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Herouvi D, Paltoglou G, Soldatou A, Kalpia C, Karanasios S, Karavanaki K. Lifestyle and Pharmacological Interventions and Treatment Indications for the Management of Obesity in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1230. [PMID: 37508727 PMCID: PMC10378563 DOI: 10.3390/children10071230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Obesity is a multifactorial chronic impairment that further decreases quality of life and life expectancy. Worldwide, childhood obesity has become a pandemic health issue causing several comorbidities that frequently present already in childhood, including cardiovascular (hypertension, dyslipidemia), metabolic (Type 2 diabetes mellitus, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal and musculoskeletal disorders. In addition, obese children frequently experience stress and psychosocial symptoms, including mood disorders, anxiety, prejudice and low self-esteem. Given that cardiovascular risk factors and pediatric obesity have the tendency to pertain into adulthood, obesity management, including weight control and physical activity, should start before the late teens and certainly before the first signs of atherosclerosis can be detected. This review aims to concisely present options for childhood obesity management, including lifestyle modification strategies and pharmacological treatment, as well as the respective treatment indications for the general practitioner.
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Affiliation(s)
- Despina Herouvi
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - George Paltoglou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Christina Kalpia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
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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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Khalafi M, Hossein Sakhaei M, Kheradmand S, Symonds ME, Rosenkranz SK. The impact of exercise and dietary interventions on circulating leptin and adiponectin in individuals who are overweight and those with obesity: A systematic review and meta-analysis. Adv Nutr 2023; 14:128-146. [PMID: 36811585 PMCID: PMC10103003 DOI: 10.1016/j.advnut.2022.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
The effects of exercise training (Ex), dietary interventions (DIs), and a combination of Ex and DI (Ex + DI) on leptin and adiponectin have been established. However, less is known regarding the comparisons of Ex with DI and of Ex + DI with either Ex or DI alone. The aim of the present meta-analysis is to compare the effects of Ex with those of DI and those of Ex + DI with those of either Ex or DI alone on circulating leptin and adiponectin in individuals who are overweight and those with obesity. PubMed, Web of Science, and MEDLINE were searched to identify original articles, published through June 2022, that compared the effects of Ex with those of DI and/or the effects of Ex + DI with those of Ex and/or DI on leptin and adiponectin in individuals with BMIs (in kg/m2) of ≥25 and aged 7-70 y. Standardized mean differences (SMDs), weighted mean differences, and 95% CIs were calculated using random-effect models for outcomes. Forty-seven studies, comprising 3872 participants who were overweight and those with obesity, were included in the current meta-analysis. DI reduced the concentration of leptin (SMD: -0.30; P = 0.001) and increased the concentration of adiponectin (SMD: 0.23; P = 0.001) compared with Ex, as did Ex + DI (leptin: SMD: -0.34; P = 0.001; adiponectin: SMD: 0.37; P = 0.004) compared with Ex alone. However, Ex + DI did not affect the concentration of adiponectin (SMD: 0.10; P = 0.11) and led to inconsistent and nonsignificant changes in the concentration of leptin (SMD: -0.13; P = 0.06) compared with DI alone. Subgroup analyses showed that age, BMI, duration of intervention, type of supervision, quality of the study, and magnitude of energy restriction are sources of heterogeneity. Our results suggest that Ex alone was not as effective as DI or Ex + DI for decreasing leptin and increasing adiponectin in individuals with overweight and obesity. However, Ex + DI was not more effective than DI alone, suggesting that diet plays a critical role in beneficially altering the concentrations of leptin and adiponectin. This review was registered at PROSPERO as CRD42021283532.
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Affiliation(s)
- Mousa Khalafi
- Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran.
| | - Mohammad Hossein Sakhaei
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Guilan, Iran
| | - Shokoufeh Kheradmand
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran
| | - Michael E Symonds
- Centre for Perinatal Research, Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sara K Rosenkranz
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV, USA
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Giannini C, Polidori N, Neri CR, D'Adamo E, Chiarelli F, Mohn A. Gut Hormones Secretion across Clusters of Metabolic Syndrome in Prepubertal Children with Obesity. Horm Res Paediatr 2022; 95:339-346. [PMID: 35580566 DOI: 10.1159/000524830] [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: 12/29/2021] [Accepted: 04/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Metabolic Syndrome (MetS) represents a common dysmetabolic state in children with obesity. Although data in youth show a role of gut hormones (GH) in the risk of developing MetS, no data are available during the prepubertal age, especially across clusters of MetS. METHODS We characterized components of MetS and changes in GH concentrations in 90 prepubertal children with obesity compared to 30 healthy age- and gender-matched peers. Children with obesity were divided into three groups according to the number of the components of MetS (group 1: 30 obese without components of MetS; group 2: 30 obese with 1 component of MetS; group 3: 30 obese with 2 or more components of MetS). Anthropometric parameters, blood pressure (BP), fasting insulin and glycemia, lipid profile, transaminases, and GH concentration were determined. Differences across the groups were evaluated by the Kruskal-Wallis test and post hoc analysis by Mann-Whitney test. RESULTS Fasting glycemia and insulin, HOMA-IR, triglycerides, and BP progressively increased and high-density lipoprotein progressively decreased across the groups of children with obesity compared to controls, showing worse values in group 3. GLP-1 and ghrelin values progressively decreased and obestatin progressively increased. The more components of the MetS were present, the further GH concentrations deviated from standard values. DISCUSSION AND CONCLUSION Components of MetS and GH concentrations are impaired in prepubertal children with obesity compared to controls. The close association between progressive alterations in GH levels and increasing number of components of the MetS might indicate a role of these hormones in the determination of metabolic risk.
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Affiliation(s)
- Cosimo Giannini
- Department of Paediatrics, University of Chieti, Chieti, Italy
| | - Nella Polidori
- Department of Paediatrics, University of Chieti, Chieti, Italy
| | | | - Ebe D'Adamo
- Department of Neonatology, University of Chieti, Chieti, Italy
| | | | - Angelika Mohn
- Department of Paediatrics, University of Chieti, Chieti, Italy
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Ataeinosrat A, Haghighi MM, Abednatanzi H, Soltani M, Ghanbari-Niaki A, Nouri-Habashi A, Amani-Shalamzari S, Mossayebi A, Khademosharie M, Johnson KE, VanDusseldorp TA, Saeidi A, Zouhal H. Effects of Three Different Modes of Resistance Training on Appetite Hormones in Males With Obesity. Front Physiol 2022; 13:827335. [PMID: 35264977 PMCID: PMC8900747 DOI: 10.3389/fphys.2022.827335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/31/2022] [Indexed: 12/19/2022] Open
Abstract
Purpose This study explored the effect of three different modes of resistance training on appetite hormones [leptin, ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide tyrosine–tyrosine (PYY)], cardiometabolic and anthropometric measures in males with obesity. Methods Forty-four males with obesity (age: 27.5 ± 9.4 yrs.; mean weight: 93.2 ± 2.2 kg, body mass index: 32.9 ± 1.2 kg/m2) were randomized to traditional resistance training (TRT, n = 11), circuit resistance training (CRT, n = 11), interval resistance training (IRT, n = 11) or control (C, n = 11) groups. All resistance training groups received 50 min of supervised training per session, three days per week, for 12 weeks. Measurements were taken at baseline and after 12 weeks of training. Results Plasma levels of leptin, ghrelin, CCK, and PYY decreased significantly in all three different modalities of resistance training groups when compared to the control group (p < 0.05). GLP-1 increased significantly in both CRT and IRT groups compared to TRT and C groups (p < 0.05). Glucose-dependent insulinotropic polypeptide decreased significantly in CRT and IRT groups compared to the C group (p < 0.05). Adiponectin levels increased significantly in all resistance training groups compared to the C group (p < 0.05). Conclusion Overall, CRT and IRT protocols had the greatest impact on appetite hormones compared to individuals who engaged in TRT or did not exercise (C).
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Affiliation(s)
- Ali Ataeinosrat
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Hossein Abednatanzi
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Soltani
- Department of Biological Sciences in Sport, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abbass Ghanbari-Niaki
- Exercise Biochemistry Division, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Mazandaran, Iran
| | - Akbar Nouri-Habashi
- Department of Exercise Physiology and Corrective Movements, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | - Sadegh Amani-Shalamzari
- Department of Exercise Physiology, Faculty of Physical Education and Sports Science, Kharazmi University, Tehran, Iran
| | - Ali Mossayebi
- Department of Kinesiology, College of Health Sciences, University of Texas at El Paso, El Paso, TX, United States
| | - Mitra Khademosharie
- Department of Physical Education, Faculty of Literature, Kosar University of Bojnord, Bojnord, Iran
| | - Kelly E Johnson
- Department of Kinesiology, Coastal Carolina University, Conway, SC, United States
| | - Trisha A VanDusseldorp
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
| | - Hassane Zouhal
- Laboratoire Mouvement, Sport, Santé (M2S), University of Rennes, Rennes, France.,Institut International des Sciences du Sport (2I2S), Iroduer, France
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6
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Hoare JK, Jebeile H, Garnett SP, Lister NB. Novel dietary interventions for adolescents with obesity: A narrative review. Pediatr Obes 2021; 16:e12798. [PMID: 33955208 DOI: 10.1111/ijpo.12798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 12/17/2022]
Abstract
Adolescent obesity is increasing and a range of treatment approaches are needed. Provision of tailored treatment options accounting for individual and family needs, preferences, and capacity may encourage adolescents with obesity to seek treatment, and/or improve treatment outcomes. Delivered by trained health care professionals, novel dietary interventions may have utility for adolescents not responding to conventional diets, adolescents with comorbidities or severe obesity, and/or when rapid or substantial weight loss is required. This review describes current evidence and clinical considerations relating to the use of very low energy diets, low carbohydrate diets, and intermittent energy restriction in the treatment of adolescent obesity. Emerging evidence on the use of these novel dietary interventions demonstrates short-term weight-related and cardiometabolic improvements. While the evidence is encouraging, and no serious adverse effects have been reported, monitoring of intervention safety is essential. Considerations for health care professionals providing care to adolescents include nutritional adequacy, psychosocial health and social relationships during the intervention. Furthermore, long-term weight-related, cardiometabolic and psychological health outcomes of these dietary interventions are not well understood. Large randomised controlled trials are warranted to inform clinical practice and future guidelines for the use of novel dietary interventions in adolescents with obesity.
