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Cao LN, Wang YY, Hou XY, Zheng HD, Wei RZ, Zhao RR, Shen WY, Yang Y, Chu JF, Tian GY, Xiao J, Tian T. New insights on the association of weight loss with the reduction in carotid intima-media thickness among patients with obesity: an updated systematic review and meta-analysis. Public Health 2024; 226:248-254. [PMID: 38091813 DOI: 10.1016/j.puhe.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis, a typical pathologic process underlying cardiovascular diseases (CVDs). It is essential to explore the relationships between weight loss and the reduction of CIMT. STUDY DESIGN This was an updated systematic review and meta-analysis. METHODS A systematic literature search was conducted to collect relevant clinical trials. The pooled results of meta-analyses were assessed by weighted mean difference (WMD) and the corresponding 95 % confidence interval (95% CI). RESULTS Thirty-three articles involving 2273 participants were collected in this meta-analysis. Among all participants with obesity, the pooled mean of weight loss was -23.26 kg (95% CI: -27.71 to -18.81), and the pooled mean change of CIMT was -0.06 mm (95% CI: -0.08 to -0.04). Compared with Non-surgical interventions, Surgical ones could lead to much higher weight loss (Pbetween groups < 0.001). A more significant CIMT reduction was identified among Surgical intervention patients than among Non-surgical intervention participants (Pbetween groups < 0.001). CONCLUSIONS Effective interventions, especially Surgical interventions, could reduce the weight of patients with obesity, followed by the decline of CIMT, which might further disturb atherosclerosis progression and lower CVD risk.
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Affiliation(s)
- L N Cao
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Y Y Wang
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - X Y Hou
- The Center for Disease Control and Prevention of Nantong, Nantong 226007, China
| | - H D Zheng
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - R Z Wei
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - R R Zhao
- The Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou 225202, China
| | - W Y Shen
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Y Yang
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - J F Chu
- The Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou 225202, China
| | - G Y Tian
- The Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou 225202, China.
| | - J Xiao
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China.
| | - T Tian
- The Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong 226019, China.
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Southcombe F, Lin F, Krstic S, Sim KA, Dennis S, Lingam R, Denney-Wilson E. Targeted dietary approaches for the management of obesity and severe obesity in children and adolescents: A systematic review and meta-analysis. Clin Obes 2023; 13:e12564. [PMID: 36394356 DOI: 10.1111/cob.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Faye Southcombe
- Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Fang Lin
- Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Slavica Krstic
- Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kyra A Sim
- Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Dennis
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia
| | - Elizabeth Denney-Wilson
- Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents. Pediatr Exerc Sci 2022:1-12. [PMID: 36150705 DOI: 10.1123/pes.2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents. METHODS Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5-17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies. RESULTS Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality. CONCLUSION While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.
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Lambertucci AC, Lofrano-Prado MC, Lambertucci RH, Botero JP, Dâmaso AR, do Prado WL. Effect of behavioral counseling therapy with or without physical activity on inflammatory markers in adolescents with obesity: a randomized clinical trial. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Strisciuglio T, Izzo R, Barbato E, Di Gioia G, Colaiori I, Fiordelisi A, Morisco C, Bartunek J, Franco D, Ammirati G, Pergola V, Imparato L, Trimarco B, Esposito G, Rapacciuolo A. Insulin Resistance Predicts Severity of Coronary Atherosclerotic Disease in Non-Diabetic Patients. J Clin Med 2020; 9:jcm9072144. [PMID: 32646007 PMCID: PMC7408744 DOI: 10.3390/jcm9072144] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). However, how IR is able to impact the severity of coronary atherosclerosis in non-diabetic patients is unknown. Objectives. We investigated the relation between the IR and the extent and severity of coronary atherosclerosis in non-diabetic patients referred to coronary angiography (CA) Methods: Consecutive patients undergoing to CA for acute coronary syndromes or stable angina were analyzed. The IR was assessed by mean of the homeostasis model assessment of insulin resistance (HOMA-IR) whereas the SYNTAX score (SS) was used as index of the severity of coronary atherosclerosis Results: Overall, 126 patients were included, with a median SS of 12 (IQR 5.25–20.5). Patients were divided in four groups according to the distribution in quartiles of SS (SS1-2-3-4). A significant correlation between HOMA-IR and SS was observed, especially in women. A progressive increase of HOMA-IR was observed in parallel with the increasing severity (from SS1 to SS4) and extension (1-2-3-vessel disease) of coronary atherosclerosis. Multivariable analysis showed that the HOMA-IR was the strongest independent predictor of severe (SS4) and extensive (three-vessel disease) coronary atherosclerosis. Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index is an independent predictor of three-vessel disease at CA. The HOMA index could be useful for risk stratification of CAD even in absence of T2DM.
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Affiliation(s)
- Teresa Strisciuglio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
- Correspondence: ; Tel./Fax.: +39-081-746-2253
| | - Giuseppe Di Gioia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
- Cardiovascular Research Center OLV Hospital, 9300 Aalst, Belgium; (I.C.); (J.B.)
| | - Iginio Colaiori
- Cardiovascular Research Center OLV Hospital, 9300 Aalst, Belgium; (I.C.); (J.B.)
| | - Antonella Fiordelisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Jozef Bartunek
- Cardiovascular Research Center OLV Hospital, 9300 Aalst, Belgium; (I.C.); (J.B.)
| | - Danilo Franco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Giuseppe Ammirati
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Valerio Pergola
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Livio Imparato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (T.S.); (R.I.); (G.D.G.); (A.F.); (C.M.); (D.F.); (G.A.); (V.P.); (L.I.); (B.T.); (G.E.); (A.R.)
