Obese children frequently show alterations of thyroid structure and function that are not completely explained by the presence of an autoimmune involvement.

Obese children are frequently affected by NAFLD, which cannot be predicted by clinical and/or anthropometrical findings. There is however a strict correlation between the degree of liver fatty infiltration and elevation of liver enzymes.

Aim: To investigate the prevalence of non‐alcoholic fatty liver disease (NAFLD) in a group of obese children (BMI> 97th %) and to establish correlations between the severity of hepatic fatty infiltration, auxological findings and parameters of insulin resistance. Methods: 44 obese children, aged 6–16 years, with a BMI above the 97th centile were selected for analysis. Hepatic fat content was assessed by phase contrast MRI. Demographic data included weight, height, body mass index, body fat mass and waist circumference. Blood tests included fasting blood glucose, fasting insulin and lipid profile. Insulin sensitivity was evaluated with QUICKI. Results: Elevated hepatic fat fraction (FF) was identified in 14 subjects (31.8%; 0.07 SEM). Children with fatty liver (FF > 9%) had higher ALT (P<0.0001), AST (P=0.002) and triglycerides (P=0.008) values compared to the children without NAFLD. All the children showed a decreased insulin sensitivity (P<0.0001), but no difference was found between children with or without NAFLD. The degree of liver fatty infiltration was positively correlated with ALT (P<0.0001), AST (P<0.002) and γGT (P<0.0001), with height (P<0.006) and BMI (P<0.05) but not with estimates of body fat mass or fat distribution. Conclusion: Obese children are frequently affected by NAFLD, which cannot be predicted by clinical and/or anthropometrical findings. There is however a strict correlation between the degree of liver fatty infiltration and elevation of liver enzymes.

ClinicalTrials.gov: NCT00808301.

Background. The challenging treatment of penetrating paediatric Crohn's disease (CD) involves pharmacological and surgical approaches. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapse during the followup. Aim. We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFα. Case Presentation. During a colonoscopy performed on a 9-year-old girl with CD, a perforation occurred in correspondence of a fistula at the colonic splenic flexure. The formation of a collection was then detected (US, enteric-CT), as well as a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. Treatment with Infliximab was also started, and after the third dose a US control showed disappearance of the collection and healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding, and no surgical treatments were needed. Discussion. In pubertal children with penetrating CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel is to be aimed for growth improvement. This approach requires a strictly monitored long-term followup.