Long-Term Effects of Aerobic Plus Resistance Training on the Metabolic Syndrome and Adiponectinemia in Obese Adolescents

Effect of different exercise modalities on nonalcoholic fatty liver disease: a systematic review and network meta-analysis

Physical exercise intervention can significantly improve the liver of patients with Non-alcoholic fatty liver disease (NAFLD), but it is unknown which exercise mode has the best effect on liver improvement in NAFLD patients. Therefore, we systematically evaluated the effect of exercise therapy on liver and blood index function of NAFLD patients through network meta-analysis (NMA). Through systematic retrieval of PubMed, Cochrane Library, Web of Science, EBSCO, and CNKI (National Knowledge Infrastructure), two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies by means of databases from inception to January 2023. The NMA was performed using the inconsistency model. A total of 43 studies, 2070 NAFLD patients were included: aerobic training (n = 779), resistance training (n = 159), high-intensity interval training (n = 160), aerobic training + resistance training (n = 96). The results indicate that aerobic training + resistance training could significantly improve serum total cholesterol (TC) (Surface under the cumulative ranking curve (SUCRA) = 71.7), triglyceride (TG) (SUCRA = 96.8), low-density lipoprotein cholesterol (LDL-C) (SUCRA = 86.1) in patients with NAFLD including triglycerides. Aerobic training is the best mode to improve ALT (SUCRA = 83.9) and high-density lipoprotein cholesterol (HDL-C) (SUCRA = 72.3). Resistance training is the best mode to improve aspartate transaminase (AST) (SUCRA = 81.7). Taking various benefits into account, we believe that the best modality of exercise for NAFLD patients is aerobic training + resistance training. In our current network meta-analysis, these exercise methods have different effects on the six indicators of NAFLD, which provides some reference for further formulating exercise prescription for NAFLD patients.

Lifestyle and Pharmacological Interventions and Treatment Indications for the Management of Obesity in Children and Adolescents

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.

Metabolic syndrome: Operational definitions and aerobic and resistance training benefits on physical and metabolic health in children and adolescents

BACKGROUND

The variation in parameters for childhood metabolic syndrome (MetS) has hindered the development of a consensus for the diagnostic criteria in this group. Despite these inconsistencies, it is accepted that exercise can ameliorate the deleterious effects of MetS. However, direct comparison between aerobic versus resistance exercise on MetS symptomology in adolescents is lacking.

AIM

Aim of this review was to discuss controversies associated with current MetS operation definitions in adolescents and present a review summarizing longitudinal studies relevant to the influence of aerobic and resistance training on children with MetS.

METHODS

Reviews of PubMed and Web of Science were conducted to identify literature focusing on the influence of aerobic and resistance training on children with MetS. Selected manuscripts featured longitudinal research only.

RESULTS

A universally accepted definition of MetS for the pediatric population has yet to be established. As such, consensus regarding diagnostic criteria for MetS among children is lacking despite the presence of various descriptions in the literature. Though studies support the importance of aerobic and resistance exercise to combat comorbidities associated with MetS, longitudinal studies investigating the benefits of each exercise type among adolescents are limited and inconsistent.

CONCLUSION

An improved understanding of the impact of aerobic and resistance training on children with MetS is clinically relevant because it may facilitate more appropriate exercise recommendations for children with MetS. Additional large cohort studies are warranted to determine optimal exercise type.

Effects of concurrent training on irisin and fibronectin type-III domain containing 5 (FNDC5) expression in visceral adipose tissue in type-2 diabetic rats

CONTEXT

Evidence suggests that myokines could have clinical implications for metabolic diseases such as type-2 diabetes.

OBJECTIVE

We investigated the effects of concurrent training (CT) on irisin and fibronectin type-III domain containing five (FNDC5) expressions in visceral adipose tissue (VAT) in type-2 diabetic rats.

MATERIALS AND METHODS

Eighteen male Wistar rats (ages four to eight weeks) became diabetic using nicotinamide and streptozotocin and were assigned to either a control (CON) or a CT group using a randomised block design. The CT group exercised on a motor-driven treadmill at 60 to 75 per cent of VO_2max (0% grade) for 10-40 min/day (aerobic training) and performed 10 climbs on a 1-meter ladder utilising weighted resistance of 30-100% of body mass (resistance exercise) for 5 days/week over 8 weeks. Forty-eight hours after the last training session, the VAT of rats was removed and washed. FNDC5-relative gene expression and irisin were measured by the reverse transcription polymerase chain reaction (RT-PCR) method and enzyme-linked immunosorbent assay (ELISA) kit. Additionally, insulin resistance and plasma insulin and glucose levels were determined.