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Campos RMDS, Masquio DCL, Corgosinho FC, Caranti DA, Ganen ADP, Tock L, Oyama LM, Dâmaso AR. Effects of magnitude of visceral adipose tissue reduction: Impact on insulin resistance, hyperleptinemia and cardiometabolic risk in adolescents with obesity after long-term weight-loss therapy. Diab Vasc Dis Res 2019; 16:196-206. [PMID: 30688518 DOI: 10.1177/1479164118825343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM To investigate the association between visceral adipose tissue loss and insulin resistance and hyperleptinemia in adolescents with obesity submitted to interdisciplinary weight-loss therapy. METHODS A total of 172 post-pubertal adolescents (body mass index greater than the 95th percentile of the Centers for Disease Control and Prevention reference growth charts) were recruited for the study. The adolescents were assigned to long-term weight-loss therapy. Body composition, visceral and subcutaneous fat, glucose metabolism, lipid profile, hepatic enzymes and leptin concentration were measured. After the therapy, the adolescents were allocated to three different groups according to the tertile of visceral fat reduction. RESULTS Positive effects on body composition were observed in all analysed groups independent of visceral fat reduction. It was found that visceral fat was an independent predictor of insulin resistance in the investigated population. Obese adolescents who lost a higher proportion of visceral adipose tissue (>1.8 cm) demonstrated improved metabolic and inflammatory parameters twice as much than those who presented smaller losses. Positive correlations between visceral fat reduction and glucose metabolism, lipid profile, hepatic enzymes and homeostasis model assessment of insulin resistance index were demonstrated. CONCLUSION The magnitude of the reduction in visceral fat was an independent predictor of insulin resistance, hyperleptinemia and metabolic disorders related to obese adolescents.
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Affiliation(s)
- Raquel Munhoz da Silveira Campos
- 1 Department of Physiotherapy, Therapeutic Resources Laboratory, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
- 5 Department of Biosciences, Universidade Federal de São Paulo (UNIFESP), Santos, Brazil
| | | | | | - Danielle Arisa Caranti
- 4 Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo (UNIFESP), Santos, Brazil
- 5 Department of Biosciences, Universidade Federal de São Paulo (UNIFESP), Santos, Brazil
| | | | | | - Lila Missae Oyama
- 7 Post Graduate Program of Nutrition, Paulista School of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- 8 Department of Physiology, Paulista School of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Raimunda Dâmaso
- 7 Post Graduate Program of Nutrition, Paulista School of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Chen J, Yu H, Chen L, Wu L, Hu B, Bao Y, Jiang L. Effect of Roux-en-Y gastric bypass on carotid intima-media thickness in Chinese obese patients with type 2 diabetes. Surg Obes Relat Dis 2017; 13:1530-1535. [DOI: 10.1016/j.soard.2017.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/29/2016] [Accepted: 01/27/2017] [Indexed: 12/27/2022]
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Szlagatys-Sidorkiewicz A, Brzeziński M, Jankowska A, Metelska P, Słomińska-Frączek M, Socha P. Long-term effects of vitamin D supplementation in vitamin D deficient obese children participating in an integrated weight-loss programme (a double-blind placebo-controlled study) - rationale for the study design. BMC Pediatr 2017; 17:97. [PMID: 28376768 PMCID: PMC5379647 DOI: 10.1186/s12887-017-0851-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/29/2017] [Indexed: 01/28/2023] Open
Abstract
Background Obesity is associated not only with an array of metabolic disorders (e.g. insulin resistance, hiperinsulinemia, impaired tolerance of glucose, lipid disorders) but also skeletal and joint abnormalities. Recently, a pleiotropic role of vitamin D has been emphasized. Obese children frequently present with vitamin D deficiency, and greater fat mass is associated with lower serum concentration of this vitamin. Although some evidence suggests that weight loss may affect vitamin D status, this issue has not been studied extensively thus far. The aim of a double-blind placebo-controlled study is to assess long-term health effects of vitamin D supplementation in vitamin D deficient obese children participating in an integrated weight-loss programme. Methods A randomized double-blind, placebo-controlled trial analysing the effects of vitamin D3 supplementation in overweight or obese vitamin D deficient (<30 ng/ml) children participating in an integrated weight-loss programme. Children are randomized to receive either vitamin D (1200 IU) or placebo for 26 weeks. Primary endpoints include changes in BMI (body mass index), body composition and bone mineral density at the end of the study period, and secondary endpoints – the changes in laboratory parameter reflecting liver and kidney function (transaminases, creatinine) and glucose homeostasis (glucose and insulin levels during oral glucose tolerance test). Discussion The effects of vitamin D supplementation in obese individuals, especially children, subjected to a weight-loss program are still poorly understood. Considering physiological processes associated with puberty and adolescent growth, we speculate that supplementation may enhance weight reduction and prevent bone loss in obese children deficient in this vitamin. Trial registration NCT 02828228; Trial registration date: 8 Jun 2016; Registered in: ClinicalTrials.gov. The trial was registered retrospectively.
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Affiliation(s)
- Agnieszka Szlagatys-Sidorkiewicz
- Department of Paediatrics, Gastroenterology, Hepatology and Nutrition, Medical University of Gdańsk, ul. Nowe Ogrody, 1-6 80-803, Gdańsk, Poland
| | - Michał Brzeziński
- Department of Public Health and Social Medicine, Medical University of Gdansk, Zwycięstwa 42a, 80-210, Gdansk, Poland.
| | - Agnieszka Jankowska
- Department of Paediatrics, Gastroenterology, Hepatology and Nutrition, Medical University of Gdańsk, ul. Nowe Ogrody, 1-6 80-803, Gdańsk, Poland
| | - Paulina Metelska
- "6-10-14 for Health" University Clinical Centre, Dębinki 7, 80-210, Gdansk, Poland
| | | | - Piotr Socha
- Department of Gastroenterology, Hepatology and Feeding Disorders, The Children's Memorial Health Institute, Dzieci Polskich 20, 00-999, Warsaw, Poland
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MENDES AA, IEKER ASD, CASTRO TFD, AVELAR A, NARDO JÚNIOR N. Multidisciplinary programs for obesity treatment in Brazil: A systematic review. REV NUTR 2016. [DOI: 10.1590/1678-98652016000600011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT This study aimed to conduct a systematic review of publications addressing the multidisciplinary treatment of obesity in Brazil and analyze their main results. A search was conducted in the databases SciELO, Lilacs, and Pubmed/Medline using the following search terms: 'obesidade', 'intervenção', 'tratamento', 'Brasil', for the search in Portuguese, and 'obesity', 'intervention', 'treatment', 'Brazil', for the search in English. Based on these terms, the following combination of words was used: 'Intervenção multiprofissional da obesidade', 'tratamento multidisciplinar da obesidade, tratamento multiprofissional da obesidade' and 'multidisciplinary obesity intervention', 'multidisciplinary obesity treatment', 'Multiprofessional obesity treatment'. Inclusion criteria were as follows: original studies carried out in Brazil involving human beings and that reported an intervention including two or more health care professionals. Articles published between January 2005 and July 2015 were analyzed independently by two reviewers. At the end of the analysis, out of 355 articles initially selected, 26 met all inclusion criteria. The following results were found: 23 studies involved children and adolescents and 03 involved adults 20-60 years of age. It was also found that the 26 studies analyzed had an impact on anthropometric parameters, 10 on physical fitness parameters, 16 on biochemical parameters, 10 on the reduction in comorbidities, 6 on nutritional parameters, and 4 on the psychological/social aspects. Based on evidence presented in the studies reviewed, it can be said that the multidisciplinary treatment for obesity greatly contributed to the reduction in the anthropometric indicators, especially BMI and the biochemical, social, and psychological parameters. Thus, these findings demonstrate that there is a need to expand the range of this type of treatment since it has proven to be effective in the fight against obesity and its comorbidities.
