Changes in body anthropometry and composition in obese adolescents in a lifestyle intervention program

Macronutrients modified dietary intervention in the management of overweight/obese children and adolescents: a systematic review

The prevalence of obesity in adults and children is rapidly increasing worldwide. Obesity is among the main causes of chronic diseases and various problems, including economic consequences and they can also be affected by genetic, environmental, psychological, and socioeconomic factors. Dietary modification is a well-known and important factor in weight control, in particular, dietary macronutrient composition, food selection, dietary patterns, and energy restriction can affect weight reduction. Therefore, this systematic review aims to provide basic evidence for identifying the optimal macronutrient composition for managing obesity in Korean children and adolescents. We searched literature through an international database, studies were selected using our eligibility criteria and quality was assessed via a risk of bias tool. In our results, several studies have demonstrated that dietary macronutrient modifications affect body composition and metabolic markers in children and adolescents. In contrast, hypocaloric diets, regardless of macronutrient composition, are reportedly effective for weight loss in obese children. However, these findings were based on intervention studies that examined the association between dietary macronutrient composition and obesity in non-Korean children and adolescents. Therefore, in the future, more intervention studies are needed to elucidate this relationship and evidence between macronutrients and obesity in Korean children and adolescents.

Who benefits most from outpatient lifestyle intervention? An IMI-SOPHIA study on pediatric individuals living with overweight and obesity

OBJECTIVE

The first-line approach for childhood obesity is lifestyle intervention (LI); however, success varies. This study aimed first to identify distinct subgroups of response in children living with overweight and obesity and second to elucidate predictors for subclusters.

METHODS

Based on the obesity patient follow-up registry the APV (Adipositas-Patienten-Verlaufsdokumentation) initiative, a total of 12,453 children and adolescents (median age: 11.5 [IQR: 9.7-13.2] years; BMI z score [BMIz]: 2.06 [IQR: 1.79-2.34]; 52.6% girls) living with overweight/obesity and participating in outpatient LI were studied. Longitudinal k-means clustering was used to identify individual BMIz response curve for up to 2 years after treatment initiation. Multinomial logistic regression was used to elucidate predictors for cluster membership.

RESULTS

A total of 36.3% of children and adolescents experienced "no BMIz loss." The largest subcluster (44.8%) achieved "moderate BMIz loss," with an average delta-BMIz of -0.23 (IQR: -0.33 to -0.14) at study end. A total of 18.9% had a "pronounced BMIz loss" up to -0.61 (IQR: -0.76 to -0.49). Younger age and lower BMIz at LI initiation, larger initial BMIz loss, and less social deprivation were linked with higher likelihood for moderate or pronounced BMIz loss compared with the no BMIz loss cluster (all p < 0.05).

CONCLUSIONS

These results support the importance of patient-tailored intervention and earlier treatment escalation in high-risk individuals who have little chance of success.

Targeted dietary approaches for the management of obesity and severe obesity in children and adolescents: A systematic review and meta-analysis

There is a need for a detailed understanding of effective dietary interventions for children with obesity. This systematic review examined the effectiveness of diets of varying energy content as a component of weight treatment in children and adolescents with obesity, severe obesity and obesity-related comorbidity. A systematic search of six databases, from 2000 to 2021, for intervention studies of targeted dietary treatment for obesity in children aged 2-18 years identified 125 studies. Dietary interventions were grouped according to diet type and energy target. Risk of bias was assessed using the Effective Public Healthcare Panacea Project assessment tool. Meta-analysis examined change in body mass index (BMI) at intervention end. A broad array of diet types were effective at reducing BMI in children with obesity. When dietary types were considered by energy target, a gradient effect was observed. Very-low energy diets were most effective with a - 4.40 kg/m² (n = 3; 95% CI -7.01 to -1.79). While dietary interventions with no specified energy target were ineffective, resulting in a BMI gain of +0.17 kg/m² (n = 22; 95% CI 0.05 to 0.40). Practical definitions of dietary energy target in the management of obesity and severe obesity are urgently required to ensure treatment seeking children have timely access to efficacious interventions.

Clinical and school-based intervention strategies for youth obesity prevention: A systematic review

Introduction

In the last couple of decades, numerous intervention strategies (ISs) have been formulated in school/community or clinical sectors using physical activity (PA) in order to prevent youth obesity because they have been highly effective in addressing this issue. These two sectors have revealed some interesting information in terms of efficient results and best practice mechanisms, but comparisons between them to learn about their functioning have been rare.

Methods

Therefore, the aim of this systematic review was to analyze and synthesize PA ISs from school/community or clinical domains for the period 2013-2017, in French or English, targeting youths aged 5-19 years old through primary, secondary, and tertiary prevention.

