Skip to main content

Advertisement

SpringerLink
Log in

Association between alanine aminotransferase as surrogate of fatty liver disease and physical activity and sedentary time in adolescents with obesity

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

To compare patterns of sedentary (SED) time (more sedentary, SED + vs less sedentary, SED-), moderate to vigorous physical activity (MVPA) time (more active, MVPA + vs less active, MVPA-), and combinations of behaviors (SED-/MVPA + , SED-/MVPA-, SED + /MVPA + , SED + /MVPA-) regarding nonalcoholic fatty liver diseases (NAFLD) markers. This cross-sectional study included 134 subjects (13.4 ± 2.2 years, body mass index (BMI) 98.9 ± 0.7 percentile, 48.5% females) who underwent 24-h/7-day accelerometry, anthropometric, and biochemical markers (alanine aminotransferase (ALT) as first criterion, and aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), AST/ALT ratio as secondary criteria). A subgroup of 39 patients underwent magnetic resonance imaging-liver fat content (MRI-LFC). Hepatic health was better in SED- (lower ALT, GGT, and MRI-LFC (p < 0.05), higher AST/ALT (p < 0.01)) vs SED + and in MVPA + (lower ALT (p < 0.05), higher AST/ALT (p < 0.01)) vs MVPA- groups after adjustment for age, gender, and Tanner stages. SED-/MVPA + group had the best hepatic health. SED-/MVPA- group had lower ALT and GGT and higher AST/ALT (p < 0.05) in comparison with SED + /MVPA + group independently of BMI. SED time was positively associated with biochemical (high ALT, low AST/ALT ratio) and imaging (high MRI-LFC) markers independently of MVPA. MVPA time was associated with biochemical markers (low ALT, high AST/ALT) but these associations were no longer significant after adjustment for SED time.

Conclusion: Lower SED time is associated with better hepatic health independently of MVPA. Reducing SED time might be a first step in the management of pediatric obesity NAFLD when increasing MVPA is not possible.

What is Known:

• MVPA and SED times are associated with cardiometabolic risks in youths with obesity.

• The relationships between NAFLD markers and concomitant MVPA and SED times have not been studied in this population.

What is New:

• Low SED time is associated with healthier liver enzyme profiles and LFC independent of MVPA.

• While low SED/high MVPA is the more desirable pattern, low SED/low MVPA pattern would have healthier liver enzyme profile compared with high MVPA/high SED, independent of BMI, suggesting that reducing SED time irrespective of MVPA is needed to optimize liver health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

Data will be made available upon reasonable request.

Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

GGT:

Gamma-glutamyl transpeptidase

HDL-c:

High-density lipoprotein cholesterol

HOMA-IR:

Homeostasis model assessment of insulin-resistance

LDL-c:

Low-density lipoprotein cholesterol

LFC:

Liver fat content

LPA:

Low physical activity

METS:

Metabolic equivalent of the task

MPA:

Moderate physical activity

MRI:

Magnetic resonance imaging

MVPA:

Moderate to vigorous physical activity

NAFLD:

Nonalcoholic fatty liver disease

PA:

Physical activity

SED:

Sedentary

TG:

Triglycerides

VPA:

Vigorous physical activity

WC:

Waist circumference

References

  1. Kansra AR, Lakkunarajah S, Jay MS (2021) Childhood and adolescent obesity: a review. Front Pediatr 8. https://doi.org/10.3389/fped.2020.581461

  2. Shapiro WL, Noon SL, Schwimmer JB (2021) Recent advances in the epidemiology of nonalcoholic fatty liver disease in children. Pediatr Obes e12849. https://doi.org/10.1111/ijpo.12849

  3. Temple JL, Cordero P, Li J et al (2016) A guide to non-alcoholic fatty liver disease in childhood and adolescence. Int J Mol Sci 17:E947. https://doi.org/10.3390/ijms17060947

    Article  CAS  PubMed  Google Scholar 

  4. Schwimmer JB, Pardee PE, Lavine JE et al (2008) Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation 118:277–283. https://doi.org/10.1161/CIRCULATIONAHA.107.739920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. de Boff R, M, Liboni RPA, Batista IP de A, et al (2017) Weight loss interventions for overweight and obese adolescents: a systematic review. Eat Weight Disord 22:211–229. https://doi.org/10.1007/s40519-016-0309-1

