Physical Activity of Obese Children and Adolescents with the Nonalcoholic Fatty Liver Disease during the Covid-19 Pandemic

ABSTRACT

Introduction: Social isolation due to the COVID-19 pandemic leads to changes in general physical activity in children with nonalcoholic fatty liver disease (NAFLD) which may aggravate the course of the disease and alleviate the efficacy of the treatment. Aims & Methods: The aim of our study was to investigate the physical activity (PA) in children and adolescents with NAFLD during the COVID-19 pandemic and its association with liver fibrosis. 40 obese patients with NAFLD aged from 10 to 17 years (average age was 12.15 +/- 2.51 years) were examined from September-October 2021. Obesity was established by body mass index (BMI) calculation and comparison with the sigma deviations of BMI values according to age and sex. The presence of liver fibrosis and steatosis was evaluated by transient elastography (Fibroscan502touch, France). Children were divided into 4 groups according to transient elastography and BMI 1 group - 13 children with NAFLD and liver fibrosis, 2 group - 13 children with NAFLD without fibrosis, 3 group - 14 obese children without NAFLD and fibrosis. The 4 group (control) consisted of 10 children with normal weight without NAFLD and fibrosis. The assessment of physical activity was conducted with the Physical Activity Questionnaire for older children (PAQ-C) and adolescents (PAQ-A). Result(s) The final summary score of the PA amounted to 2.4+/-0.3 in the 1 group, 2.2+/-0.2 in the 2 group, 2.2+/-0.3 in the 3 group, 2.4+/-0.2 in the 4 group without significant differences between the groups. The level of PA in spare time was the lowest in all groups compared to other types of activity. The highest rate of the PA score was observed in all groups during physical education classes, but the number of children who attended these classes not regularly was 43.9% among whom do not attend physical education classes at all 9.8%, almost never - 2.4%, from time to time - 31.7% of children. Only 26.8% of patients were active at recess while 73.2% of children stood or walked within the classroom or sat down. The level of PA of chil dren right after school increased slightly, also without significant differences between groups, but children with liver fibrosis had the lowest PA level (2.1 +/-0.2). 24.4% of children did not have any PA right after school. Free time at the weekend was not accompanied by an increase in physical activity, on the contrary, the summary score decreased in almost all groups to 1.94 points, and the portion of children without physical activity remains stable (24.4%). According to self-reports children of the 1-3 groups had a lower level of physical activity score compared to children of the control group. Almost 73.2% of interviewed children understood that their level of physical activity was low. The total level of physical activity on each day of the week was the lowest in children with liver fibrosis (1 group). The highest percentage of PA absence was on weekends. The total PA score was negatively correlated with calf circumference (r = -0.582, p = 0.018), self-report PA tended to a negative correlation with the level of alaninaminotransferase (r = - 0.372, p = 0.056). Conclusion(s) Physical activity of obese NAFLD children during the COVID- 19 pandemic is low, especially in spare time, and does not rise at the weekends. The majority of children (73.2%) are inactive at recess as well as self-reported low level of PA. NAFLD children with liver fibrosis have the lowest total level of PA right after school and generally on each day of the week, which may reflect an insufficiency of adaptation.