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Shah AS, Dabelea D, Fino NF, Dolan LM, Wadwa RP, D'Agostino R, Hamman R, Marcovina S, Daniels SR, Urbina EM. Predictors of Increased Carotid Intima-Media Thickness in Youth With Type 1 Diabetes: The SEARCH CVD Study. Diabetes Care 2016; 39:418-25. [PMID: 26721813 PMCID: PMC4764035 DOI: 10.2337/dc15-1963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/03/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Youth with type 1 diabetes have worse cardiovascular (CV) risk factors and higher carotid intima-media thickness (IMT) than their peers without diabetes. Whether the burden of CV risk factors over time is associated with carotid IMT at follow-up in youth with type 1 diabetes is not known. RESEARCH DESIGN AND METHODS Two hundred ninety-eight youth with type 1 diabetes (mean age 13.3 ± 2.9 years, 87.6% non-Hispanic white, 53.7% male) had two study visits 5 years apart. CV risk factors, including BMI, lipids, blood pressure, hemoglobin A(1c), and smoking status, were assessed at both visits, and carotid IMT was measured at follow-up using B-mode ultrasonography. Linear regression models with an area under the curve measurement that incorporated the baseline and follow-up CV risk factors were used to evaluate the relationship with carotid IMT at follow-up. RESULTS All CV risk factors worsened significantly over time (except LDL cholesterol) (P < 0.05). From baseline to follow-up, the number of abnormal CV risk factors also increased (P < 0.05). Predictors of carotid IMT were older age, male sex, and higher BMI z score area under the curve (all P < 0.05). CONCLUSIONS The CV risk factor burden increases over time in youth with type 1 diabetes. BMI z score was the only modifiable CV risk factor that predicted carotid IMT. This study highlights the critical need to better understand the risk factors that influence carotid IMT early in the course of type 1 diabetes.
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Affiliation(s)
- Amy S Shah
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Lawrence M Dolan
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - R Paul Wadwa
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Richard Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Elaine M Urbina
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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Masquio DCL, de Piano A, Campos RMS, Sanches PL, Carnier J, Corgosinho FC, Netto BDM, Carvalho-Ferreira JP, Oyama LM, Oller do Nascimento CM, Tock L, de Mello MT, Tufik S, Dâmaso AR. Reduction in saturated fat intake improves cardiovascular risks in obese adolescents during interdisciplinary therapy. Int J Clin Pract 2015; 69:560-70. [PMID: 25296762 DOI: 10.1111/ijcp.12573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES Obesity is related to inflammation and cardiovascular disease. The increase in saturated fatty acid intake (SFA) can potentiate cardiovascular risks. The aim of this study was to assess the influence of change in SFA on carotid intima-media thickness (cIMT), metabolic profile and anti/pro-inflammatory adipokines in obese adolescents. METHODS Sixty obese adolescents were subjected to 1 year of interdisciplinary intervention (nutrition, psychology, physical exercise and clinical therapy). Blood glucose, insulin, lipid profile, leptin and adiponectin were analysed. Insulin resistance was estimated by HOMA-IR and HOMA-AD. cIMT was measured by ultrasonography. Dietetic intake was calculated by 3-day dietary record. Volunteers were analysed according to tertiles of change (Δ) in SFA intake: Low-SFA reduction<3.68 g; Moderate-SFA reduction 3.68-13.67 g; and High-SFA reduction>13.67 g. RESULTS Moderate and High-SFA tertiles presented reduction in insulin, leptin/adiponectin ratio, cIMT and increase in adiponectin and adiponectin/leptin ratio. Adiponectin/leptin ratio was predictor of cIMT. HOMA-IR, total cholesterol and LDL-cholesterol reduced only in High-SFA tertile, and was associated with SFA independent of visceral fat. Negative correlations between Δ of SFA and adiponectin and adiponectin/leptin ratio were observed. CONCLUSION Obese adolescents with moderate and high reduction in SFA presented improvements on pro/anti-inflammatory biomarkers and cIMT, leading to reduction in cardiovascular risks.