    Article  PubMed  Google Scholar 

  6. Albert Pérez E, Mateu Olivares V, Martínez-Espinosa RM et al (2018) New insights about how to make an intervention in children and adolescents with metabolic syndrome: diet, exercise vs. changes in body composition. A systematic review of RCT. Nutrients 10:E878. https://doi.org/10.3390/nu10070878

  7. Vos MB, Abrams SH, Barlow SE et al (2017) NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the expert committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 64:319–334. https://doi.org/10.1097/MPG.0000000000001482

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chaput J-P, Willumsen J, Bull F et al (2020) 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: summary of the evidence. Int J Behav Nutr Phys Act 17:141. https://doi.org/10.1186/s12966-020-01037-z

    Article  PubMed  PubMed Central  Google Scholar 

  9. Li J, Hua S, Chen G-C et al (2020) Objectively measured sedentary time, physical activity and liver enzyme elevations in US Hispanics/Latinos. Liver Int 40:1883–1894. https://doi.org/10.1111/liv.14514

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bowden Davies KA, Sprung VS, Norman JA et al (2019) Physical activity and sedentary time: association with metabolic health and liver fat. Med Sci Sports Exerc 51:1169–1177. https://doi.org/10.1249/MSS.0000000000001901

    Article  PubMed  PubMed Central  Google Scholar 

  11. Long MT, Pedley A, Massaro JM et al (2015) Hepatic steatosis is associated with lower levels of physical activity measured via accelerometry. Obesity (Silver Spring) 23:1259–1266. https://doi.org/10.1002/oby.21058

    Article  Google Scholar 

  12. Henson J, Edwardson CL, Morgan B et al (2015) Associations of sedentary time with fat distribution in a high-risk population. Med Sci Sports Exerc 47:1727–1734. https://doi.org/10.1249/MSS.0000000000000572

    Article  PubMed  Google Scholar 

  13. Henson J, Edwardson CL, Morgan B et al (2018) Sedentary time and MRI-derived measures of adiposity in active versus inactive individuals. Obesity 26:29–36. https://doi.org/10.1002/oby.22034

    Article  PubMed  Google Scholar 

  14. Janssen I, Leblanc AG (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 7:40. https://doi.org/10.1186/1479-5868-7-40

    Article  PubMed  PubMed Central  Google Scholar 

  15. Poitras VJ, Gray CE, Borghese MM et al (2016) Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab 41:S197-239. https://doi.org/10.1139/apnm-2015-0663

    Article  PubMed  Google Scholar 

  16. Renninger M, Hansen BH, Steene-Johannessen J et al (2020) Associations between accelerometry measured physical activity and sedentary time and the metabolic syndrome: a meta-analysis of more than 6000 children and adolescents. Pediatr Obes 15:e12578. https://doi.org/10.1111/ijpo.12578

    Article  PubMed  Google Scholar 

  17. Carson V, Tremblay MS, Chaput J-P, Chastin SFM (2016) Associations between sleep duration, sedentary time, physical activity, and health indicators among Canadian children and youth using compositional analyses. Appl Physiol Nutr Metab 41:S294-302. https://doi.org/10.1139/apnm-2016-0026

    Article  PubMed  Google Scholar 

  18. Ruiz JR, Labayen I, Ortega FB et al (2014) Physical activity, sedentary time, and liver enzymes in adolescents: the HELENA study. Pediatr Res 75:798–802. https://doi.org/10.1038/pr.2014.26

    Article  CAS  PubMed  Google Scholar 

  19. Martins C, Aires L, Júnior IF et al (2015) Physical activity is related to fatty liver marker in obese youth, independently of central obesity or cardiorespiratory fitness. J Sports Sci Med 14:103–109

    PubMed  PubMed Central  Google Scholar 

  20. Medrano M, Arenaza L, Migueles JH et al (2020) Associations of physical activity and fitness with hepatic steatosis, liver enzymes, and insulin resistance in children with overweight/obesity. Pediatr Diabetes 21:565–574. https://doi.org/10.1111/pedi.13011

    Article  CAS  PubMed  Google Scholar 

  21. Norman GJ, Carlson JA, Patrick K et al (2017) Sedentary behavior and cardiometabolic health associations in obese 11–13-year olds. Child Obes 13:425–432. https://doi.org/10.1089/chi.2017.0048

