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Huh Y, Park HS. Associations of overweight and obesity with cardiometabolic risk factor clusters among Korean adolescents. Sci Rep 2024; 14:3581. [PMID: 38351083 PMCID: PMC10864260 DOI: 10.1038/s41598-024-53698-6] [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: 09/16/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
This study investigated the association between overweight, obesity, and cardiometabolic risk factor clusters in Korean adolescents. We included 2182 participants (1161 boys and 1021 girls) aged 12-18 years from the Korea National Health and Nutrition Examination Survey (2016-2021). Cardiometabolic risk factors include hypertension, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, hypertriglyceridemia, high fasting plasma glucose level, elevated alanine aminotransferase level, and hyperuricemia. The average age was 15.1 ± 0.1 years in both boys and girls. The proportion of subjects with ≥ 1, ≥ 2, and ≥ 3 cardiometabolic risk factors was 76.5%, 49.8%, and 22.7% in obese adolescents, and 60.5%, 24.0%, and 9.1%, in overweight adolescents, respectively. Compared to adolescents with underweight/normal weight, the odds ratios (ORs) and 95% confidence intervals for the clustering of cardiometabolic risk factors were at 2.76 (1.74-4.38) for ≥ 1; 3.75 (2.11-6.66) for ≥ 2; and 4.75 (1.70-13.25) for ≥ 3 factors in obese adolescents and 1.88 (1.26-2.81) for ≥ 1 factor in overweight adolescents. Overweight and obese adolescents exhibited high cardiometabolic risk clustering. Prevention and management of overweight/obesity in Korean adolescents are emerging to mitigate health risk associated with this condition.
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Affiliation(s)
- Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonngi-do, Republic of Korea
| | - Hye Soon Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Masquio DCL, Campos RMDS, Netto BDM, de Carvalho-Ferreira JP, Bueno CR, Alouan S, Poletto GT, Ganen ADP, Tufik S, de Mello MT, Nardo N, Dâmaso AR. Interdisciplinary Therapy Improves the Mediators of Inflammation and Cardiovascular Risk in Adolescents with Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7114. [PMID: 38063544 PMCID: PMC10706419 DOI: 10.3390/ijerph20237114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023]
Abstract
Obesity is associated with inflammation and an increased risk of cardiovascular disease and premature mortality, as well as a range of other conditions. Obesity is a growing global problem, not only in adults, but also in children and adolescents. Therefore, the present study aimed to assess the effects of a one-year interdisciplinary intervention on the cardiometabolic and inflammatory profiles of adolescents with obesity. Twenty-two adolescents completed the intervention, which included clinical, nutritional, psychological and physical exercise counselling. Body composition, and metabolic, inflammatory, and cardiovascular risk biomarkers were analyzed before and after one year of intervention. Visceral and subcutaneous fat were determined ultrasonographically. The homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) equation were used to estimate insulin resistance and insulin sensitivity, respectively. A reduction in body mass, adiposity, glucose, and insulin and an improved lipid profile were observed after the therapy. Hyperleptinemia was reduced from 77.3% to 36.4%. Plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule 1 (ICAM-1), leptin, the leptin/adiponectin ratio, and the adiponectin/leptin ratio were also significantly improved. Metabolic changes were associated with a reduction in visceral fat and waist circumference, and adiponectin and the leptin/adiponectin ratio were associated with HOMA-IR. The interdisciplinary therapy promoted improvements in hyperleptinemia and metabolic, inflammatory, and cardiovascular biomarkers.
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Affiliation(s)
- Deborah Cristina Landi Masquio
- Programa de Pós-Graduação em Nutrição, Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), Campus São Paulo, São Paulo 04023-061, SP, Brazil;
- Programa de Mestrado Profissional em Nutrição: do Nascimento à Adolescência, Curso de Nutrição, Centro Universitário São Camilo (CUSC), São Paulo 05025-010, SP, Brazil;
- Grupo de Estudos da Obesidade (GEO), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-061, SP, Brazil; (S.A.); (G.T.P.)
| | - Raquel Munhoz da Silveira Campos
- Programa de Pós-Graduação Interdisciplinar em Ciências da Saúde, Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Campus Baixada Santista, Santos 11010-150, SP, Brazil;
| | - Bárbara Dal Molin Netto
- Programa de Pós-Graduação em Alimentação e Nutrição, Departamento de Nutrição, Universidade Federal do Paraná (UFPR), Curitiba 80210-170, PR, Brazil;
| | - Joana Pereira de Carvalho-Ferreira
- Laboratório Multidisciplinar em Alimentos e Saúde, Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas (UNICAMP), Limeira 13484-350, SP, Brazil;
| | - Carlos Roberto Bueno
- Escola de Educação Física e Esporte de Ribeirão Preto (EEFERP), Universidade de São Paulo (USP), Ribeirão Preto 14040-900, SP, Brazil;
| | - Stella Alouan
- Grupo de Estudos da Obesidade (GEO), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-061, SP, Brazil; (S.A.); (G.T.P.)
| | - Gabriela Tronca Poletto
- Grupo de Estudos da Obesidade (GEO), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-061, SP, Brazil; (S.A.); (G.T.P.)
| | - Aline de Piano Ganen
- Programa de Mestrado Profissional em Nutrição: do Nascimento à Adolescência, Curso de Nutrição, Centro Universitário São Camilo (CUSC), São Paulo 05025-010, SP, Brazil;
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo 04724-000, SP, Brazil;
| | - Marco Túlio de Mello
- Escola de Educação Física, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 31310-250, MG, Brazil;
| | - Nelson Nardo
- Departamento de Educação Física, Universidade Estadual de Maringá (UEM), Maringá 87020-900, PR, Brazil;
| | - Ana R. Dâmaso
- Programa de Pós-Graduação em Nutrição, Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), Campus São Paulo, São Paulo 04023-061, SP, Brazil;
- Grupo de Estudos da Obesidade (GEO), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-061, SP, Brazil; (S.A.); (G.T.P.)
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Widjaja NA, Caesar LA, Nova S, Ardianah E. Beyond the Scale: Investigating Adiponectin, ICAM-1, and VCAM-1 as Metabolic Markers in Obese Adolescents with Metabolic Syndrome. J Obes 2023; 2023:4574042. [PMID: 37822716 PMCID: PMC10564580 DOI: 10.1155/2023/4574042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
Background Adiponectin acts to prevent vascular dysfunction due to obesity by inhibiting ICAM-1 and VCAM-1 expressions. Objective We investigate adiponectin ICAM-1, VCAM-1, and metabolic syndrome (MetS) in obese adolescents. Methods A cross-sectional study with healthy obese adolescents aged 13 to 18 years was conducted from October 2019 to January 2020. Statistical analysis conducted was a test of normality and homogeneity tests, ANOVA/Kruskal-Wallis, independent sample T-test/Mann-Whitney U test, and Spearman correlation and determined as significant if p value <0.05. Results 125 obese adolescents were recruited. 42 (33.6%) were obese with MetS (we grouped as MetS) and 83 (66.4%) subjects without MetS (non-MetS group). VCAM-1 was significantly higher on boys with MetS compared to girls with MetS, and even girls with MetS had lower levels of VCAM-1 than boys with non-MetS. ICAM-1 was significantly higher in boys with low-level HDL-c (p < 0.05) and correlated weakly with HDL-c, while adiponectin levels were significantly lower in girls with central obesity and hypertriglyceridemia. Path analysis showed that triglyceride had a direct effect on ICAM-1 but not VCAM-1 in both obese boys and girls. Adiponectin had a negative direct effect on ICAM-1 and VCAM-1 in girls. However, on boys, diastole blood pressure had a negative direct effect, which might be the role of sex hormones indirectly. Conclusion VCAM-1 was significantly higher in boys than girls, which showed that boys had a higher risk of atherosclerosis. ICAM-1 showed no significant difference in both gender and metabolic states. Adiponectin showed a protective effect by lowering ICAM-1 and VCAM-1 directly on girls.
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Affiliation(s)
- Nur Aisiyah Widjaja
- Faculty of Medicine, Child Health Department, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Leonardo Alexander Caesar
- Faculty of Medicine, Child Health Department, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Suhasta Nova
- Faculty of Medicine, Child Health Department, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Eva Ardianah
- Ikatan Dokter Indonesia Surabaya, Jl. Mayjen Prof. Dr. Moestopo No. 117, Surabaya 60132, Indonesia
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Bean MK, LaRose JG, Wickham EP, Raynor HA, Caccavale L, Evans RK, Thornton LM, Farthing S, Mendoza A, Mazzeo SE. The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial. BMC Public Health 2023; 23:1484. [PMID: 37537548 PMCID: PMC10401872 DOI: 10.1186/s12889-023-16421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents' inclusion in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment. METHODS Participants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up. DISCUSSION Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT03851796. Registered: February 22, 2019.
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Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA.
- Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Box 980308, Richmond, VA, 23298, USA.