RESULTS

Our findings revealed that CT significantly increased FNDC5-relative gene expression in the VAT of type-2 diabetic rats compared to controls. Furthermore, eight weeks of CT improved insulin resistance and insulin and glucose levels but did not significantly alter irisin levels in type-2 diabetic rats.

DISCUSSION AND CONCLUSION

The results of this study demonstrated that CT increased FNDC5 mRNA and improved insulin resistance, insulin, and glucose levels. Also observed were increased trends (non-significant, p = .051) in irisin levels. Hence, CT may play a role in attenuating metabolic disorders such as obesity and type-2 diabetes.

Comparative effects of 6-weeks progressive resistance exercise and moderate intensity aerobic exercise on CD4 count and weights of people living with HIV/AIDS in Alex-Ekwueme Federal University Teaching Hospital Ebonyi State

INTRODUCTION

The most significant clinical challenges in people living with HIV/AIDS (PLWHA) are decline in CD4+ T helper cells and abnormal weight reduction. Consequently, PLWHA who are on Anti-Retroviral Therapy (ART) or Highly Active Anti-Retroviral Therapy (HAART) are usually predisposed to coronary artery diseases due to abnormal weight gain (lipohypertrophy), though with improved and unstable Cluster of Differentiation 4 (CD4) counts.The main aim of this study was to compare the effects of 6 weeks progressive resistance exercise (PRE) and moderate intensity aerobic exercise (MIAE) on CD4 count, and weight of PLWHA in Alex-Ekwueme Federal University Teaching Hospital Ebonyi State.

METHOD

The study adopted quasi experimental research design. The population of the study was 60 Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome patients that attended HIV clinics at Alex-Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA) which formed 58 sample sizes for this study.Simple random sampling technique was adopted for the study and flow cytometry, Heel Densitometer (X-rite 331C), and Omron BF 400 were the instrument used for data collection of CD4 counts and weight respectively; and they are standardized hence not validated. Mean, standard deviation and Analysis of Co-variance (ANCOVA) were used to analyze the data obtained. The reliability coefficient obtained from the pilot study was 0.848 and 0.994 for CD4 and WEIGHT respectively.

RESULTS

The major findings revealed a significant difference after 6 weeks' PRE and MIAE on CD4 and Weight of PLWHA.

CONCLUSION

Health promotion policy maker's arm of the government and Healthcare givers should integrate and enforce the use of exercises either as a single regimen or combined exercises into the management plan of PLWHA for greater boost in absolute CD4 count bearing in mind that both have positive effects. Physiotherapist should be integrated in the managements of PLWHA for appropriate prescription and education of therapeutic exercises for body weight.

Exercise training modulates adipokines dysregulations in metabolic syndrome

Metabolic syndrome (MetS) is a cluster of risk factors for various metabolic diseases, and it is characterized by central obesity, dyslipidemia, hypertension, and insulin resistance. The core component for MetS is adipose tissue, which releases adipokines and influences physical health. Adipokines consist of pro and anti-inflammatory cytokines and contribute to various physiological functions. Generally, a sedentary lifestyle promotes fat accumulation and secretion of pro-inflammatory adipokines. However, regular exercise has been known to exert various beneficial effects on metabolic and cognitive disorders. Although the mechanisms underlying exercise beneficial effects in MetS are not fully understood, changes in energy expenditure, fat accumulation, circulatory level of myokines, and adipokines might be involved. This review article focuses on some of the selected adipokines in MetS, and their responses to exercise training considering possible mechanisms.

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Adipokines are a potential link between visceral fats and complications of MetS.

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Physical inactivity increases pro-inflammatory adipokines.

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Moderate aerobic exercise increases anti-inflammatory adipokines partly via reducing adipose tissue mass.

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Physical exercise-induced myokines might mediate beneficial effects via a cross-talk with adipose tissues.

Effects of aerobic exercise on obese children with metabolic syndrome: a systematic review and meta-analysis

OBJECTIVES

Metabolic syndrome (MetS) is systemic metabolic disease that results from insulin resistance or obesity. Numerous meta-analyses have investigated the effect of exercise on different populations, but none were aimed at the effect of aerobic exercise alone on obese children. This review systematically assessed and performed a meta-analysis on the effect of aerobic exercise on obese children with MetS.

CONTENT

MEDLINE via PubMed, Embase, SPORTDiscus, and the Cochrane library were searched and screened from inception to 20 October 2020 for randomized controlled trials. The inclusion criteria were obese children who met the criteria for MetS and aged 5-19 years old in an aerobic exercise group. The meta-analysis included eight trials with a total of 197 participants. Aerobic exercise significantly improved the waist circumference (mean difference [MD]=-3.97; 95% confidence interval [CI]=-6.12 to -1.83; p<0.01), body mass index (standardized MD [SMD]=-0.5; 95% CI=-0.70 to -0.29; p<0.01), triglyceride (SMD=-24.6; 95% CI=-33.85 to -15.35; p<0.01), high-density lipoprotein cholesterol (SMD=2.36; 95% CI=0.44 to 4.27; p<0.01), and systolic blood pressure (SMD=-6.90; 95% CI=-10.46 to -3.35; p<0.01).