    Article  PubMed  PubMed Central  Google Scholar 

  22. Julian V, Bergsten P, Forslund A et al (2022) Sedentary time has a stronger impact on metabolic health than moderate to vigorous physical activity in adolescents with obesity: a cross-sectional analysis of the Beta-JUDO study. Pediatr Obes. https://doi.org/10.1111/ijpo.12897

    Article  PubMed  Google Scholar 

  23. Julian V, Ciba I, Olsson R et al (2021) Association between metabolic syndrome diagnosis and the physical activity-sedentary profile of adolescents with obesity: a complementary analysis of the Beta-JUDO study. Nutrients 14:60. https://doi.org/10.3390/nu14010060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Koutny F, Stein R, Kiess W et al (2021) Elevated transaminases potentiate the risk for emerging dysglycemia in children with overweight and obesity. Pediatr Obes 16:e12822. https://doi.org/10.1111/ijpo.12822

    Article  PubMed  Google Scholar 

  25. Vajro P, Lenta S, Socha P et al (2012) Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 54:700–713. https://doi.org/10.1097/MPG.0b013e318252a13f

    Article  PubMed  Google Scholar 

  26. Forslund A, Staaf J, Kullberg J et al (2014) Uppsala longitudinal study of childhood obesity: protocol description. Pediatrics 133:e386–e393. https://doi.org/10.1542/peds.2013-2143

    Article  PubMed  Google Scholar 

  27. Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23. https://doi.org/10.1136/adc.45.239.13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Marshall WA, Tanner JM (1969) Variations in pattern of pubertal changes in girls. Arch Dis Child 44:291–303. https://doi.org/10.1136/adc.44.235.291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Henderson M, Rabasa-Lhoret R, Bastard J-P et al (2011) Measuring insulin sensitivity in youth: how do the different indices compare with the gold-standard method? Diabetes Metab 37:72–78. https://doi.org/10.1016/j.diabet.2010.06.008

    Article  CAS  PubMed  Google Scholar 

  30. Staaf J, Labmayr V, Paulmichl K et al (2017) Pancreatic fat is associated with metabolic syndrome and visceral fat but not beta-cell function or body mass index in pediatric obesity. Pancreas 46:358–365. https://doi.org/10.1097/MPA.0000000000000771

    Article  PubMed  Google Scholar 

  31. Chalasani N, Younossi Z, Lavine JE et al (2012) The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol 107:811–826. https://doi.org/10.1038/ajg.2012.128

    Article  PubMed  Google Scholar 

  32. Crouter SE, Bassett DR (2008) A new 2-regression model for the Actical accelerometer. Br J Sports Med 42:217–224. https://doi.org/10.1136/bjsm.2006.033399

    Article  CAS  PubMed  Google Scholar 

  33. Heil DP (2006) Predicting activity energy expenditure using the Actical activity monitor. Res Q Exerc Sport 77:64–80. https://doi.org/10.1080/02701367.2006.10599333

    Article  PubMed  Google Scholar 

  34. Anderson EL, Fraser A, Howe LD et al (2016) Physical activity is prospectively associated with adolescent nonalcoholic fatty liver disease. J Pediatr Gastroenterol Nutr 62:110–117. https://doi.org/10.1097/MPG.0000000000000904

    Article  PubMed  Google Scholar 

  35. Radetti G, Kleon W, Stuefer J, Pittschieler K (2006) Non-alcoholic fatty liver disease in obese children evaluated by magnetic resonance imaging. Acta Paediatr 95:833–837. https://doi.org/10.1080/08035250500449890

    Article  PubMed  Google Scholar 

  36. Kim G, Giannini C, Pierpont B et al (2013) Longitudinal effects of MRI-measured hepatic steatosis on biomarkers of glucose homeostasis and hepatic apoptosis in obese youth. Diabetes Care 36:130–136. https://doi.org/10.2337/dc12-0277

    Article  CAS  PubMed  Google Scholar 

  37. Roman-Viñas B, Chaput J-P, Katzmarzyk PT et al (2016) Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study. Int J Behav Nutr Phys Act 13:123. https://doi.org/10.1186/s12966-016-0449-8