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Box 980430, Richmond, VA, 23298, USA
| | - Edmond P Wickham
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Box 980111, Richmond, VA, 23298, USA
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, 1215 W. Cumberland Ave., Knoxville, TN, 37996, USA
| | - Laura Caccavale
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
| | - Ronald K Evans
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Box 843021, Richmond, VA, 23284, USA
| | - Laura M Thornton
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, CB#7160 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
| | - Sarah Farthing
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
| | - Ashley Mendoza
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
| | - Suzanne E Mazzeo
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
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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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Bean MK, LaRose JG, Raynor HA, Adams EL, Evans RK, Farthing S, Wickham EP, Mazzeo SE. The role of parents in adolescent obesity treatment: Results of the TEENS+ randomized clinical pilot trial. Pediatr Obes 2022; 17:e12858. [PMID: 34605188 PMCID: PMC8993159 DOI: 10.1111/ijpo.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal role for involving parents in adolescent obesity treatment is unknown. OBJECTIVE To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss. METHODS Adolescent/parent dyads (N = 82; mean adolescent age = 13.7 ± 1.2 years) participated in TEENS+, a 4-month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post-treatment), and 7-months. Within- and between-group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes). RESULTS PWL parents had greater 4-month weight losses (∆kg0-4m = -5.14 ± 4.87 kg) compared to PAC (-2.07 ± 3.89 kg; between-group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within-group adolescent ∆BMI0-4m (PWL: -0.97 ± 1.38 kg/m2 vs. PAC: -0.93 ± 1.42 kg/m2 ; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI4-7m increases (+0.41 ± 1.07 kg/m2 ; p = 0.02) while PAC did not (+0.05 ± 1.31 kg/m2 ; p = 0.82). CONCLUSION Parent treatments were distinct in implementation and both yielded significant 4-month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration.
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Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, United States,Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Box 980308, Richmond, VA 23298, United States
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Box 980430, Richmond, VA 23298, United States
| | - Hollie A. Raynor
- Department of Nutrition, University of Tennessee, Knoxville, 1215 W. Cumberland Ave., Knoxville, TN, 37996, United States
| | - Elizabeth L. Adams
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, United States
| | - Ronald K. Evans
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Box 843021, Richmond, VA 23284, United States
| | - Sarah Farthing
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, United States
| | - Edmond P. Wickham
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, United States,Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Box 980111, Richmond, VA 23298
| | - Suzanne E. Mazzeo
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, United States,Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Box 842018, Richmond, VA 23284, United States
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Vrdoljak J, Kumric M, Vilovic M, Martinovic D, Rogosic V, Borovac JA, Ticinovic Kurir T, Bozic J. Can Fasting Curb the Metabolic Syndrome Epidemic? Nutrients 2022; 14:nu14030456. [PMID: 35276815 PMCID: PMC8838760 DOI: 10.3390/nu14030456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities that includes hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia. Due to the high prevalence (around 1/3 of the world population) economic burden of MetS, there is a need for new dietary, lifestyle, and therapeutic options. Recently, fasting emerged as a dietary method proposed for controlling metabolic risk factors. Intermittent fasting (IF), or time-restricted feeding (TRF), describes an array of feeding patterns in which calorie intake is restricted to a specific time period. Hence, this review aimed to elucidate the latest data on MetS and explore the viability of simple management options, such as IF and TRF. Preclinical studies have shown how IF/TRF exerts beneficial effects on the gut microbiota, glucose and insulin metabolism, weight and visceral fat, and lipid metabolism. However, the results obtained from human studies are somewhat conflicting, as weight loss was achieved in all studies, whereas in some studies, there was no significant effect on insulin resistance, cholesterol/lipid metabolism, or blood pressure. Nevertheless, as only very few human studies were performed, there is a need for more randomized control trials on larger cohorts of patients with MetS to gather higher-yield evidence to clarify whether IF/TRF are suitable dietary patterns for this population.
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Affiliation(s)
- Josip Vrdoljak
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
| | - Veljko Rogosic
- Department of Ophthalmology, University of Split School of Medicine, 21000 Split, Croatia;
- Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia
| | - Josip A. Borovac
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
- Department of Health Studies, University of Split, 21000 Split, Croatia
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Split, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.V.); (M.K.); (M.V.); (D.M.); (J.A.B.); (T.T.K.)
- Correspondence:
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Hintze LJ, Kravchychyn ACP, Ferreira YAM, Campos RMDS, Dantas ADA, Masquio DCL, Caranti DA, Thivel D, Dâmaso AR. Semi-intensive and Intensive Interdisciplinary Treatments Have Similar Effects on Metabolic Syndrome and Selected Inflammatory Markers in Adolescents with Obesity. J Obes Metab Syndr 2021; 30:386-395. [PMID: 34966004 PMCID: PMC8735820 DOI: 10.7570/jomes21049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of the present study was to compare the impact of semi-intensive and intensive interdisciplinary weight-loss therapies on the treatment of metabolic syndrome (MS) and selected inflammatory markers in adolescents with obesity. Methods The study included 166 adolescents enrolled in two groups for 22 weeks: the intensive group (in-person aerobic and resistance exercise three times a week, and psychological and nutritional counselling once a week), or the semi-intensive group (six in-person exercise orientation meetings and six in-person psychological support sessions with an online nutritional and exercise program). Anthropometric parameters, blood pressure, fasting glucose, insulin, lipid profile, triglycerides (TG), leptin and adiponectin were assessed before and after the interventions. Results Body weight and waist circumference decreased in both groups (P<0.001) and large effect sizes (η2= 0.586 and η2=0.465, respectively) were noted. Significant time and group interactions were found (P=0.001) with medium effect sizes (η2=0.095 and η2=0.105, respectively). The prevalence of MS decreased from 27.9% to 13.1% (P=0.012) and 29.4% to 5.9% (P=0.004) in the semi-intensive and intensive groups, respectively. All MS risk factors decreased significantly over time (P<0.001) and a significant time*group interaction was observed (P<0.05), except for fasting TG (P=0.832) and glucose (P=0.128, η2=0.021). Conclusion The results suggested that both approaches promoted significant clinical improvement in the condition of adolescents with MS and reduced associated risk factors. Studies that consider the cost effectiveness of both treatments are still needed to determine whether semi-intensive care, with its lower financial costs, may be a suitable option to treat obesity and MS in adolescents with obesity.
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Affiliation(s)
- Luzia Jaeger Hintze
- Department of Biosciences, Post Graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Raquel Munhoz da Silveira Campos
- Department of Biosciences, Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Santos, Brazil
| | | | | | - Danielle Arisa Caranti
- Department of Biosciences, Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Santos, Brazil
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France
| | - Ana R Dâmaso
- Department of Biosciences, Post Graduate Program of Nutrition, Universidade Federal de São Paulo, São Paulo, Brazil
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La Grasta Sabolić L, Šepec MP, Cigrovski Berković M, Stipančić G. Time to the Peak, Shape of the Curve and Combination of These Glucose Response Characteristics During Oral Glucose Tolerance Test as Indicators of Early Beta-cell Dysfunction in Obese Adolescents. J Clin Res Pediatr Endocrinol 2021; 13:160-169. [PMID: 33006553 PMCID: PMC8186335 DOI: 10.4274/jcrpe.galenos.2020.2020.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Characteristics of the glucose response during oral glucose tolerance test (OGTT) may reflect differences in insulin secretion and action. The aim was to examine whether timing of the glucose peak, shape of the glucose curve and their combination could be indicators of beta-cell dysfunction in obese/severely obese adolescents with normal glucose tolerance (NGT). METHODS Data from 246 obese/severely obese adolescents who completed OGTT were reviewed. Out of 184 adolescents with NGT, 174 could be further classified into groups based on timing of the glucose peak (early/30 minutes vs late/≥60 minutes) and shape of the glucose curve (monophasic vs biphasic). Groups were compared with respect to insulin sensitivity (whole body insulin sensitivity index - WBISI), early-phase insulin secretion (insulinogenic index - IGI) and beta-cell function relative to insulin sensitivity (oral disposition index - oDI). RESULTS Late glucose peak (p=0.004) and monophasic glucose curve (p=0.001) were both associated with lower oDI after adjustment for age, sex, puberty stage and body mass index z-score. Among obese/severely obese adolescents with NGT, those with coexistent late glucose peak and monophasic glucose curve had lower oDI than those with early glucose peak and biphasic glucose curve (p=0.002). Moreover, a combination of late glucose peak and monophasic glucose curve was the most powerful predictor of the lowest oDI quartile [odds ratio (OR): 11.68, 95% confidence interval: 3.048-44.755, p<0.001]. CONCLUSION Late timing of the glucose peak, monophasic shape of the glucose curve and, in particular, a combination of those characteristics during OGTT may indicate early beta-cell dysfunction in obese/severely obese adolescents with NGT.