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Affiliation(s)
- D C L Masquio
- Post-Graduate Program of Nutrition, Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brasil
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The role of multicomponent therapy in the metabolic syndrome, inflammation and cardiovascular risk in obese adolescents. Br J Nutr 2015; 113:1920-30. [DOI: 10.1017/s0007114515001129] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is characterised by low-grade inflammation, which increases the metabolic syndrome (MetS) and cardiovascular risks. The aim of the present study was to verify the role of multicomponent therapy in controlling the MetS, inflammation and carotid intima-media thickness (cIMT) in obese adolescents. The second aim was to investigate the relationships between adipokines, the MetS parameters and cIMT. A total of sixty-nine obese adolescents participated in the present study and completed 1 year of multicomponent therapy (a combination of strategies involving nutrition, psychology, physical exercise and clinical therapy), and were divided according to their MetS diagnosis as follows: MetS (n 19); non-MetS (n 50). Blood analyses of glucose, lipid and adipokine concentrations (adiponectin, leptin, plasminogen activator inhibitor 1 (PAI-1) and C-reactive protein) were collected. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index and homeostasis model assessment-adiponectin. cIMT and visceral and subcutaneous fat were estimated using ultrasonography. At baseline, the MetS group presented higher waist circumference, glucose and insulin levels, and systolic and median blood pressures compared with the non-MetS group. After therapy, both groups showed improvements in the anthropometric profile, body composition, insulin level, insulin resistance, insulin sensibility, TAG and VLDL-cholesterol, adiponectin, leptin and PAI-1 levels, blood pressure and cIMT. The prevalence of the MetS was reduced from 27·5 to 13·0 %. Metabolic syndrome patients showed resistance in the attenuation of total cholesterol and LDL-cholesterol (LDL-C) levels and leptin:adiponectin and adiponectin:leptin ratios. In the MetS group, the variation in the adiponectin:leptin ratio was correlated with variations in glucose, insulin sensibility, total cholesterol, LDL-c and systolic blood pressure. Additionally, the number of MetS parameters was correlated with the carotid measurement. Moreover, the variation in cIMT was correlated with the variations in insulin sensibility, total cholesterol and LDL-c. For the entire group, the number of MetS alterations was correlated with the leptin level and leptin:adiponectin ratio and adiponectin:leptin ratio after therapy. In conclusion, multicomponent therapy was effective in controlling the MetS, inflammation and cIMT in the obese adolescents. However, the MetS patients showed resistance in the attenuation of the atherogenic lipid profile and leptin:adiponectin ratio and adiponectin:leptin ratio. These results suggest that the MetS patients have increased cardiovascular risks, and that it is important to attempt to control the inflammatory process that occurs due to obesity in clinical practice in order to improve the health of adolescents.
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Sanches PL, de Mello MT, Elias N, Fonseca FAH, Campos RMS, Carnier J, de Piano A, Masquio DCL, Silva PL, Oyama LM, Corgosinho FC, Nascimento CMO, Tock L, D'Elia CA, Tufik S, Dâmaso AR. Hyperleptinemia: implications on the inflammatory state and vascular protection in obese adolescents submitted to an interdisciplinary therapy. Inflammation 2014; 37:35-43. [PMID: 23928876 DOI: 10.1007/s10753-013-9709-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The low-grade systemic inflammation seen in obesity may affect the actions of some adipose tissue-derived adipokines that are involved in the regulation of vascular function. We sought to verify whether hyperleptinemia may influence the inflammatory and atherogenic responses in obese adolescents undergoing interdisciplinary therapy. Thirty-four obese adolescents underwent interdisciplinary therapy for 1 year. Subjects were considered hyperleptinemic if they had baseline values of leptin above 20 ng/mL for boys and 24 ng/mL for girls. Both groups showed an improvement in body composition and a reduction in carotid intima-media thickness. However, only subjects in the non-hyperleptinemic group showed an increase in adiponectin concentration after therapy. Moreover, leptin concentration was positively correlated with adiponectin and inversely correlated with PAI-1 in this group. Hyperleptinemic state may impair the attenuation of inflammation in obese adolescents undergoing interdisciplinary therapy, particularly by impeding the increase in adiponectin concentration, which is directly involved in vascular protection.
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Affiliation(s)
- Priscila L Sanches
- Post-graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil
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Mihai BM, Petriş AO, Ungureanu DA, Lăcătuşu CM. Insulin resistance and adipokine levels correlate with early atherosclerosis - a study in prediabetic patients. Open Med (Wars) 2014; 10:14-24. [PMID: 28352672 PMCID: PMC5152953 DOI: 10.1515/med-2015-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/21/2014] [Indexed: 11/22/2022] Open
Abstract
Cardiovascular risk of prediabetes is still subject to controversies. We analyzed the associations between insulin resistance, adipokines and incipient atherosclerosis estimated by intima-media thickness (IMT) in a cross-sectional study on 122 prediabetic subjects without clinical signs of atherosclerotic disease. Homeostasis model assessment of insulin resistance (HOMA-IR, calculated as fasting insulin × fasting plasma glucose / 22.5), adiponectin, leptin, leptin-to-adiponectin ratio, carotid and femoral IMT were evaluated. We also assessed other parameters related to insulin resistance and adipokines (HbA1c, anthropometric and lipid parameters), as they may also influence atherosclerosis. Carotid IMT was correlated to adiponectin and leptin-to-adiponectin ratio (all p < 0.05), but not with HOMA-IR or leptin, while femoral IMT showed no relationship with these factors. After adjusting for leptin, leptin-to-adiponectin ratio, triglycerides, HDL-cholesterol, cholesterol-to-HDL ratio, triglycerides-to-HDL ratio and HbA1c, IMT values became correlated with HOMA-IR. Adjustment for HOMA-IR induced the appearance of new correlations between adipokines and both IMT values. In conclusion, insulin resistance and adipokines seem related to IMT in prediabetic subjects without clinical signs of arterial obstruction.