    Article  PubMed  PubMed Central  Google Scholar 

  38. Saunders TJ, Gray CE, Poitras VJ et al (2016) Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Appl Physiol Nutr Metab 41:S283-293. https://doi.org/10.1139/apnm-2015-0626

    Article  PubMed  Google Scholar 

  39. González-Ruíz K, Correa-Bautista JE, Izquierdo M et al (2021) Exercise dose on hepatic fat and cardiovascular health in adolescents with excess of adiposity. Pediatr Obes e12869. https://doi.org/10.1111/ijpo.12869

  40. Jakubec L, Gába A, Dygrýn J et al (2020) Is adherence to the 24-hour movement guidelines associated with a reduced risk of adiposity among children and adolescents? BMC Public Health 20:1119. https://doi.org/10.1186/s12889-020-09213-3

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mann KD, Howe LD, Basterfield L et al (2017) Longitudinal study of the associations between change in sedentary behavior and change in adiposity during childhood and adolescence: Gateshead Millennium Study. Int J Obes (Lond) 41:1042–1047. https://doi.org/10.1038/ijo.2017.69

    Article  CAS  Google Scholar 

  42. Schwarzfischer P, Gruszfeld D, Socha P et al (2018) Longitudinal analysis of physical activity, sedentary behaviour and anthropometric measures from ages 6 to 11 years. Int J Behav Nutr Phys Act 15:126. https://doi.org/10.1186/s12966-018-0756-3

    Article  PubMed  PubMed Central  Google Scholar 

  43. Gába A, Pedišić Ž, Štefelová N et al (2020) Sedentary behavior patterns and adiposity in children: a study based on compositional data analysis. BMC Pediatr 20:147. https://doi.org/10.1186/s12887-020-02036-6

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wijndaele K, White T, Andersen LB et al (2019) Substituting prolonged sedentary time and cardiovascular risk in children and youth: a meta-analysis within the International Children’s Accelerometry database (ICAD). Int J Behav Nutr Phys Act 16:96. https://doi.org/10.1186/s12966-019-0858-6

    Article  PubMed  PubMed Central  Google Scholar 

  45. Grgic J, Dumuid D, Bengoechea EG et al (2018) Health outcomes associated with reallocations of time between sleep, sedentary behaviour, and physical activity: a systematic scoping review of isotemporal substitution studies. Int J Behav Nutr Phys Act 15:69. https://doi.org/10.1186/s12966-018-0691-3

    Article  PubMed  PubMed Central  Google Scholar 

  46. Winters-VAN Eekelen E, DER Velde VAN, JHPM, Boone SC, et al (2021) Objectively measured physical activity and body fatness: associations with total body fat, visceral fat, and liver fat. Med Sci Sports Exerc 53:2309–2317. https://doi.org/10.1249/MSS.0000000000002712

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Labayen I, Ruiz JR, Ortega FB et al (2015) Liver enzymes and clustering cardiometabolic risk factors in European adolescents: the HELENA study. Pediatr Obes 10:361–370. https://doi.org/10.1111/ijpo.273

    Article  CAS  PubMed  Google Scholar 

  48. Borghese MM, Tremblay MS, LeBlanc AG et al (2017) Comparison of ActiGraph GT3X+ and Actical accelerometer data in 9–11-year-old Canadian children. J Sports Sci 35:517–524. https://doi.org/10.1080/02640414.2016.1175653

    Article  CAS  PubMed  Google Scholar 

  49. Migueles JH, Cadenas-Sanchez C, Tudor-Locke C et al (2019) Comparability of published cut-points for the assessment of physical activity: implications for data harmonization. Scand J Med Sci Sports 29:566–574. https://doi.org/10.1111/sms.13356

    Article  PubMed  Google Scholar 

  50. Rosenberger ME, Buman MP, Haskell WL et al (2016) Twenty-four hours of sleep, sedentary behavior, and physical activity with nine wearable devices. Med Sci Sports Exerc 48:457–465. https://doi.org/10.1249/MSS.0000000000000778

    Article  PubMed  PubMed Central  Google Scholar 

  51. Fridolfsson J, Buck C, Hunsberger M et al (2021) High-intensity activity is more strongly associated with metabolic health in children compared to sedentary time: a cross-sectional study of the I.Family cohort. Int J Behav Nutr Phys Act 18:90. https://doi.org/10.1186/s12966-021-01156-1