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Affiliation(s)
- Lavinia La Grasta Sabolić
- University Hospital Center Sestre Milosrdnice, Department of Pediatric Endocrinology, Diabetes and Metabolism, Zagreb, Croatia,* Address for Correspondence: University Hospital Center Sestre Milosrdnice, Department of Pediatric Endocrinology, Diabetes and Metabolism, Zagreb, Croatia Phone: +385 1 37 87 551 E-mail:
| | - Marija Požgaj Šepec
- University Hospital Center Sestre Milosrdnice, Department of Pediatric Endocrinology, Diabetes and Metabolism, Zagreb, Croatia
| | - Maja Cigrovski Berković
- Clinical Hospital Dubrava, Department of Endocrinology, Diabetes, Metabolism and Clinical Pharmacology, Zagreb, Croatia,University Osijek, Faculty of Medicine, Department of Pharmacology, Osijek, Croatia
| | - Gordana Stipančić
- University Hospital Center Sestre Milosrdnice, Department of Pediatric Endocrinology, Diabetes and Metabolism, Zagreb, Croatia,University of Zagreb, School of Dental Medicine, Zagreb, Croatia
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Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies. BIOMED RESEARCH INTERNATIONAL 2021. [DOI: 10.1155/2021/6661457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction. Metabolic syndrome (MetS) is an assemblage of interconnected cardiovascular risk factors that are prevalent among children and adolescents in high-income countries (HICs). Despite the presence of several studies on the issue, the study findings are incongruent due to the absence of a gold standard diagnostic method of MetS in children. Thus, the findings of the original studies are inconclusive for policy makers and other stakeholders. This systematic review and meta-analysis is aimed at giving conclusive evidence about MetS among children and adolescents in HICs. Methods. We conducted searches using electronic databases (PubMed, Scopus, Web of Science, CINAHL (EBSCOhost), EMBASE (Elsevier), and Medline (EBSCOhost)) and other sources (Google Scholar and Google) up to September 2020. Observational studies reporting the prevalence of MetS were eligible in this study. The pooled estimates were computed in fixed and random effect models using six diagnostic methods (IDF, ATP III, de Ferranti et al., WHO, Weiss et al., and Cruz and Goran). Publication bias was verified using funnel plots and Egger’s regression tests. Subgroup and sensitivity analysis were performed in case of higher heterogeneities among the included studies. Result. In this study, 77 studies with a total population of 125,445 children and adolescents were used in the final analysis. Metabolic syndrome among the overweight and obese population was computed from 28 studies with the pooled prevalence of 25.25%, 24.47%, 39.41%, 29.52%, and 33.36% in IDF, ATP III, de Ferranti et al., WHO, and Weiss et al. criteria, respectively. Likewise, 49 studies were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, MetS was found in 3.70% (IDF), 5.40% (ATP III), 14.78% (de Ferranti et al.), 3.90% (WHO), and, 4.66% (Cruz and Goran) of study participants. Regarding the components of MetS, abdominal obesity in the overweight and obese population, and low HDL-C in the general population were the most common components. Besides, the prevalence of Mets among males was higher than females. Conclusion. This study demonstrates that MetS among children and adolescents is undoubtedly high in HICs. The prevalence of MetS is higher among males than females. Community-based social and behavioral change communications need to be designed to promote healthy eating behaviors and physical activities. Prospective cohort studies could also help to explore all possible risk factors of MetS and to design specific interventions accordingly.
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11
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Khammassi M, Isacco L, Pereira B, Damaso AR, Matlosz P, Maruszczak K, Weghuber D, Dutheil F, Duclos M, Boirie Y, Julian V, Thivel D. Cardiometabolic efficacy of multidisciplinary weight loss interventions is not altered in adolescents with obesity initially diagnosed or with a persistent metabolic syndrome. Nutr Res 2021; 86:79-87. [PMID: 33551258 DOI: 10.1016/j.nutres.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
The efficacy of weight loss interventions might be affected by the metabolic profile of adolescents with obesity. In this study, we hypothesized that the initial diagnosis of the MS, or its persistence after an intervention, will not reduce the efficacy of a 16-week multidisciplinary weight loss program. Ninety two adolescents (12-15 years; 62 girls) with obesity completed baseline anthropometric and body composition evaluation (DXA). Lipid profile, insulinemia, glycaemia and blood pressure were measured and metabolic syndrome (MS) diagnosed. The adolescents then followed a 4-month inpatient multidisciplinary weight-management program. All measurements were performed before (T0) and after 4 months of intervention (T1). Body weight, body mass index (BMI) and percentage of fat mass (%FM) decreased significantly between T0 and T1 (P< .001), with no difference in fat-free mass (kg). All metabolic variables (except blood pressure) were improved. 47.6% of the whole sample presented with MS at baseline against 35.7% at T1. Body weight (P = 0.006), BMI (P = 0.0261), %FM (P = 0.0211), hip circumference (= 0.0131), BMI percentile (P = 0.0319), and diastolic blood pressure (P = 0.0365) showed a time x group interaction and their deltas (variations between T0 and T1) were significantly different between adolescents with and without MS at baseline. There was no significant difference between adolescents with persistent and nonpersistent MS except for ΔBMI percentile that deceased significantly more in the nonpersistent group (P = 0.0115). According to our results, the efficacy of weight loss interventions is not reduced in adolescents initially diagnosed with MS or different between those who present a persistent or nonpersistent MS after the intervention.
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Affiliation(s)
- Marwa Khammassi
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; Research Unit, Sportive Performance and Physical Rehabilitation, High Institute of Sports and Physical Education of Kef, University of Jendouba, Kef, Tunisia, Faculty of Science of Bizerte, University of Carthage, 7021 Zarzouna, Bizerte, Tunisia.
| | - Laurie Isacco
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France.
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics unit (DRCI), Clermont-Ferrand, France.
| | - Ana Raimunda Damaso
- Paulista Medicine School, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862-Vila Clementino, São Paulo, SP 04020-050, Brazil.
| | - Piotr Matlosz
- Institute of Physical Culture Sciences, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Katharina Maruszczak
- Department of Pediatrics, Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria..
| | - Daniel Weghuber
- Department of Pediatrics, Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria..
| | - Frederic Dutheil
- Departement de Médecine du travail, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, France; University Clermont 1, UFR Medicine, Clermont-Ferrand, France.
| | - Martine Duclos
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France; INRA, UMR 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France.
| | - Yves Boirie
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Human Nutrition, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France.
| | - Valérie Julian
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France; INRA, UMR 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France.
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France.
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12
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Bean MK, Caccavale LJ, Adams EL, Burnette CB, LaRose JG, Raynor HA, Wickham EP, Mazzeo SE. Parent Involvement in Adolescent Obesity Treatment: A Systematic Review. Pediatrics 2020; 146:peds.2019-3315. [PMID: 32839242 PMCID: PMC7461263 DOI: 10.1542/peds.2019-3315] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Family-based lifestyle interventions are recommended for adolescent obesity treatment, yet the optimal role of parents in treatment is unclear. OBJECTIVE To examine systematically the evidence from prospective randomized controlled and/or clinical trials (RCTs) to identify how parents have been involved in adolescent obesity treatment and to identify the optimal type of parental involvement to improve adolescent weight outcomes. DATA SOURCES Data sources included PubMed, PsychINFO, and Medline (inception to July 2019). STUDY SELECTION RCTs evaluating adolescent (12-18 years of age) obesity treatment interventions that included parents were reviewed. Studies had to include a weight-related primary outcome (BMI and BMI z score). DATA EXTRACTION Eligible studies were identified and reviewed, following the Preferred Reporting for Systematic Review and Meta-Analyses guidelines. Study quality and risk of bias were evaluated by using the Cochrane Collaboration risk of bias tool. RESULTS This search identified 32 studies, of which 23 were unique RCTs. Only 5 trials experimentally manipulated the role of parents. There was diversity in the treatment target (parent, adolescent, or both) and format (group sessions, separate sessions, or mixed) of the behavioral weight loss interventions. Many studies lacked detail and/or assessments of parent-related behavioral strategies. In ∼40% of unique trials, no parent-related outcomes were reported, whereas parent weight was reported in 26% and associations between parent and adolescent weight change were examined in 17%. LIMITATIONS Only RCTs published in English in peer-reviewed journals were eligible for inclusion. CONCLUSIONS Further research, with detailed reporting, is needed to inform clinical guidelines related to optimizing the role of parents in adolescent obesity treatment.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Laura J. Caccavale
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth L. Adams
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Hollie A. Raynor
- Department of Nutrition, The University of Tennessee,
Knoxville, Knoxville, Tennessee
| | - Edmond P. Wickham
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Internal Medicine, School of Medicine, Virginia
Commonwealth University, Richmond, Virginia; and
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Department of Psychology, College of Humanities and
Sciences and
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13
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Li X, Shi W, Xiong Q, Hu Y, Qin X, Wan G, Zeng Q. Leptin improves intestinal flora dysfunction in mice with high-fat diet-induced obesity. J Int Med Res 2020; 48:300060520920062. [PMID: 32529880 PMCID: PMC7294385 DOI: 10.1177/0300060520920062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study investigated the effects of leptin on intestinal flora and inflammation in mice with high-fat diet (HFD)-induced obesity. METHODS Mice were fed an HFD for 8 weeks; some were concurrently administered oral leptin for 4 weeks. Pathological changes in adipose tissue were detected using hematoxylin-eosin staining; endotoxin content in adipose tissue was measured by enzyme-linked immunosorbent assay. Intestinal flora were characterized by 16S bacterial rDNA sequencing. Levels of Toll-like receptor 4 (TLR4), nuclear factor-κB inhibitor α (IκB-α), and phosphorylated c-Jun N-terminal kinase (p-JNK) were detected by western blotting. RESULTS Mice in the HFD group exhibited weight gain, elevated endotoxin content, and adipocyte hypertrophy, compared with the non-obese control group. Moreover, abundance of bacteria in the Bacteroides genus and community diversity were both reduced in the HFD group; reductions also were observed at corresponding phylum, class, and order levels. Levels of TLR4, IκB-α, and p-JNK were also elevated in the HFD group. Compared with the model group, leptin administration reduced the weight gain and endotoxin content, while increasing Bacteroides abundance and community diversity; it also reduced the levels of TLR4, IκB-α, and p-JNK. CONCLUSION Leptin administration improved intestinal flora dysfunction and inflammation in mice with HFD-induced obesity.