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Affiliation(s)
- Johanna K Hoare
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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7
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Vermeiren E, Bruyndonckx L, De Winter B, Verhulst S, Van Eyck A, Van Hoorenbeeck K. The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies. Nutr Metab Cardiovasc Dis 2021; 31:2575-2586. [PMID: 34172320 DOI: 10.1016/j.numecd.2021.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/19/2023]
Abstract
AIMS Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint. DATA SYNTHESIS A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved. CONCLUSION Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.
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Affiliation(s)
- Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium.
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
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8
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Ouerghi N, Feki M, Bragazzi NL, Knechtle B, Hill L, Nikolaidis PT, Bouassida A. Ghrelin Response to Acute and Chronic Exercise: Insights and Implications from a Systematic Review of the Literature. Sports Med 2021; 51:2389-2410. [PMID: 34374968 PMCID: PMC8514378 DOI: 10.1007/s40279-021-01518-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ghrelin is a peptide hormone predominantly produced by the stomach. It exerts a wide range of functions including stimulating growth hormone release and regulating appetite, food intake, and glucose and lipid metabolism. Since physical exercise affects all these aspects, a particular interest is accorded to the relationship between ghrelin and exercise. This systematic review aimed to summarize the current available data on the topic for a better understanding of the relationship. METHODS An extensive computerized search was performed in the PubMed and SPORTDiscus databases for retrieving relevant articles. The search contained the following keywords: ghrelin, appetite-related peptides, gastrointestinal peptides, gastrointestinal hormones, exercise, acute exercise, chronic exercise, training, and physical activity. Studies investigating the effects of acute/chronic exercise on circulating forms of ghrelin were included. RESULTS The initial search identified 840 articles. After screening, 80 articles were included. Despite a heterogeneity of studies and a variability of the findings, the review suggests that acute exercise suppresses acyl ghrelin production regardless of the participants and the exercise characteristics. Long- and very long-term exercise training programs mostly resulted in increased total and des-acyl ghrelin production. The increase is more noticeable in overweight/obese individuals, and is most likely due to weight loss resulting from the training program. CONCLUSION The review suggests that exercise may impact ghrelin production. While the precise mechanisms are unclear, the effects are likely due to blood flow redistribution and weight loss for acute and chronic exercise, respectively. These changes are expected to be metabolically beneficial. Further research is needed for a better understanding of the relationship between ghrelin and exercise.
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Affiliation(s)
- Nejmeddine Ouerghi
- High Institute of Sport and Physical Education of Kef, UR13JS01, University of Jendouba, 7100, Kef, Tunisia.,Faculty of Medicine of Tunis, Rabta Hospital, LR99ES11, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Moncef Feki
- Faculty of Medicine of Tunis, Rabta Hospital, LR99ES11, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, 16132, Genoa, Italy
| | - Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland. .,Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Lee Hill
- Division of Gastroenterology and Nutrition, Department of Pediatrics, McMaster University, Hamilton, L8S 4L8, Canada
| | | | - Anissa Bouassida
- High Institute of Sport and Physical Education of Kef, UR13JS01, University of Jendouba, 7100, Kef, Tunisia
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Becker KR, Mancuso C, Dreier MJ, Asanza E, Breithaupt L, Slattery M, Plessow F, Micali N, Thomas JJ, Eddy KT, Misra M, Lawson EA. Ghrelin and PYY in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. Psychoneuroendocrinology 2021; 129:105243. [PMID: 34049199 PMCID: PMC8363304 DOI: 10.1016/j.psyneuen.2021.105243] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating and failure to meet nutritional needs but is distinct from anorexia nervosa (AN) because restriction is not motivated by weight/shape concerns. We examined levels of orexigenic ghrelin and anorexigenic peptide YY (PYY) in young females with ARFID, AN and healthy controls (HC). METHODS 94 females (22 low-weight ARFID, 40 typical/atypical AN, and 32 HC ages 10-22 years) underwent fasting blood draws for total ghrelin and total PYY. A subset also provided blood 30, 60 and 120 min after a standardized meal. RESULTS Females with ARFID ate less than those with AN or HC (ps<0.012); were younger (14.4 ± 3.2 years) than those with AN (18.9 ± 3.1 years) and HC (17.4 ± 3.1 years) (ps<0.003) and at a lower Tanner stage (3.1 ± 1.5) than AN (4.5 ± 1.1;) and HC (4.4 ± 1.1; ps<0.005), but did not differ in BMI percentiles or BMI Z-scores from AN (ps>0.44). Fasting and postprandial ghrelin were lower in ARFID versus AN (ps≤.015), but not HC (ps≥0.62). Fasting and postprandial PYY did not differ between ARFID versus AN or HC (ps≥0.13); ARFID did not demonstrate the sustained high PYY levels post-meal observed in those with AN and HC. Secondary analyses controlling age or Tanner stage and calories consumed showed similar results. Exploratory analyses suggest that the timing of the PYY peak in ARFID is earlier than HC, showing a peak PYY level 30 min post-meal (p = .037). CONCLUSIONS ARFID and AN appear to have distinct patterns of secretion of gut-derived appetite-regulating hormones that may aid in differential diagnosis and provide new treatment targets.
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Affiliation(s)
- Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Christopher Mancuso
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elisa Asanza
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Switzerland; Department of Pediatrics Gynecology and Obstetrics, University of Geneva, Switzerland; GOSH Institute of Child Health, University College London, United Kingdom
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA, United States of America
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10
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Lobstein T, Neveux M, Brown T, Chai LK, Collins CE, Ells LJ, Nowicka P. Social disparities in obesity treatment for children age 3-10 years: A systematic review. Obes Rev 2021; 22:e13153. [PMID: 33462935 DOI: 10.1111/obr.13153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
Socio-economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio-economic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family-level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family-level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.
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Affiliation(s)
- Tim Lobstein
- World Obesity Federation, London, UK.,The Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Tamara Brown
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Li Kheng Chai
- Institute of Health and Biomedical Innovation (IHBI) at Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Louisa J Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Paulina Nowicka
- Karolinska Institute, Stockholm, Sweden.,Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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11
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Faria WFD, Mendonça FR, Elias RGM, Oliveira RGD, Stabelini Neto A. HIIT, RESISTANCE TRAINING, AND RISK FACTORS IN ADOLESCENTS: A SYSTEMATIC REVIEW. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202606201837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT It has been shown that combined physical exercise is an efficient non-pharmacological approach in the context of public health, since it has demonstrated satisfactory results in the prevention, treatment and control of various morbidities. Therefore, it is essential to systematize current knowledge to enable professionals involved in the prescription of physical exercise to do so based on evidence. Thus, the objective of this study was to perform a systematic review of randomized clinical trials to verify changes in cardiometabolic risk factors induced by high-intensity interval training (HIIT) and resistance training (RT) in adolescents. The systematic search was performed in the following databases: Pubmed, ScienceDirect, Cochrane, LILACS and Scielo. Initially 933 studies were identified, then two researchers eliminated duplications and manuscripts that did not meet the eligibility criteria. Thus, two articles were included that met these criteria: a randomized clinical trial conducted with adolescents (10 to 19 years) of both sexes, an intervention lasting for at least four weeks, which prescribed HIIT and RT in the same session or not, and evaluation of at least one cardiometabolic risk factor. The results demonstrated that eight to 12 weeks of HIIT and RT without nutritional intervention were effective in significantly reducing waist circumference and body fat percentage. However, data pertinent to the efficacy of this combination on risk of developing type 2 diabetes mellitus and arterial hypertension are controversial. In view of the above, it is ascertained from the included studies that the combination of HIIT and RT has the potential to reduce cardiometabolic risk factors in adolescents; therefore, further studies should be conducted to determine the effectiveness of this prescription of physical exercise. Level of Evidence II; Systematic review of Level II or Level I Studies with discrepant results.
