Not meeting either exercise or diet recommendations is problematic. Not meeting both is why many developed countries, like the United States, find themselves in the midst of an obesity epidemic. A recent study conducted by researchers from the University of Surrey and the Children’s Liver Disease Foundation has found children suffering for obesity or liver disease in the United Kingdom are not only missing recommendations for physical activity levels, but they also miss recommendations for a variety of vitamins and minerals.

"Rather than make new recommendations for obese children with NAFLD, our findings indicate that concerted efforts should be made to help children improve their current diet and activity patterns to achieve existing population guidelines," said Dr. Bernadette Moore from the University of Surrey in a statement.

Moore and her colleagues from the UK compared the diet and behavior of children who were previously diagnosed with non-alcoholic fatty liver disease (NAFLD) to obese children without liver disease. Children were asked to complete a short questionnaire and were fitted with pedometers, also known as step counters. The current recommended physical activity levels for children is 60 minutes five times a week.

Although children with liver disease were significantly more likely to practice restrained eating and take more steps per day compared to obese children, neither group reached the daily recommendations for physical activity or vitamins and minerals. Both groups were particularly sedentary during the week which highlights how important school-related exercise really is.

"It also appears that the diagnosis of liver disease changes children's behaviors to a degree," Moore added. "Our study showed that children with NAFLD exhibited more restrained eating behaviors and were more likely to engage in exercise than obese children without liver disease."

NAFLD — the most common form of chronic liver disease among children in Western countries — is caused by a build-up of fat in the liver cells. It is often associated with obesity and type 2 diabetes and its prevalence has increased alongside childhood obesity. At least two children are diagnosed with some type of liver disease every day in the UK.

"We have been delighted to fund this study which is the first to compare nutrient intake, eating behaviors, and physical activity of children with NAFLD to obese children who do not have liver disease," said Alison Taylor, chief executive of the Children's Liver Disease Foundation. "The results make interesting reading and take us a step forward in our understanding of this condition."

A similar study published in the Journal of Hepatology revealed that a sedentary lifestyle is also synonymous with NAFLD among middle-aged adults. Out of 140,000 middle-aged Korean adults who had undergone a health examination between March 2011 and December 2013, 40,000 were diagnosed with NAFLD. Adults who spent more time sitting and less time on exercise were significantly more likely to be diagnosed.

Source: Hart K, Gibson P, Moore B, et al. Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study. Nutrients. 2015.