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Affiliation(s)
- Xiaolin Li
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
| | - Weihong Shi
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
| | - Qinghua Xiong
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
| | - Yungang Hu
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
| | - Xu Qin
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
| | - Guanqun Wan
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
| | - Qi Zeng
- Department of Plastic Maxillofacial Surgery, People’s Hospital of Nanchang University, Nanchang, China
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14
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Matson RI, Perry R, Hunt LP, Chong AH, Beynon R, Hamilton-Shield J, Birch L. Change in obesity-related metabolic abnormalities associated with body mass index improvement through life-style intervention: A meta-regression. Pediatr Diabetes 2020; 21:173-193. [PMID: 31820534 DOI: 10.1111/pedi.12955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/28/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
The reduction in body mass index standard deviation score (BMI-SDS) associated with improvement in biomarkers relating to metabolic health in obese children is unknown. We aimed to establish the change in BMI-SDS associated with improved inflammation, liver function, and insulin resistance to inform clinical guidelines for pediatric weight management interventions and to assess the efficacy of future trials. A large-scale systematic review was conducted to identify relevant studies. Studies of children with a diagnosis of obesity according to defined BMI thresholds, participating in lifestyle interventions to reduce obesity, were included. Studies must have reported baseline (pre-) and postintervention (or change of) BMI-SDS and either fasting glucose, homeostatic model of insulin resistance (HOMA-IR), alanine aminotransferase (ALT), C-reactive protein (CRP), or interleukin-6 (IL-6). A series of meta-regressions were conducted to establish links between BMI-SDS change scores and change in metabolic markers of health. Sixty-eight articles were identified. From the meta-regression analyses, across all study subsets, greater mean falls in all four parameters, (HOMA-IR, Glucose, ALT, and CRP) were observed with greater mean loss of BMI-SDS, but the trends were only statistically significant for HOMA-IR and CRP (P = .003; P = .021). However, we could not find minimum changes in BMI-SDS that would ensure a fall in these outcomes. At this time, we are unable to recommend a definitive value of BMI-SDS reduction needed to improve the markers of metabolic health. Future trials should aim to report additional indices of derived BMI values, which may better reflect changes in actual adiposity.
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Affiliation(s)
- Rhys Ib Matson
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK.,Swansea University Medical School, Grove Building, Swansea University, Singleton Park Swansea, Swansea, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Linda P Hunt
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Amanda Hw Chong
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Rhona Beynon
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Julian Hamilton-Shield
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, University Hospitals Bristol Education Centre, Bristol, UK
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15
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Impact of Recreational Sports Activities on Metabolic Syndrome Components in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010143. [PMID: 31878170 PMCID: PMC6981663 DOI: 10.3390/ijerph17010143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 01/19/2023]
Abstract
We investigated the impact of a sports activities program on metabolic syndrome (MetS) components and pre-MetS among adolescents. Blood samples, blood pressure, weight, height, body mass index, waist circumference, body fat percentage, frequency of food consumption, daily time in moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) of 92 male adolescents aged 14-18 years (16.07 ± 0.93) were evaluated. From this initial sample, 36 participants (39.1%) were diagnosed with pre-MetS or MetS and were invited to participate in the intervention program. Twelve individuals diagnosed with pre-MetS or MetS agreed to participate in a recreational sports activities program lasting 14 weeks. The pre- and post-sport program comparison showed a reduction in total cholesterol, low-density lipoprotein, and non-high-density lipoprotein (HDL), and an increase in HDL and MVPA time in the intervention group. Sports activities accounted for 42% of the MVPA daily recommendation, and at the end of the intervention period, only seven subjects maintained a positive diagnosis for pre-MetS or MetS. This study showed that recreational sports activities had a significant impact on the lipid profile.
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16
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Bayoumi NS, Helzner E, Afable A, Joseph MA, Dhuper S. A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population. BMC Pediatr 2019; 19:378. [PMID: 31651274 PMCID: PMC6813042 DOI: 10.1186/s12887-019-1763-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents. Methods The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2–19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score. Results The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was − 3.0 (95% CI: − 5.0, − 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was − 0.15 (95% CI: − 0.2, − 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of − 15.3 mmHg (p < 0.0001) and − 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and − 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043). Conclusions Participation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.
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Affiliation(s)
- Nagla S Bayoumi
- Department of Epidemiology & Biostatistics, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Elizabeth Helzner
- Department of Epidemiology & Biostatistics, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Aimee Afable
- Department of Community Health Sciences, SUNY Downstate Medical Center, School of Public Health, Brooklyn, NY, USA
| | - Michael A Joseph
- Department of Epidemiology & Biostatistics, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Sarita Dhuper
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, USA
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17
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Birch L, Perry R, Hunt LP, Matson R, Chong A, Beynon R, Shield JP. What change in body mass index is associated with improvement in percentage body fat in childhood obesity? A meta-regression. BMJ Open 2019; 9:e028231. [PMID: 31473614 PMCID: PMC6720247 DOI: 10.1136/bmjopen-2018-028231] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/12/2019] [Accepted: 06/25/2019] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Laura Birch
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Linda P Hunt
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Rhys Matson
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Amanda Chong
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Rhona Beynon
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Julian Ph Shield
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Level 6 University Hospitals Bristol Education Centre, Bristol, UK
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18
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Papandreou D, Karavetian M, Karabouta Z, Andreou E. Obese Children with Metabolic Syndrome Have 3 Times Higher Risk to Have Nonalcoholic Fatty Liver Disease Compared with Those without Metabolic Syndrome. Int J Endocrinol 2017; 2017:2671692. [PMID: 29118811 PMCID: PMC5651153 DOI: 10.1155/2017/2671692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD) in obese children. One hundred and twenty-five subjects aged 11-12 years old participated in the study. METHODS Anthropometric and biochemical indices were measured, including lipid and liver profile, blood glucose, serum insulin, and liver ultrasound. RESULTS Forty-four children (58.6%) were found to have MS. Insulin resistance was present in 78 (62.4%) children. Patients with MS were more likely to have NAFLD (P < 0.001). Children with NAFLD had significantly higher body mass index, waist circumference, triglycerides, fasting insulin, and lower high-density lipoprotein compared to patients with normal livers (P < 0.001). Insulin resistance was significantly higher in children with NAFLD (P < 0.001). Obese children presenting with MS were 3.01 (2.87-3.57, P < 0.002) times more likely to develop NAFLD compared to those without metabolic syndrome after adjustment of cofounders. CONCLUSIONS Obese children with MS have a higher risk of developing NAFLD. Weight management and early prevention should be the first line of treatment to prevent any possible health issues later on.
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Affiliation(s)
| | - Mirey Karavetian
- Department of Health Sciences, CNHS, Zayed University, Abu Dhabi, UAE
| | - Zacharoula Karabouta
- 2nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Andreou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Cui Z, Seburg EM, Sherwood NE, Faith MS, Ward DS. Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database. Trials 2015; 16:564. [PMID: 26651822 PMCID: PMC4674912 DOI: 10.1186/s13063-015-1089-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/27/2015] [Indexed: 12/27/2022] Open
Abstract
Background Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component. Methods First, completed home-, community-, and school-based trials involving minority or low-income children aged 2–17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information. Results Our final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size. Conclusions Variable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted.