SUMMARY

Based on the results of this meta-analysis, during the intervention period of the included studies, aerobic exercise alone mainly affected the lipoprotein, blood pressure, and body dimensions but cannot completely cure the MetS of obese children.

OUTLOOK

The effects of different types of aerobic exercise on obese children with MetS and exercise dose to cure the MetS of obese children needs to be further studied.

The Role of Exercise, Diet, and Cytokines in Preventing Obesity and Improving Adipose Tissue

The prevalence of obesity continues to rise worldwide despite evidence-based public health recommendations. The promise to adopt a healthy lifestyle is increasingly important for tackling this global epidemic. Calorie restriction or regular exercise or a combination of the two is accepted as an effective strategy in preventing or treating obesity. Furthermore, the benefits conferred by regular exercise to overcome obesity are attributed not only to reduced adiposity or reduced levels of circulating lipids but also to the proteins, peptides, enzymes, and metabolites that are released from contracting skeletal muscle or other organs. The secretion of these molecules called cytokines in response to exercise induces browning of white adipose tissue by increasing the expression of brown adipocyte-specific genes within the white adipose tissue, suggesting that exercise-induced cytokines may play a significant role in preventing obesity. In this review, we present research-based evidence supporting the effects of exercise and various diet interventions on preventing obesity and adipose tissue health. We also discuss the interplay between adipose tissue and the cytokines secreted from skeletal muscle and other organs that are known to affect adipose tissue and metabolism.

HIIT, RESISTANCE TRAINING, AND RISK FACTORS IN ADOLESCENTS: A SYSTEMATIC REVIEW

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.

Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes?

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

The effect of aerobic plus resistance training associated with a long-term interdisciplinary weight loss program on visceral fat and isokinetic parameters in adolescents with obesity

BACKGROUND

Obesity can lead to a number of alterations in biomechanical structures. We aimed to assess the effect of aerobic plus resistance training associated with an interdisciplinary approach on visceral fat and isokinetic parameters in a long-term weight loss therapy program.

METHODS

Forty-four postpubertal obese adolescents were involved in the 1-year interdisciplinary weight loss therapy program (clinical, nutritional, psychological and physical training). Body composition, and visceral and subcutaneous fat were measured by DXA absorptiometry and ultrasonography, respectively. Peak torque was analyzed using an isokinetic dynamometer. Statistical analysis was performed using t-tests to assess the effect of the intervention.

RESULTS

There was a significant reduction in body fat with an inverse increase in lean mass. Positive correlations were observed between peak torque and lean body mass and negative correlations with visceral fat, gynoid fat mass, arm fat mass and subcutaneous fat.

CONCLUSIONS

An interdisciplinary weight loss program can reduce body fat and increase peak torque and improve muscle strength. The results reinforce the importance of this kind of approach to treat obesity and improve the quality of life in this population.

Physical activity in the therapy of overweight and obesity in children and adolescents. Needs and recommendations for intervention programs

Overweight and obesity may lead to serious health problems, and negatively affect everyday functioning in physical, psychological and social spheres. The high prevalence of overweight and obesity in children and adolescents constitutes a huge public health burden. One way of designing and implementing behavioral interventions aimed at the reduction of adipose tissue is to promote physical activity. In this review we present recommendations regarding the planning, monitoring and implementation of intervention programs involving controlled physical activity. Considering specific individual determinants and needs in terms of improving children's health, physical condition and physical performance, we have separately discussed recommendations for interventions involving aerobic and anaerobic exercises with moderate and high intensity, including high-intensity interval training (HIIT). We have also focused on the role of resistance training. Finally, we have emphasized that children and adolescents with overweight or obesity should also be motivated to undertake activities referred to as non-exercise activity thermogenesis (NEAT).

Effect of an 8-Week Individualized Training Program on Blood Biomarkers, Adipokines and Endothelial Function in Obese Young Adolescents with and without Metabolic Syndrome

Obesity is a chronic condition whose incidence is growing due to lack of exercise and frequent nutrition disorders. Childhood obesity has reached epidemic proportions worldwide. One of the best treatment methods is physical training. However, conflicting results have been reported regarding its clinical effectiveness. These contrasting findings may be due to the type and intensity of the adopted physical training program. Therefore, the purpose of the current study was to investigate the effect of an 8-week individualized physical training program on endothelial function, blood biomarkers and adipokine levels in obese adolescents with and without metabolic syndrome (MS). One-hundred-and-twenty-two obese adolescents (71 obese without MS and 51 obese with MS) aged 14 ± 2 years were included in this study. The 8-week individualized training program decreased glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol and leptin in obese subjects with and without MS. However, adiponectin and endothelial-dependent vasodilatation increased in the follow-up study in both groups. Taken together, the findings suggest that individualized training program is an effective means for the treatment of obesity and MS in pediatric populations.