Results

In total, 68 full articles were reserved for data extraction and synthesis and 617 were excluded because they did not meet eligibility criteria (61 of 68 were kept for the final analysis). The results identified a number of differences between the studies of the various IS sectors and also a third type of IS, mixed sector. Mixed ISs (clinical and school-community) have a special advantage because they can benefit from the strengths of both school/community-based and clinical-based ISs. Mixed ISs showed the most promising results. This review also highlighted the differences between sectors and their ISs in terms of intervention teams, prevention objectives, duration, materials, and efficiency.

Conclusion

Future studies should focus on establishing a prevention program in a given geographical area involving all stakeholders with their respective skills/knowledge, in the area of decision-making and in the development of ISs, to ensure that the program is the most efficient and best adapted to its environment.

Children’s Changes in Perceptions and Body Composition Following a Family-Based Fitness Intervention

Physical fitness is associated with decreased weight in children, which helps improve youth obesity rates. Family programs can provide practical approaches to improving physical fitness for children. The purpose of this study was to assess the influence of a family-based fitness intervention on changes in body composition, fitness status, and perceptions of obese children. Families attended exercise and education sessions for 60–90 min once per week for 10 weeks. Participants consisted of 10 children who participated in semi-structured interviews, body composition, and fitness assessments at pre- and posttest. Following the intervention, results showed that children had a significant increase in sit-ups (p = .03, effect size = 0.79), lean mass (p < .001, Cohen’s d = 1.95), and bone mineral content (p < .001, Cohen’s d = 0.46). Using thematic analysis, four main themes emerged from the pre- and postintervention interviews: an increase in after-school and weekend intentional physical fitness, rules regarding sedentary behavior and screen time, more prevalent physical fitness reinforcements, and a shift in perception of exercise. Results from this study indicate a family-based intervention had an influence on children’s appreciation for and engagement in physical fitness, as well as healthy body composition and fitness outcomes.

What change in body mass index is associated with improvement in percentage body fat in childhood obesity? A meta-regression

OBJECTIVE

Using meta-regression this paper sets out the minimum change in body mass index-SD score (BMI-SDS) required to improve adiposity as percentage body fat for children and adolescents with obesity.

DESIGN

Meta-regression.

SETTING

Studies were identified as part of a large-scale systematic review of the following electronic databases: AMED, Embase, MEDLINE via OVID, Web of Science and CENTRAL via Cochrane library.

PARTICIPANTS

Individuals aged 4-19 years with a diagnosis of obesity according to defined BMI thresholds.

INTERVENTIONS

Studies of lifestyle treatment interventions that included dietary, physical activity and/or behavioural components with the objective of reducing obesity were included. Interventions of <2 weeks duration and those that involved surgical and/or pharmacological components (eg, bariatric surgery, drug therapy) were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

To be included in the review, studies had to report baseline and post-intervention BMI-SDS or change measurements (primary outcome measures) plus one or more of the following markers of metabolic health (secondary outcome measures): adiposity measures other than BMI; blood pressure; glucose; inflammation; insulin sensitivity/resistance; lipid profile; liver function. This paper focuses on adiposity measures only. Further papers in this series will report on other outcome measures.

RESULTS

This paper explores the potential impact of BMI-SDS reduction in terms of change in percentage body fat. Thirty-nine studies reporting change in mean percentage body fat were analysed. Meta-regression demonstrated that reduction of at least 0.6 in mean BMI-SDS ensured a mean reduction of percentage body fat mass, in the sense that the associated 95% prediction interval for change in mean percentage body fat was wholly negative.

CONCLUSIONS

Interventions demonstrating reductions of 0.6 BMI-SDS might be termed successful in reducing adiposity, a key purpose of weight management interventions.

TRIAL REGISTRATION NUMBER

CRD42016025317.

A systematic review and meta-analysis of energy and macronutrient intake responses to physical activity interventions in children and adolescents with obesity

BACKGROUND

The effects of regular physical activity on energy intake in obese adolescents are unknown.

OBJECTIVE

The objective is to determine how physical activity interventions affect energy and macronutrient intake in overweight/obese youth.

DATA SOURCES

Databases were searched from December 2014 to December 2015 for studies that measured energy and/or macronutrient consumption in response to physical activity intervention in overweight/obese youth.

DATA SELECTION

The review comprises primary source articles published in English in peer-reviewed journals. Articles that presented data on energy and/or macronutrient intake before and after a physical activity intervention (without dietary restriction) in overweight or obese children and teenagers (up to 18 years old) were included. Of the initial 307 references found, nine were included.

RESULTS

The nine included studies analysed the effect of 15 different physical activity interventions. Nine showed a decrease and six unchanged energy intakes. The effect size for total energy intake ranged from -2.108 to -0.207 (n = 14). Results of the meta-analysis revealed a mean effect of physical intervention to reduce intake of -1.003 (95% confidence interval = -1.261 to -0.745, p < 0.001). Results for heterogeneity among these studies were I²  = 67.421; Q = 39.903; d_f  = 13, p < 0.001. The mean energy intake reduction was -323 ± 286 kcal. Macronutrient intake was assessed in 11 interventions. Protein intake was found decreased in five (reduction of -26.8 ± 19.2 g), seven reported fat decrease (reduction of -26.4 ± 17.8 g) and five a decrease in CHO (reduction of -72.5 ± 22.8 g). The meta-analysis revealed significant decreases of each macronutrient (p < 0.001).