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Affiliation(s)
- Zhaohui Cui
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
| | - Elisabeth M Seburg
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Myles S Faith
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
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20
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Browning MG, Bean MK, Wickham EP, Stern M, Evans RK. Cardiometabolic and Fitness Improvements in Obese Girls Who Either Gained or Lost Weight during Treatment. J Pediatr 2015; 166:1364-9. [PMID: 25890676 PMCID: PMC4446179 DOI: 10.1016/j.jpeds.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/03/2015] [Accepted: 03/05/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the quality of weight change (change in fat mass vs fat-free mass [FFM]), changes in cardiorespiratory fitness (CRF), and frequencies of metabolic risk factors in adolescent females with obesity who either lost or gained weight following lifestyle treatment. STUDY DESIGN Fifty-eight girls (mean age = 13.0 ± 1.6 years; 77% black; mean body mass index = 36.5 ± 4.5 kg/m(2)) completed a 6-month lifestyle intervention combining dietary and behavioral counseling with aerobic and resistance exercise training. We examined baseline to 6-month differences in weight (kg), body composition, CRF, and frequencies of metabolic risk factors between weight loss and weight gain groups. RESULTS In the weight loss group, body weight (-4.50 ± 3.53 kg, P < .001), fat mass (-4.50 ± 2.20 kg, P < .001), and body fat percentage (-2.97% ± 1.45%, P < .001) decreased, and FFM was unchanged at 6 months. In the weight gain group, body weight (4.50 ± 2.20 kg, P < .001), fat mass (1.52 ± 3.16 kg, P < .024), and FFM (2.99 ± 2.45 kg, P < .001) increased, and body fat percentage was unchanged. Both groups improved CRF (P < .05). Frequencies of metabolic risk factors were reduced across all participants after the 6-month treatment. CONCLUSIONS Participation in a weight management program might elicit health improvements in obese adolescent females who increase weight and fat mass, provided that FFM gains are sufficient to negate increases in body fat percentage. TRIAL REGISTRATION ClinicalTrials.gov: NCT00167830.
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Affiliation(s)
- Matthew G. Browning
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA
| | - Melanie K. Bean
- Healthy Lifestyle Center, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Edmond P. Wickham
- Healthy Lifestyle Center, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA,Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Marilyn Stern
- Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL
| | - Ronald K. Evans
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA,Healthy Lifestyle Center, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
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21
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Bean MK, Powell P, Quinoy A, Ingersoll K, Wickham EP, Mazzeo SE. Motivational interviewing targeting diet and physical activity improves adherence to paediatric obesity treatment: results from the MI Values randomized controlled trial. Pediatr Obes 2015; 10:118-25. [PMID: 24729537 PMCID: PMC4197118 DOI: 10.1111/j.2047-6310.2014.226.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adherence is a challenge in obesity treatment. Motivational interviewing (MI) may promote patient adherence. MI Values is a randomized controlled trial of MI implemented as an adjunct to an adolescent obesity treatment [Teaching Encouragement Exercise Nutrition Support (T.E.E.N.S.)]. OBJECTIVE Assess effects of MI Values on T.E.E.N.S. attrition and adherence. METHODS Participants were randomized to MI (n = 58) or control (n = 41). At weeks 1 and 10, MI participants had brief MI sessions; controls viewed health education videos. All participants continued with T.E.E.N.S. (biweekly dietitian and behavioural support visits; 3 times per week supervised physical activity). Assessments were repeated at baseline, 3 and 6 months. T-tests and chi-square analyses examined T.E.E.N.S. attrition and adherence by group. RESULTS Adolescents (N = 99) were primarily African-American (73%) females (74%); age = 13.8 ± 1.8 years, body mass index percentile = 98.0 ± 1.2. Compared with controls, MI participants had greater 3-month adherence overall (89.2% vs. 81.0%, P = 0.040), and to dietitian (91.3% vs. 84.0%; P = 0.046) and behavioural support (92.9% vs. 85.2%; P = 0.041) visits, and greater 6-month adherence overall (84.4% vs. 76.2%, P = 0.026) and to behavioural support visits (87.5% vs. 78.8%, P = 0.011). CONCLUSIONS MI enhanced adherence to this obesity intervention. MI Values is the first study to examine the impact of MI on treatment adherence among obese, primarily African-American adolescents.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University,Department of Psychology, Virginia Commonwealth University
| | | | - Alexis Quinoy
- Department of Psychology, Virginia Commonwealth University
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia
| | - Edmond P. Wickham
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University,Department of Internal Medicine, Virginia Commonwealth University
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University,Department of Psychology, Virginia Commonwealth University
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22
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Brackney DE, Cutshall M. Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse. J Sch Nurs 2014; 31:6-21. [PMID: 24862181 DOI: 10.1177/1059840514535445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Childhood obesity and the early development of type 2 diabetes (T2 DM) place students at risk for chronic health problems. The school nurse is uniquely situated to promote school health initiatives that influence health behavior. The purpose of this review was to determine effective nonpharmacological interventions for prevention of T2 DM in youth. Researchers from 35 reports modified T2 DM risk factors. These nonpharmacological interventions often include increasing daily activity, decreasing caloric intake, and increasing muscle mass. Some researchers also included psychological and social support interventions intended to strengthen initiating and/or maintaining health behavior. Characteristics of effective nonpharmacological T2 DM prevention interventions are discussed. Findings from this review are a useful guide for the implementation of T2 DM prevention strategies in the school setting. Few school-based studies included high school students; therefore, further research is needed among older adolescents on the efficacy of nonpharmacological interventions in the high school.
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Affiliation(s)
- Dana E Brackney
- Department of Nursing, College of Health Sciences, Appalachian State University, Boone, NC, USA
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23
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Schranz N, Tomkinson G, Olds T. What is the effect of resistance training on the strength, body composition and psychosocial status of overweight and obese children and adolescents? A Systematic review and meta-analysis. Sports Med 2014; 43:893-907. [PMID: 23729196 DOI: 10.1007/s40279-013-0062-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Overweight and obese children and adolescents face many physical and psychosocial hardships. Resistance training is a modality of exercise which allows this at-risk group to excel and therefore has the potential to positively affect not only their physical but also psychosocial health. OBJECTIVE To systematically review and meta-analyse the peer-reviewed literature to determine the effect of resistance training on the strength, body composition and psychosocial status of overweight and/or obese children and/or adolescents. DATA SOURCES Relevant databases (MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, CINAHL, PsycINFO, Cochrane library, ProQuest) were searched up to and including 30 January 2013. STUDY SELECTION Included studies (n = 40, from the 2,247 identified) were randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs) and uncontrolled trials (UCTs) which had run an exercise intervention, with a resistance training component, for overweight and/or obese children and/or adolescents, and which had examined the effect of resistance training on either strength, body composition or psychosocial outcomes. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were initially critically appraised for risk of bias by the lead author, following which both co-authors critically appraised five randomly selected studies to assess reliability. RESULTS Randomised controlled trials and NRCTs were analysed separately from UCTs. To determine the overall intervention effect for each outcome variable for each study design group, standardised mean differences were calculated with each individual study/data set weighted by the inverse of the pooled variance. The overall intervention effect reported for RCTs and NRCTs was relative to the control group whereas the effect reported for UCTs shows an overall post-intervention effect. Subgroup analyses, which determined whether the overall intervention effect was influenced by intervention type, training volume, age, sex, risk of bias or study design (for RCT/NRCT group only), were run using the same summary measure. Typically, resistance training had very small to small effects on body composition and moderate to large effects on strength in favour of the intervention. However, the magnitude and direction of the effect of resistance training on psychological outcomes are still unclear given the limited number of studies which looked at psychosocial outcomes and the inconclusive results shown by this review. Uncontrolled trials typically showed larger intervention effects than RCTs and NRCTs; however, these results may be greatly influenced by maturational changes rather than the intervention itself. LIMITATIONS The included studies employed a number of different exercise intervention types (e.g. resistance training, resistance plus aerobic training etc.) that ranged from 6 to 52 weeks in duration. Studies also employed a number of different methodologies to assess similar outcome measures (e.g. dual energy X-ray absorptiometry versus skinfolds to assess body composition; one-repetition maximum testing versus hand grip strength to assess strength). However, by completing subgroup analyses and using a standardised summary measure these limitations have been accounted for. CONCLUSION While the effect of resistance training on the body composition and strength of overweight and obese children and adolescents is clear, given the paucity of conclusive data more studies are needed to fully understand the effect of resistance training on the psychosocial status of this population.
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Affiliation(s)
- Natasha Schranz
- Health and Use of Time (HUT) Group, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Vanguri P, Brengman M, Oiticica C, Wickham E, Bean M, Lanning D. Laparoscopic gastric plication in the morbidly obese adolescent patient. Semin Pediatr Surg 2014; 23:24-30. [PMID: 24491365 PMCID: PMC3924861 DOI: 10.1053/j.sempedsurg.2013.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Childhood obesity is a significant problem. Due in part to suboptimal weight loss with lifestyle intervention alone, bariatric surgery, combined with ongoing lifestyle changes, has become a favorable approach in adolescents with severe obesity and weight-related comorbidities and is associated with effective weight loss and reducing weight-related comorbidities. Laparoscopic greater curvature plication is a promising new bariatric surgical procedure that has been shown to be effective in adults with severe obesity but has not been evaluated in the adolescent population. Gastric plication may be a particularly attractive approach for the adolescent patient as it is potentially reversible, does not involve the surgical removal of tissue, and is without a significant malabsorptive component. Our team has obtained approval from our Institutional Review Board to perform a laparoscopic greater curvature plication on 30 adolescent patients with severe obesity and study its effect on weight loss, metabolic effects, and psychological functioning in the setting of a multidisciplinary program. Results of this study, including comprehensive clinical and psychological data collected over a 3.5-year span, will inform larger prospective investigations comparing the laparoscopic greater curvature plication and other bariatric operations in the adolescent population.