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12
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McGavock J, Chauhan BF, Rabbani R, Dias S, Klaprat N, Boissoneault S, Lys J, Wierzbowski AK, Sakib MN, Zarychanski R, Abou-Setta AM. Layperson-Led vs Professional-Led Behavioral Interventions for Weight Loss in Pediatric Obesity: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2010364. [PMID: 32658289 PMCID: PMC7358915 DOI: 10.1001/jamanetworkopen.2020.10364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE The appropriate approach for weight loss among children and adolescents with overweight and obesity remains unclear. OBJECTIVE To evaluate the difference in the treatment outcomes associated with behavioral weight loss interventions led by laypersons and professionals in comparison with unsupervised control arms among children and adolescents with overweight and obesity. DATA SOURCES For this systematic review and meta-analysis, the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, the Cochrane Library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 1996, to June 1, 2019. STUDY SELECTION Included in this study were randomized clinical trials (RCTs) of behavioral interventions lasting at least 12 weeks for children and adolescents (aged 5-18 years) with overweight and obesity. Exclusion criteria included non-RCT studies, interventions lasting less than 12 weeks, adult enrollment, participants with other medical diagnoses, pharmacological treatment use, and articles not written in English. Two of 6 reviewers independently screened all citations. Of 25 586 citations, after duplicate removal, 78 RCTs (5780 participants) met eligibility criteria. DATA EXTRACTION AND SYNTHESIS A bayesian framework and Markov chain Monte Carlo simulation methods were used to combine direct and indirect associations. Random-effects and fixed-effect network meta-analysis models were used with the preferred model chosen by comparing the deviance information criteria. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES The immediate and sustained changes in weight and body mass index (BMI) standardized mean difference (SMD) were primary outcomes planned before data collection began, whereas waist circumference and percent body fat were secondary outcomes. The hypothesis being tested was formulated before the data collection. RESULTS Of 25 586 citations retrieved, we included 78 RCTs (5780 participants), with a follow-up of 12 to 104 weeks. Compared with the control condition, random-effects models revealed that professional-led weight loss interventions were associated with reductions in weight (mean difference [MD], -1.60 kg [95% CI, -2.30 to -0.99 kg]; 68 trials; P < .001) and BMI (SMD, -0.30 [95% CI, -0.39 to -0.20]; 59 trials; P < .001) that were not sustained long term (weight MD, -1.02 kg [95% CI, -2.20 to 0.34 kg]; 21 trials; P = .06; BMI SMD, -0.12 [95% CI, -0.46 to 0.21]; 20 trials; P < .001). There was no association between layperson-led interventions and weight loss in the short-term (MD, -1.40 kg [95% CI, -3.00 to 0.26 kg]; 5 trials; P = .05) or long-term (MD, -0.98 kg [95% CI, -3.60 to 1.80 kg]; 1 trial; P = .23) compared with standard care. No difference was found in head-to-head trials (professional vs layperson MD, -0.25 kg [95% CI -1.90 to 1.30 kg]; 5 trials; P = .38). CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found that professional-led weight loss interventions were associated with short-term but not sustained weight reduction among children and adolescents with overweight or obesity, and the evidence for layperson-led approaches was insufficient to draw firm conclusions.
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Affiliation(s)
- Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Bhupendrasinh F. Chauhan
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- I. H. Asper Clinical Research Institute, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Nika Klaprat
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Sara Boissoneault
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | | | - Mohammad Nazmus Sakib
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
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Hao M, Han W, Yamauchi T. Short-Term and Long-Term Effects of a Combined Intervention of Rope Skipping and Nutrition Education for Overweight Children in Northeast China. Asia Pac J Public Health 2019; 31:348-358. [PMID: 31091980 DOI: 10.1177/1010539519848275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to evaluate whether an exercise intervention, nutrition education, or the combination of both were effective in weight reduction and maintenance for rural school children. Two hundred twenty-nine primary school children aged 9 to 12 years determined as overweight/obese were randomly assigned to 1 of 4 groups: exercise intervention, nutrition education, combination of both, and control. Nutrition education and rope-skipping sessions were performed for 2 months. Anthropometric measurements were administered at baseline, after 2 months (postintervention), and 1 year later (follow-up). The order of change from high to low in the body mass index standard deviation scores (BMI-SDS) between postintervention and baseline was combined intervention, exercise intervention, and nutrition education. The BMI-SDS between following-up and baseline was for combined intervention, exercise intervention, and nutrition education. The combined intervention had the best short-term and long-term effects. The exercise intervention had a better short-term effect than nutrition education, while nutrition education had a better long-term effect than the exercise intervention.
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Affiliation(s)
- Ming Hao
- 1 Hokkaido University, Sapporo, Japan
| | - Wei Han
- 2 Wo Long Hospital, Benxi City, China
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14
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Zouhal H, Sellami M, Saeidi A, Slimani M, Abbassi-Daloii A, Khodamoradi A, El Hage R, Hackney AC, Ben Abderrahman A. Effect of physical exercise and training on gastrointestinal hormones in populations with different weight statuses. Nutr Rev 2019; 77:455-477. [DOI: 10.1093/nutrit/nuz005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hassane Zouhal
- Movement, Sport and Health Sciences Laboratory, University of Rennes 2, Rennes, France
| | - Maha Sellami
- Sport Science Program, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Ayoub Saeidi
- Department of Biological Sciences in Sport and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Maamer Slimani
- Higher Institute of Sport and Physical Education of Ksar Said, Tunis, Tunisia
| | - Asieh Abbassi-Daloii
- Department of Sport Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
| | - Arash Khodamoradi
- Department of Biological Sciences in Sport and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Abderraouf Ben Abderrahman
- Laboratory of Biomonitoring of the Environment, Faculty of Science of Bizerte, University of Carthage, Carthage, Tunisia
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15
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Lewis KA, Brown SA. Searching for Evidence of an Anti-Inflammatory Diet in Children: A Systematic Review of Randomized Controlled Trials for Pediatric Obesity Interventions With a Focus on Leptin, Ghrelin, and Adiponectin. Biol Res Nurs 2017; 19:511-530. [PMID: 28743192 DOI: 10.1177/1099800417715734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PROBLEM To address the complex phenomenon of pediatric obesity, one must understand the physiological mechanisms regulating energy intake and inflammation. The peptide hormones leptin, ghrelin, and adiponectin are involved in both, but their functions are dysregulated in obesity. The purpose of this systematic review is (1) to characterize studies of nutrition interventions for weight management in children who measure these peptides as outcomes, (2) to assess risk of bias in the studies, and (3) to determine the relationships between these peptides and body mass index (BMI). Eligibility Criteria: Peer-reviewed articles written in English, published in 2001-2016, and describing randomized controlled trials of pediatric interventions involving a nutrition component with the outcome measures leptin, ghrelin, and/or adiponectin were included. Articles were excluded if the intervention involved pharmaceuticals, supplements, infant formula, breastfeeding, or surgery. SAMPLE The 25 international studies represented 2,153 obese children. RESULTS Ten diets were identified. Successful interventions included both structured exercise and hypocaloric dietary components, with or without counseling, resistance training, or medical components. Direct measures of adiposity were used in 69% of studies. Comparison group designs were disparate. Leptin levels decreased as BMI decreased. Evidence regarding the relationships of ghrelin and adiponectin with BMI was inconclusive. CONCLUSIONS Despite known effects of maturation on hormones, studies did not consistently differentiate findings by maturational stage. Common anti-inflammatory and disease risk modification diets were missing or underrepresented. Studies that include children with comorbidities are needed. BMI and leptin levels have a positive relationship, but evidence on ghrelin and adiponectin was inconclusive.
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Affiliation(s)
- Kimberly A Lewis
- 1 School of Nursing, The University of Texas at Austin, Austin, TX, USA.,2 Pediatric Clinical Research Enterprise, Dell Children's Medical Center, Seton Family of Hospitals, Austin, TX, USA
| | - Sharon A Brown
- 1 School of Nursing, The University of Texas at Austin, Austin, TX, USA
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16
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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17
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Hume MP, Nicolucci AC, Reimer RA. Prebiotic supplementation improves appetite control in children with overweight and obesity: a randomized controlled trial. Am J Clin Nutr 2017; 105:790-799. [PMID: 28228425 DOI: 10.3945/ajcn.116.140947] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Prebiotics have been shown to improve satiety in adults with overweight and obesity; however, studies in children are limited.Objective: We examined the effects of prebiotic supplementation on appetite control and energy intake in children with overweight and obesity.Design: This study was a randomized, double-blind, placebo-controlled trial. Forty-two boys and girls, ages 7-12 y, with a body mass index (BMI) of ≥85th percentile were randomly assigned to 8 g oligofructose-enriched inulin/d or placebo (maltodextrin) for 16 wk. Objective measures of appetite included energy intake at an ad libitum breakfast buffet, 3-d food records, and fasting satiety hormone concentrations. Subjective appetite ratings were obtained from visual analog scales before and after the breakfast. Children's Eating Behavior Questionnaires were also completed by caregivers.Results: Compared with placebo, prebiotic intake resulted in significantly higher feelings of fullness (P = 0.04) and lower prospective food consumption (P = 0.03) at the breakfast buffet at 16 wk compared with baseline. Compared with placebo, prebiotic supplementation significantly reduced energy intake at the week 16 breakfast buffet in 11- and 12-y-olds (P = 0.04) but not in 7- to 10-y-olds. Fasting adiponectin (P = 0.04) and ghrelin (P = 0.03) increased at 16 wk with the prebiotic compared with placebo. In intent-to-treat analysis, there was a trend for prebiotic supplementation to reduce BMI z score to a greater extent than placebo (-3.4%; P = 0.09) and a significant -3.8% reduction in per-protocol analysis (P = 0.043).Conclusions: Independent of other lifestyle changes, prebiotic supplementation in children with overweight and obesity improved subjective appetite ratings. This translated into reduced energy intake in a breakfast buffet in older but not in younger children. This simple dietary change has the potential to help with appetite regulation in children with obesity. This trial was registered at clinicaltrials.gov as NCT02125955.