CONCLUSION

Structured physical activity interventions favour decreased daily energy intake in obese adolescents.

Profiles of body mass index and the nutritional status among children and adolescents categorized by waist-to-height ratio cut-offs

BACKGROUND

Waist-to-height ratio (WHtR) is proposed as a simple, valid and convenient measure of abdominal obesity and health risks in practice. The present study examined the distribution of nutritional status among children and adolescents categorized by WHtR cut-offs.

METHODS

A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and WHtR were calculated. The grades of nutritional status (thinness, normal weight, overweight and obesity) was defined by the international BMI cut-offs. All subjects were divided into three groups (low, moderate and high) according to their WHtR, BMI level and the distribution of nutritional status among the three groups were compared.

RESULTS

In both boys and girls, significant differences in BMI level and the nutritional status were observed among the three groups. Children and adolescents aged 7-18years in the 'high WHtR group' (≥0.5) had higher BMI than those in the 'low WHtR group' (<0.4) by 6.00-10.15kg/m² for boys and 5.24-9.51kg/m² for girls. 'low WHtR group' had higher prevalence of thinness, and 'high WHtR group' had higher prevalence of overweight and obesity. The optimal distribution of nutritional status is found in the 'moderate WHtR group' (between 0.4 and 0.5) with the highest proportion of normal weight and low prevalence of thinness and obesity.

CONCLUSION

WHtR is associated with nutritional status, which could be an indicator of nutritional status and early health risk. It is necessary to develop optimal boundary values in the future.

Childhood Risk Factors and Pregnancy-Induced Hypertension: The Bogalusa Heart Study

BACKGROUND

Pregnancy-induced hypertension (PIH) causes increased risk of maternal, fetal, and neonatal morbidity and mortality. Identification of risk factors for PIH in early life is central to the development of prevention strategies.

METHODS

A cohort of 703 women aged 25.5-51.3 years from the Bogalusa Heart Study were included. PIH were defined as self-reported hypertension during pregnancy and a blood pressure level <140/90mm Hg without antihypertensive medication (n = 131) at the subsequent examinations. Body mass index (BMI), systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, and triglycerides measured during childhood (4-17 years) were considered. General linear models were used to examine differences in childhood between those who did and those who did not develop PIH. Logistic regression models were used to estimate odds ratios for PIH associated with childhood risk factors.

RESULTS

Compared to women who did not develop PIH, those who developed PIH had higher BMI (20.2 vs. 19.2kg/m(2), P = 0.0002) and systolic blood pressure (104.1 vs. 103.3mm Hg, P = 0.008) in childhood. After adjustment for other variables, childhood BMI was the only risk factor associated with PIH, with each standard deviation increase in childhood BMI being associated with an odds ratio of 1.35 (95% confidence interval: 1.08-1.68) for PIH. The odds of PIH increased significantly as childhood BMI increased from the bottom quartile to the top quartile (P for trend = 0.006).

CONCLUSIONS

Elevated childhood BMI is a significant risk factor for PIH in adulthood, which underscores the importance of body weight control in childhood for prevention of PIH.

Inter-daily variability in body composition among young men

Background

The present study analyses changes in body composition over the course of a working week. The purpose of the study is to identify the size of the changes in the observed parameters by means of typical error of measurement (TE) as the initial value for the interpretation of the detected changes in the repeated measurement in diagnostic practice.

Methods

The researched group consisted of 86 males, aged 21.4 ± 1.0 years. All the participants were free of any medical conditions. The measurement of each participant took place over 1 week from Monday till Friday, in the morning hours. Parameters measured: body mass (BM), total body water (TBW), and body fat (BF). The measurement employed two devices using the bioelectric impedance analysis. These devices were the analyzers Tanita BC 418 MA and Nutriguard MS. In order to assess the differences between the average values, the analysis of repeated measurements was used. To assess the material significance, eta squared was used. TE was used to express the size of the changes in the observed parameters.

Results

A statistically significant difference between the average values of the observed parameters was only detected when using the Tanita BC 418 MA analyzer. Based on the post-hoc tests, these differences in the average values were always detected on Monday and Friday. No material significance was proved, however. The highest TE values were also detected in measurements carried out on Monday and Friday. For BM, the value of TE was 0.6 kg, for TBW 1.0–1.1 %, 0.8–0.9 kg, and for BF 1.2–1.6 %, 1.1–1.3 kg depending on the analyzer used.

Conclusions

The results of the present study demonstrate the stability of parameters of body composition throughout a working week, with the provision that standard measuring conditions are fulfilled. For the purpose of diagnostic practice, when interpreting the results of the repeated measurements, it is advisable to take as provable change caused by the observed factors only the ones whose values exceed the value of a weekly TE or the upper limit of the interval of the measurement reliability.