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Affiliation(s)
- Poornima Vanguri
- Department of Surgery, Virginia Commonwealth University Medical Center
| | | | - Claudio Oiticica
- Department of Surgery, Virginia Commonwealth University Medical Center
| | - Edmond Wickham
- Department of Internal Medicine, Virginia Commonwealth University Medical Center
| | - Melanie Bean
- Department of Endocrinology, Virginia Commonwealth University Medical Center
| | - David Lanning
- Department of Surgery, Virginia Commonwealth University Medical Center,corresponding author: PO Box 980015, Richmond, VA 23298-0015, Office (804) 828-3500; fax (804) 828-8606,
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25
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Vanguri P, Lanning D, Wickham EP, Anbazhagan A, Bean MK. Pediatric health care provider perceptions of weight loss surgery in adolescents. Clin Pediatr (Phila) 2014; 53:60-5. [PMID: 23983022 DOI: 10.1177/0009922813500848] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored pediatric health care providers' obesity treatment practices and perceptions about adolescent weight loss surgery (WLS). Surveys were e-mailed to pediatric listservs. After descriptive analyses, correlations, chi-squares, and one-way analyses of variance compared responses by provider characteristics. Surveys were completed by 109 providers. Almost half do not routinely measure body mass index. Providers typically counsel patients about lifestyle change, with limited perceived benefit; <10% have ever referred patients for WLS, citing cost (20%), risk (49%), or "not indicated in pediatrics" (17%) as reasons. However, when presented with patient scenarios of different ages and comorbidities, likeliness to refer for WLS increased substantially. Surgeons, younger providers and those with fewer years of experience were more likely to refer for WLS (P < .05). Despite expert consensus recommendations supporting WLS as part of a comprehensive obesity treatment plan, significant pediatric provider resistance to refer obese adolescents remains. Improved referral and management practices are needed.
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Affiliation(s)
- Poornima Vanguri
- 1Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
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26
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Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol 2013; 3:1-58. [PMID: 23720280 DOI: 10.1002/cphy.c110062] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Metabolic syndrome (MS) is a collection of cardiometabolic risk factors that includes obesity, insulin resistance, hypertension, and dyslipidemia. Although there has been significant debate regarding the criteria and concept of the syndrome, this clustering of risk factors is unequivocally linked to an increased risk of developing type 2 diabetes and cardiovascular disease. Regardless of the true definition, based on current population estimates, nearly 100 million have MS. It is often characterized by insulin resistance, which some have suggested is a major underpinning link between physical inactivity and MS. The purpose of this review is to: (i) provide an overview of the history, causes and clinical aspects of MS, (ii) review the molecular mechanisms of insulin action and the causes of insulin resistance, and (iii) discuss the epidemiological and intervention data on the effects of exercise on MS and insulin sensitivity.
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Affiliation(s)
- Christian K Roberts
- Exercise and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing, University of California at Los Angeles, Los Angeles, California, USA.
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27
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Abrams P, Levitt Katz LE, Moore RH, Xanthopoulos MS, Bishop-Gilyard CT, Wadden TA, Berkowitz RI. Threshold for improvement in insulin sensitivity with adolescent weight loss. J Pediatr 2013; 163:785-90. [PMID: 23706362 PMCID: PMC3817268 DOI: 10.1016/j.jpeds.2013.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 02/11/2013] [Accepted: 04/03/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the association of weight loss and insulin sensitivity, glucose tolerance, and metabolic syndrome (MS) in obese adolescents following weight loss treatment, and to determine the threshold amount of weight loss required to observe improvements in these measures. STUDY DESIGN A randomized, controlled behavioral weight loss trial was conducted with 113 obese adolescents. Changes in fasting insulin, homeostasis model assessment of insulin resistance, whole body insulin sensitivity index (WBISI), body mass index (BMI), and MS criteria were assessed at baseline and at month 4. RESULTS There was significant improvement in all measures of insulin sensitivity at month 4. Mean fasting insulin dropped from 22.3 to 16.6 μU/mL (P < .0001). Homeostasis model assessment of insulin resistance decreased significantly from 4.9 to 3.7 (P = .001) and WBISI increased significantly from 2.87 to 3.98 (P < .0001). An 8% reduction in BMI led to a significant improvement in WBISI (P = .03) and was the optimal threshold. Fewer individuals met criteria for MS after weight loss (P = .0038), although there were no significant changes in the individual features of the syndrome. CONCLUSIONS In this trial, weight loss at month 4 was associated with improved insulin sensitivity in obese adolescents. An approximate decrease in BMI of 8% was the threshold level at which insulin sensitivity improved. As more weight loss programs are designed for obese adolescents, it will be important to have reasonable weight loss goals that will yield improvements in metabolic and cardiovascular disease risk factors.
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Affiliation(s)
- Pamela Abrams
- Division of Endocrinology and Diabetes, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Lorraine E. Levitt Katz
- Division of Endocrinology and Diabetes, Dept of Pediatrics, The Children's Hospital of Philadelphia, Dept of Pediatrics, University of Pennsylvania School of Medicine
| | - Reneé H. Moore
- Dept of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine
| | | | - Chanelle T. Bishop-Gilyard
- Dept of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia, Dept of Psychiatry, University of Pennsylvania School of Medicine
| | - Thomas A. Wadden
- Dept of Psychiatry, University of Pennsylvania School of Medicine
| | - Robert I. Berkowitz
- Dept of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia; Dept of Psychiatry, University of Pennsylvania School of Medicine
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DeBoer MD. Obesity, systemic inflammation, and increased risk for cardiovascular disease and diabetes among adolescents: a need for screening tools to target interventions. Nutrition 2013; 29:379-86. [PMID: 23022122 PMCID: PMC3578702 DOI: 10.1016/j.nut.2012.07.003] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 12/16/2022]
Abstract
Cardiovascular disease (CVD) and type 2 diabetes mellitus have their roots in childhood, particularly in obese children and adolescents, raising important opportunities for early lifestyle intervention in at-risk individuals. However, not all obese individuals are at the same risk for disease progression. Accurate screening of obese adolescents may identify those in greatest need for intensive intervention to prevent or delay future disease. One potential screening target is obesity-related inflammation, which contributes to insulin resistance, metabolic syndrome, and CVD. In adults, the inflammatory marker high-sensitivity C-reactive protein (hsCRP) has utility for risk stratification and treatment initiation in individuals of intermediate CVD risk. In adolescents, hsCRP shares many of the associations of hsCRP in adults regarding the degree of insulin resistance, metabolic syndrome, and carotid artery media thickness. However, long-term data linking increased hsCRP levels-and increased insulin or decreased adiponectin-in childhood to adult disease outcomes are lacking at this time. Future efforts continue to be needed to identify childhood clinical and laboratory characteristics that could be used as screening tests to predict adult disease progression. Such tests may have utility in motivating physicians and patients' families toward lifestyle changes, ultimately improving prevention efforts.
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Affiliation(s)
- Mark D DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA.
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29
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Bianchini JAA, da Silva DF, Nardo CCS, Carolino IDR, Hernandes F, Nardo N. Multidisciplinary therapy reduces risk factors for metabolic syndrome in obese adolescents. Eur J Pediatr 2013; 172:215-21. [PMID: 23097084 DOI: 10.1007/s00431-012-1865-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
Abstract
This study aims to assess the effects of a 16-week multidisciplinary program of obesity treatment on the control of metabolic syndrome (MS) and dyslipidemia in obese adolescents. Eighty-six adolescents aged 10-18 years were allocated in either the intervention group (IG; n = 44) or control group (CG; n = 42). IG was submitted to a multidisciplinary intervention based on cognitive behavioral therapy that aimed to modify eating habits and exercise behavior. We analyzed, before and after the intervention period, anthropometric parameters, body composition, bone mineral density, cardiorespiratory fitness, blood pressure, glucose, insulin, and lipid profile of the subjects. MS was classified according to International Diabetes Federation (2007) and the presence of dyslipidemia according to Back et al. (Arq Bras Cardiol 85:4-36, 2005). In the beginning of the intervention, the median number (range) of risk factors for MS present was 2.0 (0.0-5.0) in the IG and 2.0 (0.0-4.0) in the CG. After the intervention, this parameter reduced significantly in the IG (1.0 (0.0-5.0); p = 0.004) while no change was observed in the CG (2.0 (0.0-4.0); p = 0.349). In addition, we observed improvements in body mass index, waist circumference, hip circumference, maximal oxygen uptake, absolute and relative body fat, systolic blood pressure, diastolic blood pressure, and total cholesterol in the IG which was not identified in the CG. Conclusio n: We suggest that a 16-week multidisciplinary intervention based on cognitive behavioral therapy was adequate to reduce risk factors for MS in obese adolescents.