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Affiliation(s)
| | | | - Raylene A Reimer
- Faculty of Kinesiology and .,Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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18
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Soriano-Guillén L, Ortega L, Navarro P, Riestra P, Gavela-Pérez T, Garcés C. Sex-related differences in the association of ghrelin levels with obesity in adolescents. Clin Chem Lab Med 2017; 54:1371-6. [PMID: 26695196 DOI: 10.1515/cclm-2015-0555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/12/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The utility of ghrelin as a biomarker may be different depending on gender. The aim of this study was to assess ghrelin levels in a population-based sample of adolescents, and to evaluate their association with obesity and obesity-related parameters depending on sex. METHODS The studied population included 601 randomly selected 14-to 16-year-old children. Anthropometrical data were measured and body mass index (BMI) and waist to hip ratio calculated. Body composition was assessed using an impedance body composition analyzer. Total serum ghrelin levels were determined using a multiplexed bead immunoassay. Serum leptin and adiponectin levels were determined by ELISA and insulin by RIA. RESULTS Ghrelin levels were significantly higher in girls than in boys. Serum ghrelin concentrations were significantly lower (p<0.01) in obese than in normal weight (NW) girls, but showed no differences by weight category in boys. Ghrelin showed a significant negative relationship with waist circumference (WC), waist to hip ratio and fat mass (p<0.05) in both genders, and with weight and BMI (p<0.01) in girls, and insulin (p<0.01) and HOMA (p<0.05) in boys. Ghrelin also correlated negatively with leptin levels in girls (p<0.01). CONCLUSIONS Our study describes serum ghrelin levels in adolescents, showing a sexual dimorphism in ghrelin levels in these 14-to 16-year-old children, and a different association of ghrelin levels with obesity by gender that suggests a different appetite and energy expenditure control depending on sex at this age.
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19
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Heshmat R, Shafiee G, Qorbani M, Azizi-Soleiman F, Djalalinia S, Esmaeil Motlagh M, Ardalan G, Ahadi Z, Safari O, Safiri S, Kelishadi R. Association of ghrelin with cardiometabolic risk factors in Iranian adolescents: the CASPIAN-III study. J Cardiovasc Thorac Res 2016; 8:107-112. [PMID: 27777695 PMCID: PMC5075358 DOI: 10.15171/jcvtr.2016.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/29/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction: Current evidence suggests that ghrelin could contribute to the development of metabolic syndrome (MetS) in adults, but limited experience exists in adolescents. This study aims to explore the association of ghrelin levels with the MetS components among Iranian adolescents.
Methods: In this case-control study, 32 adolescents with MetS and 148 healthy controls were selected randomly from the childhood and Adolescence Surveillance and Prevention of Adult Non communicable disease (CASPIAN-III) study. MetS was defined according to the Adult Treatment Panel III (ATP III) criteria modified for children and adolescents. Anthropometric measures (including body mass index [BMI], waist circumference [WC] and waist to height ratio [WHtR]), blood pressure (BP) and biochemical data (including fasting blood sugar [FBS], triglyceride [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC] and gerlin) were measured.
Results: Total ghrelin level was significantly higher in students without MetS compared to those
with MetS (748.89 ± 85.04 vs. 728.72 ± 90.36 [pg/mL]; P < 0.001). Significant negative correlations
were seen between ghrelin levels and BMI, WC, WHtR, TG, and TC. Ghrelin had also relatively
strong inverse correlations with FBS (r = −0.59, P< 0.001), LDL-C (r = −0.56, P < 0.001), and
positive correlation with HDL-C (r = 0.60, P < 0.001). Compared with the children with MetS, in
those without MetS, ghrelin was significantly associated with HDL-C and LDL-C. A decreasing
trend was observed in the mean ghrelin level across increasing number of MetS components (P
for trend <0.001).
Conclusion: We observed a relationship between ghrelin concentration and MetS components in adolescents.
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Affiliation(s)
- Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran ; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azizi-Soleiman
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non- Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Djalalinia
- Development of Research & Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non- Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Ahadi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Safari
- Department of Pediatrics, Alborz University of Medical Sciences, Karaj, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non- Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Robberecht H, Hermans N. Biomarkers of Metabolic Syndrome: Biochemical Background and Clinical Significance. Metab Syndr Relat Disord 2016; 14:47-93. [PMID: 26808223 DOI: 10.1089/met.2015.0113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biomarkers of the metabolic syndrome are divided into four subgroups. Although dividing them in groups has some limitations, it can be used to draw some conclusions. In a first part, the dyslipidemias and markers of oxidative stress are discussed, while inflammatory markers and cardiometabolic biomarkers are reviewed in a second part. For most of them, the biochemical background and clinical significance are discussed, although here also a well-cut separation cannot always be made. Altered levels cannot always be claimed as the cause, risk, or consequence of the syndrome. Several factors are interrelated to each other and act in a concerted, antagonistic, synergistic, or modulating way. Most important conclusions are summarized at the end of every reviewed subgroup. Genetic biomarkers or influences of various food components on concentration levels are not included in this review article.
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Affiliation(s)
- Harry Robberecht
- Department of Pharmaceutical Sciences, NatuRA (Natural Products and Food Research and Analysis), University of Antwerp , Wilrijk, Antwerp, Belgium
| | - Nina Hermans
- Department of Pharmaceutical Sciences, NatuRA (Natural Products and Food Research and Analysis), University of Antwerp , Wilrijk, Antwerp, Belgium
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21
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Katz M, Giani E, Laffel L. Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth With Type 1 Diabetes: Lifestyle and Beyond. Curr Diab Rep 2015; 15:119. [PMID: 26520142 PMCID: PMC4893313 DOI: 10.1007/s11892-015-0692-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in persons with type 1 diabetes (T1D). Specific risk factors associated with diabetes, such as hyperglycemia and kidney disease, have been demonstrated to increase the incidence and progression of CVD. Nevertheless, few data exist on the effects of traditional risk factors such as dyslipidemia, obesity, and hypertension on CVD risk in youth with T1D. Improvements in understanding and approaches to the evaluation and management of CVD risk factors, specifically for young persons with T1D, are desirable. Recent advances in noninvasive techniques to detect early vascular damage, such as the evaluation of endothelial dysfunction and aortic or carotid intima-media thickness, provide new tools to evaluate the progression of CVD in childhood. In the present review, current CVD risk factor management, challenges, and potential therapeutic interventions in youth with T1D are described.
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Affiliation(s)
- Michelle Katz
- Genetics and Epidemiology Section, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA.
| | - Elisa Giani
- Genetics and Epidemiology Section, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA.
| | - Lori Laffel
- Genetics and Epidemiology Section, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA.
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22
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Horner K, Lee S. Appetite-related peptides in childhood and adolescence: role of ghrelin, PYY, and GLP-1. Appl Physiol Nutr Metab 2015; 40:1089-99. [PMID: 26466085 DOI: 10.1139/apnm-2015-0050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During childhood and adolescence, a number of factors, including age, puberty, sex, race, and body composition, may contribute to differences in satiety, food intake, and appetite-related peptides. These peptides include the orexigenic peptide ghrelin and anorexigenic gut peptides peptide YY (PYY) and glucagon-like peptide-1 (GLP-1). For example, lower fasting ghrelin levels, lower postprandial ghrelin suppression, and blunted PYY and GLP-1 responses to food intake could contribute to a dysregulation of appetite in already obese children and adolescents. Whereas, changes in these peptides observed during puberty could facilitate growth. A greater understanding of the major moderating factors of appetite-related peptides in the pediatric population is essential to improve interpretation of study findings and for effective tailoring of strategies targeting appetite control to individuals. While more studies are needed, there is some evidence to suggest that exercise-based lifestyle interventions could be a potential therapeutic strategy to improve appetite-peptide profiles in overweight and obese children and adolescents. The aim of this review is (i) to discuss the potential moderating factors of ghrelin, PYY, and GLP-1, including age and puberty, sex, race and body composition; and (ii) to examine the effects of exercise interventions on these appetite-related gut peptides in children and adolescents.
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Affiliation(s)
- Katy Horner
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15226, USA.,Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15226, USA
| | - SoJung Lee
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15226, USA.,Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15226, USA
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Bryant M, Ashton L, Brown J, Jebb S, Wright J, Roberts K, Nixon J. Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity. Health Technol Assess 2015; 18:1-380. [PMID: 25125212 DOI: 10.3310/hta18510] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials. OBJECTIVE To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions. DATA SOURCES Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases. REVIEW METHODS Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework. RESULTS Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness. LIMITATIONS Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs. CONCLUSIONS The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Maria Bryant
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Lee Ashton
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Susan Jebb
- Medical Research Council (MRC) Human Nutrition Research, Cambridge, UK
| | - Judy Wright
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Jane Nixon
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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Iwakura H, Kangawa K, Nakao K. The regulation of circulating ghrelin - with recent updates from cell-based assays. Endocr J 2015; 62:107-22. [PMID: 25273611 DOI: 10.1507/endocrj.ej14-0419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ghrelin is a stomach-derived orexigenic hormone with a wide range of physiological functions. Elucidation of the regulation of the circulating ghrelin level would lead to a better understanding of appetite control in body energy homeostasis. Earlier studies revealed that circulating ghrelin levels are under the control of both acute and chronic energy status: at the acute scale, ghrelin levels are increased by fasting and decreased by feeding, whereas at the chronic scale, they are high in obese subjects and low in lean subjects. Subsequent studies revealed that nutrients, hormones, or neural activities can influence circulating ghrelin levels in vivo. Recently developed in vitro assay systems for ghrelin secretion can assess whether and how individual factors affect ghrelin secretion from cells. In this review, on the basis of numerous human, animal, and cell-based studies, we summarize current knowledge on the regulation of circulating ghrelin levels and enumerate the factors that influence ghrelin levels.