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Affiliation(s)
- Bogdan Mircea Mihai
- Discipline of Diabetes, Nutrition and Metabolic Diseases, First Medical Department, University of Medicine and Pharmacy "Grigore T. Popa", 16th Universităţii Street, 700115, Iaşi, Romania
| | - Antoniu Octavian Petriş
- Discipline of Internal Medicine and Cardiology, First Medical Department, University of Medicine and Pharmacy "Grigore T. Popa", 16th Universităţii Street, 700115, Iaşi, Romania
| | - Didona Anca Ungureanu
- Discipline of Biochemistry, Morpho-Functional Sciences Department, University of Medicine and Pharmacy "Grigore T. Popa", 16th Universităţii Street, 700115, Iaşi, Romania
| | - Cristina Mihaela Lăcătuşu
- Discipline of Diabetes, Nutrition and Metabolic Diseases, First Medical Department, University of Medicine and Pharmacy "Grigore T. Popa", 16th Universităţii Street, 700115, Iaşi, Romania
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Sanches PL, de Piano A, Campos RM, Carnier J, de Mello MT, Elias N, Fonseca FA, Masquio DC, da Silva PL, Corgosinho FC, Tock L, Oyama LM, Tufik S, Dâmaso AR. Association of nonalcoholic fatty liver disease with cardiovascular risk factors in obese adolescents: The role of interdisciplinary therapy. J Clin Lipidol 2014; 8:265-72. [DOI: 10.1016/j.jacl.2014.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 12/11/2022]
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Dâmaso AR, da Silveira Campos RM, Caranti DA, de Piano A, Fisberg M, Foschini D, de Lima Sanches P, Tock L, Lederman HM, Tufik S, de Mello MT. Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents. J Sports Sci 2014; 32:1435-45. [PMID: 24730354 DOI: 10.1080/02640414.2014.900692] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to determine whether aerobic plus resistance training (AT + RT) is more effective than aerobic training (AT) at reducing inflammatory markers and cardiovascular risk in obese adolescents. A total of 139 obese adolescents were enrolled, aged 15-19 years, body mass index (BMI) ≥ 95th percentile and participated in 1 year of interdisciplinary intervention. They were randomised into two groups: AT (n = 55), AT + RT (n = 61). Blood samples were collected to analyse glycaemia, insulin, the lipid profile, leptin and adiponectin concentrations. Insulin resistance was measured by homeostasis model assessment of insulin resistance index (HOMA-IR). The AT + RT group showed better results with regard to decreased body fat mass, low-density lipoprotein concentration (LDL-c) levels, subcutaneous and visceral fat and increased body lean mass. Indeed, a reduction of hyperleptinaemia and an increase in adiponectin concentrations, promoting an improvement in the leptin/adiponectin ratio, was observed. Important clinical parameters were improved in both types of exercise; however, AT + RT was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than AT alone, suggesting clinical applications for the control of intra-abdominal obesity and cardiovascular risk in the paediatric population.
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Affiliation(s)
- Ana Raimunda Dâmaso
- a Post Graduate Program of Nutrition , Universidade Federal de São Paulo , São Paulo , Brazil
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Masquio DCL, de Piano A, Sanches PL, Corgosinho FC, Campos RMS, Carnier J, da Silva PL, Caranti DA, Tock L, Oyama LM, Oller do Nascimento CM, de Mello MT, Tufik S, Dâmaso AR. The effect of weight loss magnitude on pro-/anti-inflammatory adipokines and carotid intima-media thickness in obese adolescents engaged in interdisciplinary weight loss therapy. Clin Endocrinol (Oxf) 2013; 79:55-64. [PMID: 22809141 DOI: 10.1111/j.1365-2265.2012.04504.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/28/2012] [Accepted: 07/13/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity is a chronic disease defined by an excess amount of adipose tissue and presents a low-grade inflammatory state, increasing cardiovascular risk. OBJECTIVE To assess the effect of weight loss magnitude on the inflammatory profile and carotid intima-media thickness (cIMT) in obese adolescents engaged in interdisciplinary therapy. DESIGN AND PATIENTS Seventy-seven postpubertal obese adolescents with a BMI greater than the 95th percentile (37·18 ± 5·14), of both genders and between the ages of 14 and 19 years (16·74 ± 1·59) were subjected to a 1-year period of interdisciplinary intervention (nutrition, psychology, physical exercise and clinical support). MEASUREMENTS Blood samples were collected to analyse glucose, lipid and adipokine concentrations. Body composition, anthropometric profiles and cIMT were measured. The results are presented according to quartiles of weight loss: 1st (≤5·80 kg) = low; 2nd (5·80-10·90 kg) = low to moderate; 3rd (10·90-15·90 kg) = moderate; and 4th (>15·90 kg) = massive. RESULTS Leptin, the leptin/adiponectin ratio and plasminogen activator inhibitor 1 (PAI-1) were decreased significantly in the low-to-moderate weight loss. The cIMT was reduced in the moderate weight loss. Moreover, adiponectin was increased only in the massive weight loss. Additionally, weight loss was an independent predictor of changes in leptin level, the adiponectin/leptin ratio (A/L ratio) and PAI-1 when the data were adjusted for age and gender. BMI changes were predictors of changes in leptin and PAI-1 levels. A/L ratio was associated with lean body mass (%), independent of gender and age. In addition, changes in A/L ratio were independent predictors of cIMT alterations. CONCLUSIONS Interdisciplinary therapy may reduce cardiovascular risk factors among adolescents depending on their degree of weight loss (moderate to massive) and when correlated with their inflammatory profile, metabolic state and cIMT.
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Affiliation(s)
- Deborah C L Masquio
- Post-Graduate Program of Nutrition, Universidade Federal de São Paulo, SP, Brazil.
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18
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Jamar G, Pisani LP, Oyama LM, Belote C, Masquio DCL, Furuya VA, Carvalho-Ferreira JP, Andrade-Silva SG, Dâmaso AR, Caranti DA. Is the neck circumference an emergent predictor for inflammatory status in obese adults? Int J Clin Pract 2013; 67:217-24. [PMID: 23409690 DOI: 10.1111/ijcp.12041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Plasminogen Activator Inhibitor 1 (PAI-1) is a prothrombotic adipokine involved in the coagulation cascade and fibrinolysis that associated with proinflammatory adipokines may increase the risk related to obesity. Anthropometric measures are commonly used in clinical practice and, currently, neck circumference (NC) has been used as a marker of cardiovascular risk that can favour inflammatory factors. OBJECTIVE To verify the possible correlations between prothrombotic and pro/anti-inflammatory markers with anthropometric measurements in obese. SUBJECTS AND METHODS A total of 43 obese adults were enrolled. The variables include body mass, stature, body mass index (BMI), NC, chest circumference (CC), abdominal circumference (AC), hip circumference (HC), blood pressure and blood collection used to assess the level of adipokines. RESULTS The sample was stratified by BMI. PAI-1 levels were positively correlated with body mass (r=0.31, p=0.04), NC (r=0.43, p=0.004), CC (r=0.40, p=0.004), AC (r=0.37, p=0.01), diastolic blood pressure (r=0.35, p=0.03), leptin/adiponectin ratio (r=0.36, p=0.01) and negatively correlated with adiponectin (r=-0.34, p=0.02). In stepwise multiple linear regression analysis, NC showed to be an independent predictor to PAI-1 when adjusted for gender and BMI, according to the age (β=0.47, p=0.02 and β=0.42, p=0.02 respectively). CONCLUSION In conclusion, NC could be suggested as an independent predictor higher PAI-1. This association can be a new screening of persons at an enhanced cardiovascular risk and inflammation in this obese population, so useful in clinical practice.