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Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol 2013. [PMID: 23720280 DOI: 10.1002/cphy.c110062.metabolic] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Metabolic syndrome (MS) is a collection of cardiometabolic risk factors that includes obesity, insulin resistance, hypertension, and dyslipidemia. Although there has been significant debate regarding the criteria and concept of the syndrome, this clustering of risk factors is unequivocally linked to an increased risk of developing type 2 diabetes and cardiovascular disease. Regardless of the true definition, based on current population estimates, nearly 100 million have MS. It is often characterized by insulin resistance, which some have suggested is a major underpinning link between physical inactivity and MS. The purpose of this review is to: (i) provide an overview of the history, causes and clinical aspects of MS, (ii) review the molecular mechanisms of insulin action and the causes of insulin resistance, and (iii) discuss the epidemiological and intervention data on the effects of exercise on MS and insulin sensitivity.
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Affiliation(s)
- Christian K Roberts
- Exercise and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing, University of California at Los Angeles, Los Angeles, California, USA.
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31
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Schwarz ER, Willix RD. Impact of a physician-supervised exercise-nutrition program with testosterone substitution in partial androgen-deficient middle-aged obese men. J Geriatr Cardiol 2012; 8:201-6. [PMID: 22783306 PMCID: PMC3390090 DOI: 10.3724/sp.j.1263.2011.00201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/09/2011] [Accepted: 09/16/2011] [Indexed: 11/25/2022] Open
Abstract
Background Partial androgen deficiency syndrome in the aging male is associated with signs of aging such as a development of abdominal obesity, sexual dysfunction, increase body fat, weight gain and the development of cardiac disease. Objective We assessed the outcome of a commercially available physician supervised nutrition and exercise program with concomitant testosterone replacement therapy in middle age obese men with partial androgen deficiency in order to reduce cardiac risks factors. Methods Fifty-six self referred men without diabetes mellitus, hypertension, or cardiovascular disease (ages 52.3 ± 7.8 years) were randomly selected from a large cohort. Baseline weight, body fat composition, fasting glucose, hemoglobin A1c and fasting lipid levels, as well as free and total testosterone levels were assessed. All patients were assessed and followed 6–18 months after initiation of the program. The program consisted of a low glycemic load balanced nutrition diet, a recommended structured daily exercise program of 30–60 minutes, as well as once to twice weekly intramuscular testosterone injections (113.0 ± 27.8 mg). Results At follow up, weight was reduced from 233.9 ± 30.0 pounds (lbs) to 221.3 ± 25.1 lbs (P < 0.001), BMI was reduced from 33.2 ± 3.3 kg/m2 to 31.3 ± 2.8 kg/m2 (P < 0.0001). Total body fat was 27.1% ± 5.2% vs. 34.3% ± 5.7% at baseline (P < 0.0001). Fasting glucose was reduced from 95.3 ± 14.4 mg/dL to 87.5 ± 12.6 mg/dL (P < 0.0001). Total cholesterol was reduced from 195.4 ± 33.0 mg/dL to 172.7 ± 35.0 mg/dL (P < 0.005). No clinically significant adverse events were recorded. Conclusions Testosterone replacement therapy in middle aged obese men with partial androgen deficiency appeared safe and might have promoted the effects of a weight reduction diet and daily exercise program as long as an adequate physician supervision and follow up was granted. The combination therapy significantly reduced coronary risk factors such as glucose intolerance and hyperlipidemia.
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Affiliation(s)
- Ernst R Schwarz
- Cenegenics Education and Research Foundation, Las Vegas and Heart Institute of Southern California, Beverly Hills, 348 S Oakhurst Dr, Beverly Hills, CA 90212, USA
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Niemeier BS, Hektner JM, Enger KB. Parent participation in weight-related health interventions for children and adolescents: a systematic review and meta-analysis. Prev Med 2012; 55:3-13. [PMID: 22575353 DOI: 10.1016/j.ypmed.2012.04.021] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/26/2012] [Accepted: 04/27/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review child and adolescent weight-related health intervention characteristics, with a particular focus on levels of parental participation, and examine differences in intervention effectiveness. METHODS Multiple social science, health, and medical databases were searched, and experimental randomized controlled studies of child and adolescent weight-related health interventions, reported in January 2004 through December 2010, were collected. Intervention characteristics were reviewed, and pre- and post-measurement data, including body mass index, were extracted for analyses. Differences in effect sizes of experimental and control groups were used to evaluate effectiveness of interventions. RESULTS Reports of 42 interventions were included. Intervention activities consisted of nutrition education, physical activity education, physical activity sessions, behavior education, behavior therapy, or a combination of these activities. Significant differences existed among levels of parent participation, p<0.05. In addition, intervention duration positively predicted intervention effectiveness, p=0.006, and the linear combination of parent participation and intervention duration significantly predicted intervention effectiveness, p=0.001. CONCLUSIONS This study suggests that weight-related health interventions that require parent participation more effectively reduce body mass indexes of child and adolescent participants. In addition, longer interventions that include parent participation appear to have greater success. Suggestions for future research and related interventions are provided.
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Affiliation(s)
- Brandi S Niemeier
- University of Wisconsin-Whitewater, Department of Health, Physical Education, Recreation, & Coaching, 130 Williams Center, 800 West Main Street, Whitewater, WI 53190, USA.
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El-Koofy NM, Anwar GM, El-Raziky MS, El-Hennawy AM, El-Mougy FM, El-Karaksy HM, Hassanin FM, Helmy HM. The association of metabolic syndrome, insulin resistance and non-alcoholic fatty liver disease in overweight/obese children. Saudi J Gastroenterol 2012; 18:44-9. [PMID: 22249092 PMCID: PMC3271694 DOI: 10.4103/1319-3767.91738] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/AIM To study the prevalence of metabolic syndrome (MS), insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) in overweight/obese children with clinical hepatomegaly and/or raised alanine aminotransferase (ALT). PATIENTS AND METHODS Thirty-three overweight and obese children, aged 2-13 years, presenting with hepatomegaly and/or raised ALT, were studied for the prevalence of MS, IR and NAFLD. Laboratory analysis included fasting blood glucose, serum insulin, serum triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c) and liver biochemical profile, in addition to liver ultrasound and liver biopsy. RESULTS Twenty patients (60.6%) were labeled with MS. IR was present in 16 (48.4%). Fifteen (44%) patients had biopsy-proven NAFLD. Patients with MS were more likely to have NAFLD by biopsy (P=0.001). Children with NAFLD had significantly higher body mass index, waist circumference, ALT, total cholesterol, LDL-c, TG, fasting insulin, and lower HDL-c compared to patients with normal liver histology (P< 0.05) and fitted more with the criteria of MS (80% vs. 44%). IR was significantly more common among NAFLD patients (73% vs. 28%). CONCLUSION There is a close association between obesity, MS, IR and NAFLD. Obese children with clinical or biochemical hepatic abnormalities are prone to suffer from MS, IR and NAFLD.
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Affiliation(s)
| | - Ghada M. Anwar
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | | | | | - Hanaa M. El-Karaksy
- Department of Pediatrics, Cairo University, Cairo, Egypt,Address for correspondence: Dr. Hanaa El-Karaksy, 44 Mohei El-Deen Abu El-Ezz Street, Dokki, Cairo, 12311, Egypt. E-mail:
| | | | - Heba M. Helmy
- Department of Pediatrics, Cairo University, Cairo, Egypt
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Tamariz L, Palacio A, Yang Y, Parris D, Ben-Joseph R, Florez H. Health economics perspective of the components of the cardiometabolic syndrome. J Clin Hypertens (Greenwich) 2011; 12:549-55. [PMID: 20629820 DOI: 10.1111/j.1751-7176.2010.00297.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The components of the cardiometabolic syndrome (CMS) increase the risk of coronary artery disease (CAD). The authors compared 12-month costs of subjects with different number of components of the CMS. In claims data from a large health benefits company, 383,420 individuals with the first International Classification of Diseases, Ninth Revision codes for hypertension, diabetes, lipid abnormalities, and obesity were identified. Patients were stratified according to presence of CAD and the number of components of the CMS. Twelve-month costs were added after the identification of the risk factor. Mean annual costs increased with the number of components of CMS both in those with and without CAD, even after adjusting for age, sex, and comorbidities (P<.01). Similar trends were seen for medical and pharmacy costs. The adjusted total annual health care cost in those with an isolated component of the CMS was $5564 (95% confidence interval: $5491-$5631) while in those with 4 components was $12,287 (95% confidence interval: $11,987-$12,587). Individuals with accumulating components of the CMS have higher health care costs regardless of age, sex, and other comorbidities.