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Affiliation(s)
- Hiroshi Iwakura
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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25
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van Hoek E, Feskens EJM, Bouwman LI, Janse AJ. Effective interventions in overweight or obese young children: systematic review and meta-analysis. Child Obes 2014; 10:448-60. [PMID: 25333421 DOI: 10.1089/chi.2013.0149] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment programs for overweight and obese young children are of variable effectiveness, and the characteristics of effective programs are unknown. In this systematic review with meta-analysis, the effectiveness of treatment programs for these children is summarized. METHODS PubMed, Embase, Web of Science, and PsycINFO databases were searched up to April 2012. Articles reporting the effect of treatment on the body weight of overweight or obese children with a mean age in the range of 3-<8 years are included. Studies reporting the change in BMI z-score with standard error were included in a meta-analysis. For this purpose, a random-effects model was used. RESULTS The search identified 11,250 articles, of which 27 were included in this review. Eleven studies, including 20 treatment programs with 1015 participants, were eligible for the meta-analysis. The pooled intervention effect showed high heterogeneity; therefore, subgroup analysis was performed. Subgroup analysis showed that program intensity and used components partly explained the heterogeneity. The subgroup with two studies using multicomponent treatment programs (combining dietary and physical activity education and behavioral therapy) of moderate or high intensity showed the largest pooled change in BMI z-score (-0.46; I2, 0%). CONCLUSION Although the subgroup multicomponent treatment programs of moderate to high intensity contained only two studies, these treatment programs appeared to be most effective in treating overweight young children.
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Affiliation(s)
- Esther van Hoek
- 1 Department of Pediatrics, Gelderse Vallei Hospital , Ede, The Netherlands
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26
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Bagheri M, Ansari S, Sotoudeh G, Mahmoudi M, Speakman JR, Djafarian K. Serum ghrelin levels and gender-related indices of body composition in prepubertal children: a cross-sectional study. Eur J Nutr 2014; 54:283-90. [DOI: 10.1007/s00394-014-0709-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/25/2014] [Indexed: 12/11/2022]
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27
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Yang J, Feng X, Zhong S, Wang Y, Liu J. Gastric Bypass Surgery May Improve Beta Cell Apoptosis with Ghrelin Overexpression in Patients with BMI ≥ 32.5 kg/m2. Obes Surg 2013; 24:561-71. [DOI: 10.1007/s11695-013-1135-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Huang F, del-Río-Navarro BE, Pérez Ontiveros JA, Ruiz-Bedolla E, Navarro-Olivos E, Villafaña S, Bravo G, Hong E. Changes in ghrelin and asymmetrical dimethylarginine in obese Mexican adolescents after six-month lifestyle intervention. Endocrine 2013; 43:603-10. [PMID: 23055013 DOI: 10.1007/s12020-012-9808-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/21/2012] [Indexed: 12/11/2022]
Abstract
The aim of this study was to evaluate the effect of a six-month lifestyle intervention on ghrelin and asymmetrical dimethylarginine (ADMA) in obese Mexican adolescents. A total of 65 obese Mexican adolescents aged 10-16 years completed a six-month lifestyle intervention. Anthropometric and biochemical parameters were assessed at baseline and at six months. Twenty normal-weight adolescents were also evaluated at baseline. Insulin resistance (IR) was determined by the homeostasis model assessment of IR (HOMA-IR). Ghrelin and ADMA were determined by enzyme-linked immunosorbent assay. Obese adolescents presented significantly higher triglycerides, cholesterol, glucose, insulin, HOMA-IR, and ADMA levels, while ghrelin was significantly lower. The lifestyle intervention led to a significant improvement in HOMA-IR, ghrelin, and ADMA in the whole studied obese subjects. ADMA and ghrelin levels were associated with BMI and IR components. According to the value of HOMA-IR, the obese subjects were divided into subjects with or without IR, no difference in ghrelin and ADMA was observed in these two subgroups. After intervention, the obese with IR showed increased ghrelin and decreased ADMA, while the obese without IR only showed improvement in ghrelin. The multiple linear regression analysis revealed that the changes of systolic blood pressure were the only predictor for the changes of ghrelin in the obese with IR. Our study demonstrated the increase of ADMA and the decrease of ghrelin in obese adolescents. Lifestyle intervention improved insulin resistance, decreased ADMA, and increased ghrelin in obese subjects with IR although no significant weight loss was observed.
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Affiliation(s)
- Fengyang Huang
- Department of Pharmacology and Toxicology, Hospital Infántil de México Federico Gómez (HIMFG), Mexico City, Mexico.
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29
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Ueda SY, Miyamoto T, Nakahara H, Shishido T, Usui T, Katsura Y, Yoshikawa T, Fujimoto S. Effects of exercise training on gut hormone levels after a single bout of exercise in middle-aged Japanese women. SPRINGERPLUS 2013; 2:83. [PMID: 23504454 PMCID: PMC3597337 DOI: 10.1186/2193-1801-2-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/25/2013] [Indexed: 01/15/2023]
Abstract
The purpose of this study was to investigate the effects of 12 weeks of exercise training on gut hormone levels after a single bout of exercise in middle-aged Japanese women. Twenty healthy middle-aged women were recruited for this study. Several measurements were performed pre and post exercise training, including: body weight and composition, peak oxygen consumption (peak VO2), energy intake after the single bout of exercise, and the release of gut hormones with fasting and after the single bout of exercise. Exercise training resulted in significant increases in acylated ghrelin fasting levels (from 126.6 ± 5.6 to 135.9 ± 5.4 pmol/l, P < 0.01), with no significant changes in GLP-1 (from 0.54 ± 0.04 to 0.55 ± 0.03 pmol/ml) and PYY (from 1.20 ± 0.07 to 1.23 ± 0.06 pmol/ml) fasting levels. GLP-1 levels post exercise training after the single bout of exercise were significantly higher than those pre exercise training (areas under the curve (AUC); from 238.4 ± 65.2 to 286.5 ± 51.2 pmol/ml x 120 min, P < 0.001). There was a tendency for higher AUC for the time courses of PYY post exercise training than for those pre exercise training (AUC; from 519.5 ± 135.5 to 551.4 ± 128.7 pmol/ml x 120 min, P = 0.06). Changes in (delta) GLP-1 AUC were significantly correlated with decreases in body weight (r = -0.743, P < 0.001), body mass index (r = -0.732, P < 0.001), percent body fat (r = -0.731, P < 0.001), and energy intake after a single bout exercise (r = -0.649, P < 0.01) and increases in peak VO2 (r = 0.558, P < 0.05). These results suggest that the ability of exercise training to create a negative energy balance relies not only directly on its impact on energy expenditure, but also indirectly on its potential to modulate energy intake.
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Affiliation(s)
- Shin-Ya Ueda
- Department of Acupuncture, Morinomiya University of Medical Sciences, 1-26-16, Nankokita, Suminoe-ku, Osaka City, Osaka, 559-8611 Japan
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30
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King NA, Horner K, Hills AP, Byrne NM, Wood RE, Bryant E, Caudwell P, Finlayson G, Gibbons C, Hopkins M, Martins C, Blundell JE. The Interaction Between Exercise, Appetite, and Food Intake. Am J Lifestyle Med 2013. [DOI: 10.1177/1559827613475584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Exercise could indirectly affect body weight by exerting changes on various components of appetite control, including nutrient and taste preferences, meal size and frequency, and the drive to eat. This review summarizes the evidence on how exercise affects appetite and eating behavior and in particular answers the question, “Does exercise induce an increase in food intake to compensate for the increase in energy expenditure?” Evidence will be presented to demonstrate that there is no automatic increase in food intake in response to acute exercise and that the response to repeated exercise is variable. The review will also identify areas of further study required to explain the variability. One limitation with studies that assess the efficacy of exercise as a method of weight control is that only mean data are presented—the individual variability tends to be overlooked. Recent evidence highlights the importance of characterizing the individual variability by demonstrating exercise-induced changes in appetite. Individuals who experience lower than theoretically predicted reductions in body weight can be characterized by hedonic (eg, pleasure) and homeostatic (eg, hunger) features.
