الفهرس 
Introduction
Chapter I Childhood ObesityOnly 14 pages are availabe for public view
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Abstract
Background: The general prevalence of NAFLD in the child population varies between 2.6% and 10%, but increases up to 80% in obese children. NAFLD is strongly associated with obesity, insulin resistance, hypertension and dyslipidemia and is now regarged as liver manifestation of the metabolic syndrome. However, the use of liver biopsy is clinically limited in children due to its invasiveness. Noninvasive diagnostic methods such as imaging studies, biomarkers of inflammation, oxidative stress, hepatic apoptosis, and hepatic fibrosis, may be useful for overcoming these disadvantages. Objective: was to evaluate: the prevalence of hepatic steatosis and steatohepatitis in obese children in our locality, study the relation between body composition, and % segmental fat by bioimpedance analysis and steatohepatitis, study the relation between insulin resistance and hepatic steatosis and steatohepatitis and study the role of adipocytokine as non-invasive predictors of NAFLD through the relation between its serum level and presence of steatosis and steatohepatitis. Patients and methods: This is an observational cross-sectional study conducted on 60 simple obese children aged between 2-18 years were enrolled in this study. They include 18 males and 42 females. They were selected from patient attending outpatient clinic of Endocrinology Unit of Mansoura University Children’s Hospital (MUCH) during the period between July, 2014 and January, 2016. Patients were subdivided into two groups: a-Forty obese children with non-alcoholic steatohepatitis and b-Twenty obese children without non-alcoholic steatohepatitis. Twenty healthy children of the same age, gender and socioeconomic standard were enrolled in this study as controls. The patients were assessed by measuring their anthropometric measures, performing ultrasound and laboratory investigations, and analyzing body composition (BIA). Liver biopsy was performed for selected cases with grade II and III fatty infiltration. Results: Statistically, It was observed significant increase in anthropometric measures, laboratory parameters and BIA parameters in obese patients with NAFLD in comparison to obese patients without NAFLD and non-obese subjects. It was observed that with increase the degree of steatosis there was significant increase in post prandial blood glucose level, however fasting insulin, HOMA IR and serum vaspin increase also with increase the degree of steatosis but, it was statistically insignificant. in multivariate regression analysis, total fat percentage, leg fat, arm fat percentage and arm free fat mass were good predictors for NAFLD. It was observed significant correlation between HOMA IR and height Z score and trunk/leg fat percentage in patients with grade III fatty infiltration. Conclusion: the present study is the first to use body composition determined by bioimpedance equipment (model TBF-401, Tanita Corporation) along with laboratory factors, anthropometric parameters to evaluate obese patients with NASH, obese patients without NASH and non-obese subjects and correlate it with the degree of steatosis as detected by US. BMI and waist circumference perform well as indices of central adiposity in children and adolescents of both sexes over a wide age range. Our study supports the validity of HOMA-IR index as an adequate tool for determining insulin resistance in obese children. vaspin is not a sensitive indicator of abdominal obesity and insulin resistance.