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Affiliation(s)
- Leonardo Tamariz
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Pacifico L, Anania C, Martino F, Poggiogalle E, Chiarelli F, Arca M, Chiesa C. Management of metabolic syndrome in children and adolescents. Nutr Metab Cardiovasc Dis 2011; 21:455-466. [PMID: 21565479 DOI: 10.1016/j.numecd.2011.01.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 02/06/2023]
Abstract
Concomitantly with the increasing prevalence of childhood obesity, the prevalence of metabolic syndrome (MS) is rising among children and adolescents, leading to fears for future epidemics of type 2 diabetes mellitus and cardiovascular disease in the young. This makes the accurate identification and the appropriate treatment of children and adolescents with MS an important priority for health care systems. This review will focus on the management of each component of MS, including the nonalcoholic fatty liver disease (NAFLD), which is currently considered as the hepatic component of the syndrome. The most relevant target of treatment of MS in children and adolescents is the abdominal obesity. To this end, we will discuss the efficacy of dietary approaches, possibly coupled with regular physical activity, on eliciting visceral fat reduction. We will also highlight several aspects of the treatment of the high triglyceride/low high-density lipoprotein cholesterol phenotype, including the use of non-pharmacological measures, and indications for instituting drug therapies. Part of this review will address treatment of glucose abnormalities, including the benefits of lifestyle modification alone, and the potential adjunctive role of hypoglycemic drugs. The treatment of hypertension in children with MS also requires a multifaceted approach and the available data of this topic will be examined. The remainder of this review will address treatment to reverse NAFLD and prevent progression to end-stage disease.
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Affiliation(s)
- L Pacifico
- Department of Pediatrics, La Sapienza University of Rome, 00161 Rome, Italy
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Buonani C, Fernandes RA, Silveira LS, Bastos KDN, Monteiro PA, Viotto Filho I, F. Júnior IF. Prevenção da síndrome metabólica em crianças obesas: uma proposta de intervenção. REVISTA PAULISTA DE PEDIATRIA 2011. [DOI: 10.1590/s0103-05822011000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJETIVO: Analisar o efeito de 12 semanas de intervenção envolvendo prática de atividade física, orientações alimentar e psicológica sobre fatores de risco para o desenvolvimento da síndrome metabólica em crianças e adolescentes obesos. MÉTODOS: Estudo longitudinal com 23 crianças e adolescentes obesos, com idade entre seis e 16 anos (12,0±3,2 anos). Foram mensurados: gordura corporal total e de tronco, glicemia, colesterol total e triglicérides, pressão arterial sistólica e diastólica. Os jovens foram submetidos a três sessões semanais de 60 minutos de exercício físico (atividades esportivas recreativas, ginástica, circuitos e caminhadas), durante 12 semanas. O teste do qui-quadrado foi usado para comparar dados categóricos daqueles que apresentaram valores acima das recomendações para cada fator de risco. O teste t para dados pareados foi aplicado para comparar os dois momentos do estudo. RESULTADOS: Em indivíduos com alterações metabólicas no início do estudo, observou-se, após a intervenção, a diminuição de 11,6% na glicemia (105 para 93mg/dL; p=0,046) e de 24,9% no triglicérides (217 para 163mg/dL; p=0,013); porém, não houve diferenças na pressão arterial e no colesterol total. CONCLUSÕES: O programa de exercício físico aplicado nas crianças e adolescentes foi eficiente para melhorar os valores de glicemia e triglicérides.
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Affiliation(s)
- Camila Buonani
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
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Kolsgaard MLP, Joner G, Brunborg C, Anderssen SA, Tonstad S, Andersen LF. Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study - a hospital/public health nurse combined treatment. BMC Pediatr 2011; 11:47. [PMID: 21619652 PMCID: PMC3121603 DOI: 10.1186/1471-2431-11-47] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/27/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Weight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results. METHODS From 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1-< 0.23, Group 3: decrease in/stable BMI z-score≥0.0-< 0.1, Group 4: increase in BMI z-score (>0.00-0.55). RESULTS 230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio. CONCLUSIONS Even a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.
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Bean MK, Mazzeo SE, Stern M, Evans R, Bryan D, Ning Y, Wickham EP, Laver J. Six-month dietary changes in ethnically diverse, obese adolescents participating in a multidisciplinary weight management program. Clin Pediatr (Phila) 2011; 50:408-16. [PMID: 21224253 PMCID: PMC3683394 DOI: 10.1177/0009922810393497] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study's objective was to examine dietary and metabolic changes in obese adolescents who completed 6 months of participation in an outpatient multidisciplinary weight management program (N = 67). Participants (75% African American, 66% female, mean age = 13.7 years) completed 24-hour dietary recalls and underwent measurement of anthropometrics and fasting blood lipid parameters at baseline and after 6 months of participation. General linear models suggested that participants significantly reduced total energy, total fat, saturated fat, carbohydrate, sodium, and sugar intakes, and increased fiber and fruit and vegetable intake (P < .05). Gender-stratified models showed differences in fruit/vegetable intake, percentage calories from fat, sodium, and dietary cholesterol intakes by gender. Significant improvements in body mass index percentile and lipid profiles were also found, lending objective support to the dietary changes participants made. Findings suggest that participation in this multidisciplinary treatment helped participants make behaviorally based dietary changes, which were associated with improved dietary intakes and health status.
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Affiliation(s)
- MK Bean
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298,Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298
| | - SE Mazzeo
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298,Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298
| | - M Stern
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298,Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298
| | - R Evans
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA 23298
| | - D Bryan
- Department of Family Medicine, Virginia Commonwealth University, Richmond, VA 23298
| | - Y Ning
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23298
| | - EP Wickham
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298,Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298
| | - J Laver
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298
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Bean MK, Mazzeo SE, Stern M, Bowen D, Ingersoll K. A values-based Motivational Interviewing (MI) intervention for pediatric obesity: study design and methods for MI Values. Contemp Clin Trials 2011; 32:667-74. [PMID: 21554994 DOI: 10.1016/j.cct.2011.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 03/22/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
To reduce pediatric obesity in clinical settings, multidisciplinary behaviorally-based treatment programs are recommended. High attrition and poor compliance are two difficulties frequently encountered in such programs. A brief, empathic and directive clinical intervention, Motivational Interviewing (MI), might help address these motivational and behavioral issues, ultimately resulting in more positive health outcomes. The efficacy of MI as an adjunct in the treatment of pediatric obesity remains relatively understudied. MI Values was developed to implement within an existing multidisciplinary treatment program for obese, ethnically diverse adolescents, the T.E.E.N.S. Program (Teaching, Encouragement, Exercise, Nutrition, Support). T.E.E.N.S. participants who consent to MI Values are randomized to either MI or an education control condition. At weeks 1 and 10 of T.E.E.N.S. participation, the subset of participants assigned to the MI condition engages in individual MI sessions and control participants view health education videos. All MI sessions are audiotaped and coded to monitor treatment fidelity, which has been satisfactory thus far. Participants complete comprehensive assessments at baseline, 3- and 6-month follow-ups. We hypothesize that MI participants will demonstrate greater reductions in Body Mass Index (BMI) percentile, improved diet and physical activity behaviors, better compliance with T.E.E.N.S., and lower attrition than participants in the control group. We present study design and methods for MI Values as well as data on feasibility of recruitment methods and treatment integrity. At study completion, findings will contribute to the emerging literature examining the efficacy of MI in the treatment of pediatric obesity.
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Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298-0440, United States.
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Deboer MD. Ethnicity, obesity and the metabolic syndrome: implications on assessing risk and targeting intervention. Expert Rev Endocrinol Metab 2011; 6:279-289. [PMID: 21643518 PMCID: PMC3105461 DOI: 10.1586/eem.11.17] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric obesity threatens the future health of a growing number of children worldwide. An added challenge in identifying the patients at greatest need for intervention due to their elevated risk for future disease is that pediatric obesity and the associated metabolic syndrome manifest differently among different ethnic groups. African-Americans and Hispanics are more likely to exhibit obesity and insulin resistance and are at a higher risk for developing Type 2 diabetes. Nevertheless, using current criteria, African-American adolescents are much less likely to be diagnosed with metabolic syndrome, largely owing to lower rates of dyslipidemia. Further development is needed in ethnicity-inclusive means of risk identification among adolescents to accurately target treatment toward children at highest risk for future disease and to motivate adolescent patients and their families towards lifestyle improvement. Effective targeting and intensive treatment efforts may help in avoiding future sequelae of obesity among all ethnicities.
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Affiliation(s)
- Mark D Deboer
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA 22908, USA Tel.: +1 434 924 9833
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de Mello MT, de Piano A, Carnier J, Sanches PDL, Corrêa FA, Tock L, Ernandes RMY, Tufik S, Dâmaso AR. Long-Term Effects of Aerobic Plus Resistance Training on the Metabolic Syndrome and Adiponectinemia in Obese Adolescents. J Clin Hypertens (Greenwich) 2010; 13:343-50. [DOI: 10.1111/j.1751-7176.2010.00388.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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