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Affiliation(s)
- Neil Anthony King
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Katy Horner
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Andrew Peter Hills
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Nuala Mary Byrne
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Rachel Elise Wood
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Eleanor Bryant
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Phillipa Caudwell
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Graham Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Catherine Gibbons
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Mark Hopkins
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - Catia Martins
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
| | - John Edward Blundell
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (NAK, KH, APH, NMB, REW)
- Centre for Psychology Studies, University of Bradford, UK (EB)
- BioPsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK (PC, GF, CG, JEB)
- Department of Sport, Health, and Nutrition, Leeds Trinity University College, Leeds, UK (MH)
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (CM)
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Stip E, Lungu OV, Anselmo K, Letourneau G, Mendrek A, Stip B, Lipp O, Lalonde P, Bentaleb LA. Neural changes associated with appetite information processing in schizophrenic patients after 16 weeks of olanzapine treatment. Transl Psychiatry 2012; 2:e128. [PMID: 22714121 PMCID: PMC3384221 DOI: 10.1038/tp.2012.53] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
There is evidence that some atypical antipsychotics, including olanzapine, can produce unwanted metabolic side effects, weight gain and diabetes. However, neuronal correlates of change related to food information processing have not been investigated with these medications. We studied the effect of a pharmacological manipulation with an antipsychotic known to cause weight gain on metabolites, cognitive tasks and neural correlates related to food regulation. We used functional magnetic resonance imaging in conjunction with a task requiring visual processing of appetitive stimuli in schizophrenic patients and healthy controls before and after 16 weeks of antipsychotic medication with olanzapine. In patients, the psychological and neuronal changes associated following the treatment correlated with appetite control measures and metabolite levels in fasting blood samples. After 16 weeks of olanzapine treatment, the patients gained weight, increased their waist circumference, had fewer positive schizophrenia symptoms, a reduced ghrelin plasma concentration and an increased concentration of triglycerides, insulin and leptin. In premotor area, somatosensory cortices as well as bilaterally in the fusiform gyri, the olanzapine treatment increased the neural activity related to appetitive information in schizophrenic patients to similar levels relative to healthy individuals. However, a higher increase in sensitivity to appetitive stimuli after the treatment was observed in insular cortices, amygdala and cerebellum in schizophrenic patients as compared with healthy controls. Furthermore, these changes in neuronal activity correlated with changes in some metabolites and cognitive measurements related to appetite regulation.
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Affiliation(s)
- E Stip
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada.
| | - O V Lungu
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,Centre de Recherche de l′Institut Universitaire de gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada,Department of Research, Donald Berman Maimonides Geriatric Center, Montréal, QC, Canada
| | - K Anselmo
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,CHUM, Centre de Recherche Fernand Seguin, Université de Montréal, Notre Dame Hospital, Montréal, QC, Canada
| | - G Letourneau
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,CHUM, Centre de Recherche Fernand Seguin, Université de Montréal, Notre Dame Hospital, Montréal, QC, Canada
| | - A Mendrek
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,CHUM, Centre de Recherche Fernand Seguin, Université de Montréal, Notre Dame Hospital, Montréal, QC, Canada
| | - B Stip
- École Polytechnique de Montréal, Montréal, QC, Canada
| | - O Lipp
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,Centre de Recherche de l′Institut Universitaire de gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - P Lalonde
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,CHUM, Centre de Recherche Fernand Seguin, Université de Montréal, Notre Dame Hospital, Montréal, QC, Canada
| | - L A Bentaleb
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada,CHUM, Centre de Recherche Fernand Seguin, Université de Montréal, Notre Dame Hospital, Montréal, QC, Canada
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Kelishadi R, Malekahmadi M, Hashemipour M, Soghrati M, Soghrati M, Mirmoghtadaee P, Ghatrehsamani S, Poursafa P, Khavarian N. Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors? Pediatr Neonatol 2012; 53:90-7. [PMID: 22503255 DOI: 10.1016/j.pedneo.2012.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 03/28/2011] [Accepted: 04/18/2011] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study was conducted to assess the effectiveness of a simple office-based program for encouraging healthy lifestyle on controlling childhood obesity and associated cardiometabolic risk factors. METHODS This non-randomized 24-week lifestyle modification trial was conducted among 457 obese children and adolescents, aged 2-18 years, who had at least one cardiometabolic risk factor in addition to obesity. This trial included three components of exercise, diet education and behavior modification, with all recommendations provided by a pediatrician, two general physicians and a nurse. Instead of strict inhibitory recommendations, healthier lifestyle was encouraged. RESULTS Overall 448 (98.04%) of enrolled children completed the trial with a mean age of 9.6 ± 2.9 years. After the trial, the mean of anthropometric measures and cardiometabolic risk factors decreased significantly, the mean high-density lipoprotein cholesterol (HDL-C) increased significantly, and the prevalence of the metabolic syndrome decreased from 20.8% to 1.8%. Triglycerides, LDL-C, diastolic blood pressure and WC had the highest decrease in all age groups, with the most prominent changes in the 14-18-year age group. By each -1SD decline in BMI and WC, risk factors had significant improvement. CONCLUSION Motivational office-based counseling can be effective in treatment of childhood obesity and its associated cardio-metabolic risk factors. Such approach can be implemented in the primary health care system; and can be of special concern in low- and middle-income countries with limited human and financial resources. We suggest that expanding the roles of non-physician clinicians such as nurse practitioners can help to increase the amount of time available for such services.
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Affiliation(s)
- Roya Kelishadi
- Pediatric Preventive Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
The clinical outcomes achieved by bariatric surgery have been impressive. However, the physiologic mechanisms and complex metabolic effects of bariatric surgery are only now beginning to be understood. Ongoing research has contributed a large amount of data and shed new light on the science behind obesity and its treatment, and this article reviews the current understanding of metabolic and bariatric surgery physiology.
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Affiliation(s)
- Chan W Park
- Duke Endosurgery, Department of Surgery, Duke University, DUMC 3351, Duke University Medical Center, Durham, NC 27713, USA
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Cederberg H, Koivisto VM, Jokelainen J, Surcel HM, Keinänen-Kiukaanniemi S, Rajala U. Unacylated ghrelin is associated with changes in insulin sensitivity and lipid profile during an exercise intervention. Clin Endocrinol (Oxf) 2012; 76:39-45. [PMID: 21645020 DOI: 10.1111/j.1365-2265.2011.04135.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Ghrelin has been implicated in energy homeostasis, body weight regulation and glucose metabolism. Level of unacylated ghrelin (UAG), but not acylated ghrelin (AG), has been suggested to increase during long-term exercise. However, the association of the level of UAG with exercise-induced changes of insulin sensitivity and lipid metabolism has not been previously investigated. We hypothesized that an increase in UAG level in response to a long-term exercise programme improves insulin sensitivity and associated lipid profile, independently of weight loss. DESIGN, PATIENTS AND MEASUREMENTS A prospective study of 552 young men (mean age 19·3 and range 19-28 years) undergoing military service with structured 6-month exercise training programme. Exercise performance, clinical and biochemical measurements were obtained at baseline and follow-up. Association between UAG level and fasting glucose, insulin, insulin sensitivity and lipid levels were evaluated. RESULTS An overall increase in the level of UAG was observed during the 6-month follow-up (P < 0·001), which was largest among those with weight loss ≥ 2·5% or among those whose reduction in waist circumference was largest (P = 0·007 and P < 0·001, respectively). A change in UAG level correlated inversely with a change in fasting glucose and insulin levels, HOMA-IR, total cholesterol and total triglyceride levels (P < 0·001 for all). The association between change in the UAG level and the change in insulin sensitivity was independent of weight loss or reduction in waist circumference. CONCLUSIONS Increase in UAG level was associated with improved insulin sensitivity via mechanisms independent of weight loss during an intensive, long-term exercise intervention in young healthy men.
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Affiliation(s)
- Henna Cederberg
- Institute of Health Sciences, Faculty of Medicine, University of Oulu, Finland.
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Martins C, Kjelstrup L, Mostad IL, Kulseng B. Impact of sustained weight loss achieved through Roux-en-Y gastric bypass or a lifestyle intervention on ghrelin, obestatin, and ghrelin/obestatin ratio in morbidly obese patients. Obes Surg 2011; 21:751-8. [PMID: 21484524 PMCID: PMC3094661 DOI: 10.1007/s11695-011-0399-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Appetite-regulating hormones seem to play an important role in weight loss after bariatric surgery. Less is known regarding long-term weight loss maintenance. The objective of the study was to evaluate ghrelin and obestatin levels following long-term weight loss achieved through bariatric surgery or a lifestyle intervention in morbidly obese patients. Methods The study was cross-sectional in design carried out in a university research center setting. The participants were weight-stable morbidly obese patients who had undergone, on average, 3 years ago, Roux-en-Y gastric bypass (RYGB) surgery (n = 9) or a lifestyle weight loss intervention (n = 8), and patients on a waiting list for bariatric surgery (control group; n = 9). The main outcome measures were fasting/postprandial plasma levels of total ghrelin and obestatin and ghrelin/obestatin ratio. Results Fasting ghrelin and obestatin plasma levels were significantly elevated in the RYGB, but not in the lifestyle group, as compared with the control group. There was no statistical significant difference in fasting ghrelin/obestatin ratio among study groups. Ghrelin levels were suppressed after breakfast in all groups, with no significant differences in postprandial levels overtime between them. Obestatin levels did not change postprandially in any of the groups, but the area under the curve was significantly higher in the RYGB than in the control group. Conclusions Sustained weight loss maintenance seems to be associated with increased fasting levels of ghrelin and obestatin after RYGB surgery, but not after a lifestyle intervention, while maintaining ghrelin/obestatin ratio. Ghrelin is, therefore, unlikely to contribute to weight loss maintenance after RYGB, and other mechanisms are probably involved.
