T he prevalence of childhood overweight and obesity has approximately doubled in Canada, the United States, Europe and Australia over the past 20 years (1-5). In addition to psychological consequences, important health problems related to obesity are increasingly found in children, including essential hypertension, type 2 diabetes mellitus, sleep apnea, degenerative joint disease and chronic renal dysfunction. A less well-recognized association with childhood overweight and obesity is chronic

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... ver disease, known as nonalcoholic fatty liver disease (NAFLD). This disorder was first described in adults in the late 1970s (6) and in children in the mid-1980s (7,8). It involves accumulation of large-droplet fat in hepatocytes, and may evolve to a fibrosing inflammatory liver disorder. NAFLD is predicted to become the most common chronic liver disease in North America, with an estimated prevalence of 20% to 30%