  52. Tremblay MS, Carson V, Chaput J-P et al (2016) Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab 41:S311-327. https://doi.org/10.1139/apnm-2016-0151

    Article  PubMed  Google Scholar 

  53. Cappuccio FP, Taggart FM, Kandala N-B et al (2008) Meta-analysis of short sleep duration and obesity in children and adults. Sleep 31:619–626. https://doi.org/10.1093/sleep/31.5.619

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research was funded by European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement number 279153 (Beta-JUDO). In addition, support for the study was received from the Regional Research Council in Uppsala-Örebro, Sweden, the Swedish Diabetes Foundation, the Swedish Society for Diabetology, and the Swedish Research Council (2016–01040).

Author information

Authors and Affiliations

  1. Department of Sport Medicine and Functional Explorations, Human Nutrition Research Center (CRNH), University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, INRA, University of Clermont Auvergne, Clermont-Ferrand, Europe, France

    Valérie Julian

  2. Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria

    Valérie Julian, Julian Gomahr, Katharina Maruszczak, Katharina Morwald, Anna Schneider & Daniel Weghuber

  3. Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden

    Peter Bergsten

  4. Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden

    Peter Bergsten, Anders Forslund, Iris Ciba & Marie Dahlbom

  5. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

    Peter Bergsten, Anders Forslund, Iris Ciba, Marie Dahlbom & Roger Olsson

  6. Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), University of Clermont Auvergne, Clermont-Ferrand, France

    Gael Ennequin & David Thivel

  7. Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden

    Hakan Ahlstrom & Joel Kullberg

  8. Antaros Medical AB, BioVenture Hub, 431 53, Mölndal, Sweden

    Hakan Ahlstrom & Joel Kullberg

  9. Department of Pediatrics and Adolescent Medicine, Salzkammergut-Klinikum, Vöcklabruck, Austria

    Dieter Furthner & Thomas Pixner

  10. Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria

    Dieter Furthner, Julian Gomahr, Katharina Maruszczak, Katharina Morwald, Thomas Pixner, Anna Schneider & Daniel Weghuber

  11. Department of Biostatistics, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France

    Bruno Pereira

  12. Department of Sport Science and Kinesiology, Paris Lodron University, Salzburg, Austria

    Suzanne Ring-Dimitriou

Authors
  1. Valérie Julian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Bergsten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gael Ennequin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anders Forslund
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hakan Ahlstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Iris Ciba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marie Dahlbom
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dieter Furthner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Julian Gomahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Joel Kullberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Katharina Maruszczak
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Katharina Morwald
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Roger Olsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Thomas Pixner
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Anna Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Bruno Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Suzanne Ring-Dimitriou
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. David Thivel
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Daniel Weghuber
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Peter Bergsten, Anders Forslund, Hakan Ahlstrom, Iris Ciba, Marie Dahlbom, Dieter Furthner, Julian Gomahr, Joel Kullberg, Katharina Maruszczak, Katharina Morwald, Roger Olsson, Thomas Pixner, Anna Schneider, Bruno Pereira, and Susanne Ring-Dimitriou. The first draft of the manuscript was written by Valérie Julian, David Thivel, and Daniel Weghuber and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Valérie Julian.

Ethics declarations

Ethics approval

The study was accepted for Voluntary Harmonisation Procedure (VHP673, VHP2015061) and approved by Ethics Committees and Regulatory Authorities (EudraCT No: 2015–001628-45; EC Sweden: Dnr 2015/279; EC Austria: 415-E/1544/20–2014).

Consent to participate

Written informed consent was obtained from participants and parents. The trial was conducted according to the Declaration of Helsinki (World Medical Association; Version 2013) and the E6 Guideline for Good Clinical Practice (International Conference on Harmonisation).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 28 KB)

Supplementary file2 (DOCX 15 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Julian, V., Bergsten, P., Ennequin, G. et al. Association between alanine aminotransferase as surrogate of fatty liver disease and physical activity and sedentary time in adolescents with obesity. Eur J Pediatr 181, 3119–3129 (2022). https://doi.org/10.1007/s00431-022-04539-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-022-04539-z

Keywords

Search

Navigation