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Affiliation(s)
- Catia Martins
- Faculty of Medicine, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Baragli A, Lanfranco F, Allasia S, Granata R, Ghigo E. Neuroendocrine and metabolic activities of ghrelin gene products. Peptides 2011; 32:2323-32. [PMID: 22056513 DOI: 10.1016/j.peptides.2011.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 10/03/2011] [Accepted: 10/25/2011] [Indexed: 12/15/2022]
Abstract
Acylated ghrelin (AG) is a 28 amino acid gastric peptide a natural ligand for the growth hormone secretagogue (GHS) receptor type 1a (GHS-R1a), endowed with GH-secreting and orexigenic properties. Besides, ghrelin exerts several peripheral metabolic actions, including modulation of glucose homeostasis and stimulation of adipogenesis. Notably, AG administration causes hyperglycemia in rodents as in humans. Ghrelin pleiotropy is supported by a widespread expression of the ghrelin gene, of GHS-R1a and other unknown ghrelin binding sites. The existence of alternative receptors for AG, of several natural ligands for GHS-R1a and of acylation-independent ghrelin non-neuroendocrine activities, suggests that there might be a complex 'ghrelin system' not yet completely explored. Moreover, the patho-physiological implications of unacylated ghrelin (UAG), and obestatin (Ob), the other two ghrelin gene-derived peptides, need to be clarified. Within the next few years, we may better understand the 'ghrelin system', where we might envisage clinical applications.
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Affiliation(s)
- Alessandra Baragli
- Laboratory of Molecular and Cellular Endocrinology, Division of Endocrinology, Department of Internal Medicine, University of Turin, Turin, Italy.
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Ghrelin and PYY levels in adolescents with severe obesity: effects of weight loss induced by long-term exercise training and modified food habits. Eur J Appl Physiol 2011; 112:1797-805. [PMID: 21909986 DOI: 10.1007/s00421-011-2154-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 08/27/2011] [Indexed: 01/10/2023]
Abstract
This study investigated (a) changes in ghrelin and peptide YY (PYY) concentrations during a weight reduction programme and (b) baseline ghrelin and PYY levels as predictors of weight loss in 32 severely obese adolescents (BMI z score = 4.1). Subjects spent an academic year in an institution for childhood obesity. Fasting ghrelin and PYY, leptin, insulin levels and insulin resistance were measured at baseline (month 0) and during the programme (months 3, 6, 9). In addition, 15 normal-weight teenagers served as reference for the baseline assessments. At baseline, obese teenagers had lower ghrelin and PYY concentrations than normal-weight adolescents (P < 0.05). Moreover, they showed significantly higher leptin, insulin levels and homeostasis model assessment (HOMA) (P < 0.0001). During the lifestyle modification, there was a significant decrease in body weight among obese teenagers, associated with an increase in ghrelin (apparent from month 6; P < 0.05), a decrease in leptin (from month 3; P < 0.05) and a decrease in insulin and HOMA (from month 3; P < 0.0001), without any significant change in PYY. Anthropometrical changes were correlated neither with baseline ghrelin levels nor with changes in ghrelin and PYY after the lifestyle modification. However, higher baseline PYY tended to correlate with greater anthropometrical changes (P < 0.1). In adolescents with severe obesity, a long-term combination of supervised aerobic exercises and a balanced diet led to weight reduction and increased ghrelin concentrations, without any change in PYY concentrations. Moreover, baseline PYY concentrations might be considered as predictors of weight loss.
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Cederberg H, Rajala U, Koivisto VM, Jokelainen J, Surcel HM, Keinänen-Kiukaanniemi S, Laakso M. Unacylated ghrelin is associated with changes in body composition and body fat distribution during long-term exercise intervention. Eur J Endocrinol 2011; 165:243-8. [PMID: 21646288 DOI: 10.1530/eje-11-0334] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Ghrelin, a gut-brain peptide involved in energy homeostasis, circulates predominantly (>90%) in unacylated form. Previous studies, however, have focused on total and acylated ghrelin, and the role of unacylated ghrelin (UAG) is not well understood. Particularly, the association of UAG with weight loss and changes in body composition in adults remains unclear. We hypothesized that exercise-associated increase in UAG level is associated with weight loss, favorable changes in body composition, and body fat distribution. DESIGN AND METHODS A prospective study of 552 young men (mean age 19.3 and range 19-28 years) undergoing military service with structured 6-month exercise training program. Exercise performance, body composition, and biochemical measurements were obtained at baseline and follow-up. Association between changes in UAG levels and body composition and body fat distribution were evaluated. RESULTS An increase in UAG level during the exercise intervention was associated with reduced weight, fat mass (FM), fat percentage (fat %), and waist circumference, but not with fat-free mass. Inverse associations of changes in UAG level with changes in waist circumference and fat % were independent of weight at baseline, and changes in weight and exercise performance. Associations of changes in UAG level with waist circumference were significantly stronger than with fat % after the adjustment for confounding variables. CONCLUSION UAG is associated with changes in body weight and body composition during an intensive long-term exercise intervention in young men. The association of UAG levels with changes in central obesity was stronger than with total FM.
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Affiliation(s)
- Henna Cederberg
- Faculty of Medicine, Institute of Health Sciences, University of Oulu, PO Box 5000, FIN-90014 Oulu, Finland.
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Metabolic syndrome, adipokines and ghrelin in overweight and obese schoolchildren: results of a 1-year lifestyle intervention programme. Eur J Pediatr 2011; 170:483-92. [PMID: 20957391 DOI: 10.1007/s00431-010-1316-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/20/2010] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the effect of a lifestyle intervention programme (nutrition and exercise counselling) on metabolic syndrome (MS) components, adipokines (leptin, adiponectin) and ghrelin levels in overweight children. A total of 61 overweight children aged 7-9 years (≥ 85th body mass index (BMI) percentile; 27 boys/34 girls) were randomly assigned and completed a 1-year individual (IT) or group-based treatment (GT). Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. Twenty-two normal weight children (<85th BMI percentile; 7-9 years old; 13 boys/nine girls) were also evaluated at baseline. Insulin resistance (IR) was determined by the homeostasis model assessment of IR (HOMA-IR). Overweight children presented significantly higher blood pressure, triglycerides, apolipoprotein B, insulin, HOMA-IR, leptin, C-reactive protein and homocysteine levels, while apolipoprotein A-I was significantly lower. At baseline, MS was present in ten overweight children, of which only five maintained it at 1 year. Leptin and ghrelin levels were associated with IR and MS components. MS was predicted by apolipoprotein A-I, insulin and pre-puberty. The lifestyle intervention led to a significant improvement in standard deviation score of BMI, waist circumference/height ratio and lipid profile. Changes in insulin, HOMA-IR, leptin and adiponectin were not significant. Ghrelin behaved differently between IT and GT. The GT intervention seems to be more successful, with a decrease in BMI Z-score and an improvement of metabolic parameters. In conclusion, overweight children have multiple risk factors associated with MS. A lifestyle intervention programme seems to be an effective mean for reducing obesity and MS components and improving adipokines concentrations.
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Martos-Moreno GA, Barrios V, Martínez G, Hawkins F, Argente J. Acylated ghrelin levels in pre-pubertal obese children at diagnosis and after weight reduction: effect of oral glucose ingestion. J Endocrinol Invest 2011; 34:117-23. [PMID: 20585204 DOI: 10.1007/bf03347041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ghrelin isoforms are involved in energy homeostasis and carbohydrate metabolism. AIM To determine the influence of oral glucose ingestion and weight reduction on acylated ghrelin (AG) serum levels and on the AG to total ghrelin (TG) ratio (AG/TGr) in obese pre-pubertal children. SUBJECTS AND METHODS Seventy obese children were studied at diagnosis (D) and after reduction of their body mass index (BMI) of over 1 (-1; no.=51) and 2 SD score (-2; no.=21). Body composition was analyzed and serum levels of glucose, insulin, TG and AG, and the AG/TGr were determined at every time-point in an oral glucose tolerance test (OGTT) at D and at -2. The control group consisted of 32 lean children. RESULTS At D AG and TG levels were lower in obese children and negatively correlated with BMI. TG levels were negatively correlated with the homeostasis model assessment (HOMA) index in the whole cohort, as with the body fat content (BFC) in the obese patients. Weight loss exclusively reduced BFC and improved HOMA, increasing AG transiently and TG sustainedly, with AG/TGr exclusively decreasing at -2. Glucose ingestion caused a sustained increase in AG and decrease in TG, thus increasing the AG/TGr throughout the entire OGTT; this remained unaltered after weight reduction. CONCLUSIONS TG and AG levels are influenced by BMI, showing an impairment in childhood obesity that can be improved through weight loss. The different fractions of ghrelin appear to play different roles in carbohydrate metabolism and the calculation of AG/TGr could be useful in the follow up of childhood obesity.
