Weight Science, Rua Teodoro Sampaio, 744 – Pinheiros, S~ ao Paulo, Brazil (Dr. Tock); and Universidade Federal de Goi as, Goi^ ania, Brazil (Dr. da Silva) KEYWORDS: Cardiovascular risk factors; Interdisciplinary intervention; Non-alcoholic fatty liver disease; Obesity BACKGROUND: Obesity is associated with several cardiovascular risk factors, including nonalcoholic fatty liver disease (NAFLD). These risk factors can induce changes in the arteries such as an increase in the carotid intima-media thickness (cIMT), which contributes to the early development of atherosclerosis. OBJECTIVE: To determine whether NAFLD is associated with an atherogenic lipid profile, inflamma- tory markers, or cIMT in obese adolescents and to compare the effects of therapeutic lifestyle changes in NAFLD and non-NAFLD groups. METHODS: A total of 79 obese adolescents were divided into two groups: 33 NAFLD and 46 non- NAFLD. They were submitted to an interdisciplinary therapy involving diet exercise and psychological support during the course of 1 year. The cIMT and estimates of fat mass (liver, intra-abdominal, and sub- cutaneous) were determined ultrasonographically. Body composition, glucose, lipid profile, and adipokines were analyzed before and after the therapy. RESULTS: At baseline, only in the NAFLD group was the homeostasis model assessment of insulin resistance positively correlated with cIMT and triglyceride/high-density lipoprotein cholesterol ratio. Therapy was associated with an increase in adiponectin concentrations and reduced visceral fat, cIMT, leptin, and plasminogen activator inhibitor-1 concentrations, as well as the ratios of total cholesterol/ * Corresponding authors. E-mail addresses: ana.damaso@unifesp.br; priscilalsanches@gmail.com Submitted September 6, 2013. Accepted for publication February 21, 2014. 1933-2874/$ - see front matter Ó 2014 National Lipid Association. All rights reserved. http://dx.doi.org/10.1016/j.jacl.2014.02.007 Journal of Clinical Lipidology (2014) 8, 265–272