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Affiliation(s)
- G Jamar
- Post Graduate Program of Interdisciplinary Health Sciences, Federal University of São Paulo - UNIFESP - Santos (SP), Brazil.
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Estadella D, da Penha Oller do Nascimento CM, Oyama LM, Ribeiro EB, Dâmaso AR, de Piano A. Lipotoxicity: effects of dietary saturated and transfatty acids. Mediators Inflamm 2013; 2013:137579. [PMID: 23509418 PMCID: PMC3572653 DOI: 10.1155/2013/137579] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/19/2012] [Accepted: 12/19/2012] [Indexed: 01/18/2023] Open
Abstract
The ingestion of excessive amounts of saturated fatty acids (SFAs) and transfatty acids (TFAs) is considered to be a risk factor for cardiovascular diseases, insulin resistance, dyslipidemia, and obesity. The focus of this paper was to elucidate the influence of dietary SFA and TFA intake on the promotion of lipotoxicity to the liver and cardiovascular, endothelial, and gut microbiota systems, as well as on insulin resistance and endoplasmic reticulum stress. The saturated and transfatty acids favor a proinflammatory state leading to insulin resistance. These fatty acids can be involved in several inflammatory pathways, contributing to disease progression in chronic inflammation, autoimmunity, allergy, cancer, atherosclerosis, hypertension, and heart hypertrophy as well as other metabolic and degenerative diseases. As a consequence, lipotoxicity may occur in several target organs by direct effects, represented by inflammation pathways, and through indirect effects, including an important alteration in the gut microbiota associated with endotoxemia. Interactions between these pathways may perpetuate a feedback process that exacerbates an inflammatory state. The importance of lifestyle modification, including an improved diet, is recommended as a strategy for treatment of these diseases.
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Affiliation(s)
- Débora Estadella
- Programa de Pós-Graduação em Nutrição, Disciplina de Fisiologia da Nutrição, EPM, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 Edifício de Ciências Biomédicas, 2 andar, Vila Clementino, 04023-060 São Paulo, SP, Brazil
| | - Claudia M. da Penha Oller do Nascimento
- Programa de Pós-Graduação em Nutrição, Disciplina de Fisiologia da Nutrição, EPM, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 Edifício de Ciências Biomédicas, 2 andar, Vila Clementino, 04023-060 São Paulo, SP, Brazil
| | - Lila M. Oyama
- Programa de Pós-Graduação em Nutrição, Disciplina de Fisiologia da Nutrição, EPM, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 Edifício de Ciências Biomédicas, 2 andar, Vila Clementino, 04023-060 São Paulo, SP, Brazil
| | - Eliane B. Ribeiro
- Programa de Pós-Graduação em Nutrição, Disciplina de Fisiologia da Nutrição, EPM, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 Edifício de Ciências Biomédicas, 2 andar, Vila Clementino, 04023-060 São Paulo, SP, Brazil
| | - Ana R. Dâmaso
- Departamento de Biociências, UNIFESP, Campus Baixada Santista, 11060-001 Santos, SP, Brazil
| | - Aline de Piano
- Programa de Pós-Graduação em Nutrição, Disciplina de Fisiologia da Nutrição, EPM, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 Edifício de Ciências Biomédicas, 2 andar, Vila Clementino, 04023-060 São Paulo, SP, Brazil
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20
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Dâmaso AR, de Piano A, Campos RMDS, Corgosinho FC, Siegfried W, Caranti DA, Masquio DCL, Carnier J, Sanches PDL, Leão da Silva P, Nascimento CMO, Oyama LM, Dantas ADA, de Mello MT, Tufik S, Tock L. Multidisciplinary approach to the treatment of obese adolescents: effects on cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance. Int J Endocrinol 2013; 2013:541032. [PMID: 24285955 PMCID: PMC3826292 DOI: 10.1155/2013/541032] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/06/2013] [Accepted: 09/09/2013] [Indexed: 12/14/2022] Open
Abstract
The prevention of obesity and health concerns related to body fat is a major challenge worldwide. The aim of this study was to investigate the role of a medically supervised, multidisciplinary approach, on reduction in the prevalence of obesity related comorbidities, inflammatory profile, and neuroendocrine regulation of energy balance in a sample of obese adolescents. A total of 97 postpuberty obese adolescents were enrolled in this study. Body composition, neuropeptides, and adipokines were analysed. The metabolic syndrome was defined by the International Diabetes Federation (IDF). The abdominal ultrasonography was performed to measure visceral, subcutaneous fat and hepatic steatosis. All measures were performed at baseline and after one year of therapy. The multidisciplinary management promoted the control of obesity reducing body fat mass. The prevalence of metabolic syndrome, asthma, nonalcoholic fatty liver disease (NAFLD), binge eating, and hyperleptinemia was reduced. An improvement in the inflammatory profile was demonstrated by an increase in anti-inflammatory adiponectin and reduction in proinflammatory adipokines, plasminogen activator inhibitor-1, interleukin-6 concentrations, and in the Lep/Adipo ratio. Moreover, a reduction in the AgRP and an increase in the alfa-MSH were noted. The multidisciplinary approach not only reduced obesity but also is efficacious in cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance.