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Affiliation(s)
- G A Martos-Moreno
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
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Kelishadi R, Hashemipour M, Sarrafzadegan N, Mohammadifard N, Alikhasy H, Beizaei M, Sajjadi F, Poursafa P, Amin Z, Ghatreh-Samani S, Khavarian N, Siadat ZD. Effects of a lifestyle modification trial among phenotypically obese metabolically normal and phenotypically obese metabolically abnormal adolescents in comparison with phenotypically normal metabolically obese adolescents. MATERNAL AND CHILD NUTRITION 2010; 6:275-86. [PMID: 20929499 DOI: 10.1111/j.1740-8709.2009.00207.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to assess the effects of a 2-month lifestyle modification trial on cardio-metabolic abnormalities and C-reactive protein (CRP) among obese adolescents with metabolic syndrome [phenotypically obese metabolically abnormal (POMA)] and obese adolescents without a cardio-metabolic disorder [phenotypically obese metabolically normal (POMN)], as well as in normal-weight adolescents with at least one cardio-metabolic disorder [phenotypically normal metabolically obese (PNMO)]. The study comprised 360 adolescents assigned in three groups of equal number of POMN, POMA and PNMO. They were enrolled in a trial consisting of aerobic activity classes, diet and behaviour modification, and were recalled after 6 months. Overall, 94.7% of participants completed the 2-month trial, and 87.3% of them returned after 6 months. The mean CRP was not significantly different between the POMA and PNMO groups, but was higher than in the POMN group. After the trial, body mass index (BMI) and waist circumference (WC) decreased in obese participants, and the mean body fat mass decreased in all groups. At 2 months, the mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and CRP decreased in the POMA and PNMO groups. After 2 and 6 months, the decrease in mean TC, LDL-C, TG, CRP and systolic blood pressure was greater in the POMA than in the POMN group. The magnitude of decrease in CRP correlated with that of BMI, WC, fat mass, TG, TC and LDL-C. Lifestyle modification programmes for primordial/primary prevention of chronic diseases would be beneficial at the population level and should not be limited to obese children.
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Affiliation(s)
- Roya Kelishadi
- Pediatric Preventive Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Iran.
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Oyama LM, do Nascimento CMO, Carnier J, de Piano A, Tock L, Sanches PDL, Gomes FAC, Tufik S, de Mello MT, Dâmaso AR. The role of anorexigenic and orexigenic neuropeptides and peripheral signals on quartiles of weight loss in obese adolescents. Neuropeptides 2010; 44:467-74. [PMID: 20709393 DOI: 10.1016/j.npep.2010.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 06/23/2010] [Accepted: 07/20/2010] [Indexed: 11/23/2022]
Abstract
Obesity is characterized as an inflammatory state associated with a modification in the pattern of adipokine secretion. The present study aimed to assess the role of anorexigenic and orexigenic neuropeptides and peripheral signals in obese adolescents submitted to 1 year of weight loss interdisciplinary therapy and grouped according to quartiles of weight loss. A total of 111 post-puberty adolescents, with a BMI >95th percentile, were included. Glycemia and lipid profiles were analyzed. Insulin resistance was estimated by HOMA-IR. Cytokine concentrations were measured by ELISA. The results are presented according to quartiles of weight loss: 1st (<2.5 kg)=low; 2nd (2.5-8 kg)=low to moderate; 3rd (8-14 kg)=moderate; and 4th (>14 kg)=massive. The most important finding was that the NPY concentration increased significantly only in the first phase of weight loss. Moreover, α-MSH variation was an independent factor in explaining the NPY changes during the intervention, confirming the role of the α-MSH concentration in the peripheral control of energy balance in obese adolescents. Indeed, BMI reduction was correlated with increased α-MSH (p<0.05). Massive weight loss promoted a significant increase in α-MSH concentration, and hyperleptinemia was reduced after intervention. All together, our findings, which contribute to our understanding of how orexigenic and anorexigenic systems are regulated by weight loss, will provide insight into the pathogenesis and treatment of obesity and other metabolic diseases, especially in obese adolescents.
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Affiliation(s)
- Lila Missae Oyama
- Post Graduate Program of Nutrition, Federal University of São Paulo-Unifesp, São Paulo, SP, Brazil
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Pedrosa C, Oliveira BMPM, Albuquerque I, Simões-Pereira C, Vaz-de-Almeida MD, Correia F. Obesity and metabolic syndrome in 7-9 years-old Portuguese schoolchildren. Diabetol Metab Syndr 2010; 2:40. [PMID: 20537155 PMCID: PMC2901245 DOI: 10.1186/1758-5996-2-40] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 06/10/2010] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Body fat is related to changes in lipid profile, blood pressure and metabolism of insulin and glucose, known as the metabolic syndrome (MS). The aim of this study was to estimate the prevalence of metabolic syndrome (MS) and its components among overweight and obese Portuguese schoolchildren, and to identify associated clinical and biochemical characteristics. METHODS A total of 82 children (14 overweight and 68 obese; 40 boys and 42 girls) aged 7-9 years, underwent anthropometric measurements. A blood sample was obtained to assess biochemical parameters. Insulin resistance (IR) was determined by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). MS was defined by the National Cholesterol Education Program Adult Treatment Panel III criteria modified by Cook. RESULTS The prevalence of MS was 15.8%. Abdominal obesity was present in all children. Frequency of elevated blood pressure, low HDL-cholesterol and elevated triglyceride concentrations were 62.6%, 13.4% and 11.0%, respectively. None of the children presented impaired fasting glucose, however hyperinsulinemia (7.3%) and IR (8.5%) were observed. The number of components of MS was higher in children with higher z-BMI (rho = 0.411; p < 0.001). MS was associated with higher leptin concentrations. No association was found with adiponectin or ghrelin levels. Leptin correlated positively with obesity, glucose metabolism, lipid profile, hepatic function and C-reactive protein, and negatively with HDL and Apolipoprotein A-I/B ratio. CONCLUSIONS This study shows a significant prevalence of MS among obese schoolchildren. Abdominal obesity and elevated blood pressure were the most frequent components of this syndrome. Dyslipidemia, IR and high levels of leptin were also associated with MS in this young group.
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Affiliation(s)
- Carla Pedrosa
- Faculty of Nutrition and Food Sciences of University of Porto. Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- Department of Endocrinology, Diabetes and Nutrition; Hospital Infante D. Pedro, EPE. Avenida Artur Ravara, 3814-501 Aveiro, Portugal
| | - Bruno MPM Oliveira
- Faculty of Nutrition and Food Sciences of University of Porto. Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Isabel Albuquerque
- Department of Endocrinology, Diabetes and Nutrition; Hospital Infante D. Pedro, EPE. Avenida Artur Ravara, 3814-501 Aveiro, Portugal
| | - Carlos Simões-Pereira
- Department of Endocrinology, Diabetes and Nutrition; Hospital Infante D. Pedro, EPE. Avenida Artur Ravara, 3814-501 Aveiro, Portugal
| | - Maria D Vaz-de-Almeida
- Faculty of Nutrition and Food Sciences of University of Porto. Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Flora Correia
- Faculty of Nutrition and Food Sciences of University of Porto. Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- Department of Endocrinology; Hospital de S. João. Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Veldhuis JD, Bowers CY. Integrating GHS into the Ghrelin System. INTERNATIONAL JOURNAL OF PEPTIDES 2010; 2010:879503. [PMID: 20798846 PMCID: PMC2925380 DOI: 10.1155/2010/879503] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 12/30/2009] [Indexed: 12/21/2022]
Abstract
Oligopeptide derivatives of metenkephalin were found to stimulate growth-hormone (GH) release directly by pituitary somatotrope cells in vitro in 1977. Members of this class of peptides and nonpeptidyl mimetics are referred to as GH secretagogues (GHSs). A specific guanosine triphosphatate-binding protein-associated heptahelical transmembrane receptor for GHS was cloned in 1996. An endogenous ligand for the GHS receptor, acylghrelin, was identified in 1999. Expression of ghrelin and homonymous receptor occurs in the brain, pituitary gland, stomach, endothelium/vascular smooth muscle, pancreas, placenta, intestine, heart, bone, and other tissues. Principal actions of this peptidergic system include stimulation of GH release via combined hypothalamopituitary mechanisms, orexigenesis (appetitive enhancement), insulinostasis (inhibition of insulin secretion), cardiovascular effects (decreased mean arterial pressure and vasodilation), stimulation of gastric motility and acid secretion, adipogenesis with repression of fat oxidation, and antiapoptosis (antagonism of endothelial, neuronal, and cardiomyocyte death). The array of known and proposed interactions of ghrelin with key metabolic signals makes ghrelin and its receptor prime targets for drug development.
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Affiliation(s)
- Johannes D. Veldhuis
- Department of Medicine, Endocrine Research Unit, Mayo School of Graduate Medical Education, Clinical Translational Science Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Cyril Y. Bowers
- Division of Endocrinology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
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Gil-Campos M, Aguilera C, Ramirez-Tortosa M, Cañete R, Gil A. Fasting and postprandial relationships among plasma leptin, ghrelin, and insulin in prepubertal obese children. Clin Nutr 2010; 29:54-9. [DOI: 10.1016/j.clnu.2009.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/01/2009] [Accepted: 06/15/2009] [Indexed: 11/28/2022]
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Kelishadi R, Zemel MB, Hashemipour M, Hosseini M, Mohammadifard N, Poursafa P. Can a Dairy-Rich Diet Be Effective in Long-Term Weight Control of Young Children? J Am Coll Nutr 2009; 28:601-10. [DOI: 10.1080/07315724.2009.10719792] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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