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Affiliation(s)
- Ana Raimunda Dâmaso
- Department of Biosciences, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136 Térreo, Vila Mathias, 11015-020 Santos, SP, Brazil
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
- *Ana Raimunda Dâmaso: and
| | - Aline de Piano
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
| | - Raquel Munhoz da Silveira Campos
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
- *Raquel Munhoz da Silveira Campos:
| | - Flávia Campos Corgosinho
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
| | - Wolfgang Siegfried
- Obesity Rehabilitation Centre INSULA, Insulaweg, Bischofswiesen, Germany
| | - Danielle Arisa Caranti
- Department of Biosciences, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136 Térreo, Vila Mathias, 11015-020 Santos, SP, Brazil
| | - Deborah Cristina Landi Masquio
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
| | - June Carnier
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
| | - Priscila de Lima Sanches
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
| | - Patrícia Leão da Silva
- Post-Graduate Program of Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil
| | - Cláudia Maria Oller Nascimento
- Department of Physiology, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 726, Vila Clementino, 04021-001 São Paulo, SP, Brazil
| | - Lila Missae Oyama
- Department of Physiology, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 726, Vila Clementino, 04021-001 São Paulo, SP, Brazil
| | | | - Marco Túlio de Mello
- Psychobiology Department, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 726, Vila Clementino, 04021-001 São Paulo, SP, Brazil
| | - Sergio Tufik
- Psychobiology Department, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 726, Vila Clementino, 04021-001 São Paulo, SP, Brazil
| | - Lian Tock
- Weight Science, Rua Teodoro Sampaio, 744 Cj 98 Jardim America, 05406-000 São Paulo, SP, Brazil
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Cooper JN, Columbus ML, Shields KJ, Asubonteng J, Meyer ML, Sutton-Tyrrell K, Goodpaster BH, DeLany JP, Jakicic JM, Barinas-Mitchell E. Effects of an intensive behavioral weight loss intervention consisting of caloric restriction with or without physical activity on common carotid artery remodeling in severely obese adults. Metabolism 2012; 61:1589-97. [PMID: 22579053 PMCID: PMC3419808 DOI: 10.1016/j.metabol.2012.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/09/2012] [Accepted: 04/11/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Obesity increases cardiovascular disease risk and adversely affects vascular structure and function. Few studies have evaluated the vascular effects of non-surgical weight reduction in the severely obese. We hypothesized that weight loss and improvements in cardiometabolic factors would reduce common carotid artery intima-media thickness (CIMT) and inter-adventitial diameter (AD) in severely obese adults. METHODS We performed carotid ultrasound and measured cardiometabolic factors in 90 severely obese participants (body mass index (BMI)≥35 kg/m(2), age 30-55) at baseline and 6 months in a randomized clinical trial of dietary intervention with (n=45) or without (n=45) physical activity. RESULTS The achieved weight loss (mean=8%) did not differ significantly by intervention group (P=0.10) and resulted in a 0.07 mm mean decrease in AD (P=0.001). AD change was positively correlated with changes in BMI, waist circumference, abdominal visceral and subcutaneous fat, and body fat mass, and AD decreased more in men (P<0.05 for all). After multivariable adjustment, changes in BMI (P=0.03) and abdominal subcutaneous fat (P=0.04) were significant determinants of AD change. Although CIMT did not decrease significantly overall (-0.008 mm, P=0.16), individuals who lost at least 5% of their body weight experienced a significant mean reduction in CIMT of 0.02 mm (P=0.002). CIMT change was positively correlated with changes in BMI, waist circumference, fat-free mass, leptin, and insulin (P<0.05 for all). After multivariable adjustment, insulin reduction remained a significant determinant of CIMT decrease (P=0.03). CONCLUSION A 6 month intensive behavioral intervention can significantly reverse metabolic and vascular abnormalities in severely obese adults.
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Affiliation(s)
- Jennifer N Cooper
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA.
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22
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Lira FS, Rosa JC, Pimentel GD, Santos RV, Carnier J, Sanches PL, de Piano A, de Souza CT, Tock L, Tufik S, de Mello MT, Seelaender M, Oller do Nascimento CM, Oyama LM, Dâmaso AR. Long-term interdisciplinary therapy reduces endotoxin level and insulin resistance in obese adolescents. Nutr J 2012; 11:74. [PMID: 22989045 PMCID: PMC3478966 DOI: 10.1186/1475-2891-11-74] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 09/11/2012] [Indexed: 12/26/2022] Open
Abstract
AIM The purpose of the present study was to assess the dietary fat intake, glucose, insulin, Homeostasis model assessment for insulin resistance HOMA-IR, and endotoxin levels and correlate them with adipokine serum concentrations in obese adolescents who had been admitted to long-term interdisciplinary weight-loss therapy. DESIGN The present study was a longitudinal clinical intervention of interdisciplinary therapy. Adolescents (n = 18, aged 15-19 y) with a body mass index > 95th percentile were admitted and evaluated at baseline and again after 1 year of interdisciplinary therapy. We collected blood samples, and IL-6, adiponectin, and endotoxin concentrations were measured by ELISA. Food intake was measured using 3-day diet records. In addition, we assessed glucose and insulin levels as well as the homeostasis model assessment for insulin resistance (HOMA-IR). RESULTS The most important finding from the present investigation was that the long-term interdisciplinary lifestyle therapy decreased dietary fat intake and endotoxin levels and improved HOMA-IR. We observed positive correlations between dietary fat intake and endotoxin levels, insulin levels, and the HOMA-IR. In addition, endotoxin levels showed positive correlations with IL-6 levels, insulin levels and the HOMA-IR. Interestingly, we observed a negative correlation between serum adiponectin and both dietary fat intake and endotoxin levels. CONCLUSIONS The present results indicate an association between dietary fat intake and endotoxin level, which was highly correlated with a decreased pro-inflammatory state and an improvement in HOMA-IR. In addition, this benefits effect may be associated with an increased adiponectin level, which suggests that the interdisciplinary therapy was effective in improving inflammatory pathways.
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Affiliation(s)
- Fábio S Lira
- Departamento de Fisiologia, Rua Botucatu nº 862 Vila Clementino, São Paulo, Brazil.
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The role of PAI-1 and adiponectin on the inflammatory state and energy balance in obese adolescents with metabolic syndrome. Inflammation 2012; 35:944-51. [PMID: 22038064 DOI: 10.1007/s10753-011-9397-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is a chronic inflammatory disease and is considered a risk factor for metabolic syndrome. In this study, 57 obese adolescents with and without metabolic syndrome underwent 1 year of weight loss therapy. At baseline, the metabolic syndrome (MS) patients presented higher values of PAI-1 than the non-metabolic syndrome patients (n-MS). After therapy, significant improvements in anthropometrics and biochemical, inflammatory, and neuroendocrine variables were observed in both groups. However, the n-MS group presented better results than the MS group. Indeed, we found positive correlations in both groups between PAI-1 and neuropeptide Y (NPY) and between PAI-1 and NPY/AgRP. Inflammatory biomarkers may thus play a role in energy balance. The clinical trial registration number is NCT01358773.
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Carvalho-Ferreira JPD, Cipullo MAT, Caranti DA, Masquio DCL, Andrade-Silva SG, Pisani LP, Dâmaso AR. Interdisciplinary lifestyle therapy improves binge eating symptoms and body image dissatisfaction in Brazilian obese adults. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2012; 34:223-33. [DOI: 10.1590/s2237-60892012000400008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/17/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Obesity is related to numerous negative consequences for physical and mental health. It is often associated with the presence of binge eating disorder, body image dissatisfaction, and general psychopathology. OBJECTIVE: To assess the effects of an interdisciplinary lifestyle therapy on binge eating symptoms, depression, anxiety, body dissatisfaction, and quality of life in obese adults. METHODS: A total of 49 obese adults (body mass index = 37.35±5.82 kg/m²; age = 44.14±10.00 years) participated in a weight-loss program for 6 months. Symptoms suggestive of binge eating, body dissatisfaction, depression, anxiety, and quality of life were measured using self-reported questionnaires. Food intake was assessed using a 3-day dietary record. Data were analyzed using analysis of variance (ANOVA). RESULTS: ANOVA results showed a reduction in binge eating symptoms and in body dissatisfaction results. Depression and anxiety symptoms also decreased, and an increase was observed in quality of life scores. After therapy, a significant improvement was observed in dietary patterns, as well as significant weight loss. A positive correlation was found between variation of anxiety symptoms and lipid intake. Binge eating symptoms were associated with anxiety symptoms and body image dissatisfaction, and body image dissatisfaction correlated positively with anxiety symptoms in males only. In females, a positive correlation was observed between depression and binge eating symptoms. CONCLUSION: The interdisciplinary therapy was effective in promoting positive physical and psychological changes and in improving the quality of life of obese adults.
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Leão da Silva P, de Mello MT, Cheik NC, Sanches PL, Munhoz da Silveira Campos R, Carnier J, Inoue D, do Nascimento CMO, Oyama LM, Tock L, Tufik S, Dâmaso AR. Reduction in the leptin concentration as a predictor of improvement in lung function in obese adolescents. Obes Facts 2012. [PMID: 23207491 DOI: 10.1159/000345840] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the effects of weight loss on adipokines, asthma-related symptoms, exercise-induced bronchospasm (EIB) and lung function, and to evaluate the role of leptin and adiponectin levels on lung function after treatment in obese adolescents. METHODS 84 postpubertal obese adolescents were enrolled and distributed in quartiles according to weight loss (low (<2.5 kg), low to moderate (>2.5 and <8 kg), moderate (<8 and <14 kg) and massive (<14 kg)). Body composition was measured by plethysmography, and visceral and subcutaneous fat were detected by ultrasound. Serum levels of adiponectin and leptin were analyzed. Lung function, asthma and EIB were evaluated according to the American Thoracic Society criteria. Patients were submitted to 1 year of interdisciplinary intervention consisting of physiotherapy, medical, nutritional, exercise, and psychological therapy. RESULTS After treatment the moderate and massive weight loss promoted an increase in adiponectin and adiponectin/leptin (A/L) ratio as well as a decrease in leptin levels and a reduction in EIB frequency and asthma-related symptoms. Furthermore, the reduction in leptin levels was a predictor factor to improvement in lung function. CONCLUSION Interdisciplinary therapy was able to decrease EIB and asthma-related symptoms and to improve pro/anti-inflammatory adipokines. Additionally, the leptin concentration was a predictor factor to explain changes in lung function.
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Affiliation(s)
- Patrícia Leão da Silva
- Post Graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil
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da Silva PL, de Mello MT, Cheik NC, Sanches PL, Correia FA, de Piano A, Corgosinho FC, Campos RMDS, do Nascimento CMO, Oyama LM, Tock L, Tufik S, Dâmaso AR. Interdisciplinary therapy improves biomarkers profile and lung function in asthmatic obese adolescents. Pediatr Pulmonol 2012; 47:8-17. [PMID: 22170805 DOI: 10.1002/ppul.21502] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/25/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND The simultaneous rise in the prevalence of asthma and obesity in the world, have demonstrated the importance of the development of treatment strategies. The purpose of this study was to evaluate the short- and long-term results of interdisciplinary therapy on inflammatory biomarkers and lung function in asthmatics obese adolescents. METHODS Seventy-six post-pubertal obese adolescents were recruited, including 50 non-asthmatics [body mass index (BMI), 36 ± 5 kg/m(2) ) and 26 asthmatics (BMI, 39 ± 4 kg/m(2) ). Body composition was measured by plethysmography, and visceral fat was analyzed by ultrasound. Serum levels of adiponectin, leptin, and C-reactive protein (CRP) were analyzed. Asthma and lung function were evaluated according to the American Thoracic Society criteria. Patients were submitted to 1-year weight loss interdisciplinary intervention consisting of medical, nutritional, exercise, and psychological therapy. RESULTS After interdisciplinary intervention, the lung function and pro/anti-inflammatory adipokines improved significantly in both groups. Most importantly, there was an increase in adiponectin [4 (1.86-12.9) to 5.1 (2.48-16)], a reduction in CRP [2,073 (385-9,174) to 1,538 (205-7,083)] and leptin concentrations [59 (29-69) to 33 (9-49)] in the asthmatics patients. Furthermore, it was observed a reduction in asthma severity after treatment. In addition, Δ adiponectin was an independent factor to improve lung function after therapy in both groups. CONCLUSIONS Interdisciplinary therapy resulted in beneficial changes in inflammatory biomarkers profile and lung function in asthmatic and non-asthmatic obese adolescents. Additionally, for the first time we showed that change in adiponectin level was an independent predictor to improve lung function in Brazilian obese adolescents.
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Affiliation(s)
- Patrícia Leão da Silva
- Post Graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil.
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