One-year weight loss maintenance outcomes following a worksite-based weight reduction program among Japanese men with cardiovascular risk factors

Objectives

Worksite‐based programs present a simple and effective approach to facilitate weight reduction in employees. Despite the importance of 1‐year weight loss maintenance, studies have generally focused on the short‐term effects of weight reduction programs. In addition, little is known about the long‐term weight maintenance outcomes in Asian populations. We examined the long‐term maintenance effects of a worksite‐based weight reduction program among Japanese men with cardiovascular risk factors.

Methods

The study sample comprised 58 overweight men with cardiovascular risk factors who had voluntarily participated in a randomized crossover trial involving a 3‐month weight reduction program. Participants were followed up for 1 year after the trial concluded, and both groups were merged for the analysis. We compared the changes in body weight before the post‐trial follow‐up and after 12 months to examine the long‐term maintenance effects of the program. Changes in other cardiovascular risk factors (eg, waist circumference, blood pressure, lipid measures, and diabetes‐related measures) were also examined.

Results

Both groups of study participants achieved weight loss during the weight reduction program. Total 53 participants (91.4%) completed the 12‐month post‐trial follow‐up. There were no significant changes in mean body weight (mean: −0.11, 95% confidence interval: −0.7‐0.49 kg) and other cardiovascular risk factors between the beginning and end of the follow‐up period.

Conclusions

This study showed that the worksite‐based weight reduction program not only enabled short‐term weight loss, but that the participants were able to successfully maintain their weight for 1 year after the program without any supplementary interventions.

The Effects of a 12-Week Combined Exercise Training Program on Arterial Stiffness, Vasoactive Substances, Inflammatory Markers, Metabolic Profile, and Body Composition in Obese Adolescent Girls

PURPOSE

Childhood and adolescent obesity is a major international public health crisis. It is crucial to prevent the negative effects of obesity at an early age by implementing appropriate lifestyle interventions, such as exercise training. We evaluated the effects of a combined resistance and aerobic exercise training (CET) regimen on arterial stiffness, vasoactive substances, inflammatory markers, metabolic profile, and body composition in obese adolescent girls.

METHODS

A total of 30 obese adolescent girls were randomly assigned to a CET (n = 15) or a control group (n = 15). The CET group trained for 3 days per week. Plasma nitric oxide, endothelin-1, C-reactive protein, arterial stiffness, glucose, insulin, the adiponectin/leptin ratio, and body fat were measured before and after 12 weeks.

RESULTS

There were significant increases (P < .05) in nitric oxide (4.0 μM) and adiponectin/leptin ratio (0.33); and decreases (P < .05) in arterial stiffness (-1.0 m/s), C-reactive protein (-0.5 mg/L), glucose (-1.2 mmol/L), insulin (-17.1 μU/mL), and body fat (-3.6%) following CET compared with control. There were no significant changes in endothelin-1 after CET or control.

CONCLUSIONS

The findings of this study indicate that CET improves arterial stiffness, nitric oxide, and inflammatory and metabolic markers in obese adolescent girls. CET may have important health implications for the prevention of atherosclerosis at an early age.

Home-exercise Childhood Obesity Intervention: A Randomized Clinical Trial Comparing Print Versus Web-based (Move It) Platforms

PURPOSE

To compare the impact of adhering to a Mediterranean diet plus mixed physical exercise program (Move-It) implemented by means of printed instructions or via a web-platform (with or without e-mail support) on body composition, physical fitness, and blood pressure.

DESIGN AND METHODS

Randomized clinical trial. Fifty-two overweight or obese Spanish children and adolescents were randomly assigned to the print-based (n = 18), Move-It (n = 18), or Move-It plus support (n = 16) intervention groups. Two-way mixed ANOVA tests were used to compare any changes between the groups in terms of percentage body fat, physical fitness (VO₂peak), handgrip strength, and systolic and diastolic blood pressure. The measurements were taken before and after a three-month mixed-exercise (aerobic and resistance) and Mediterranean-diet program which was either implemented by means of printed instructions or via a web-platform (with or without e-mail support).

RESULTS

No statistical differences were found between groups. However, the results highlighted significant improvements in body fat percentage metrics over time for all three groups (print-based: -1.8%, 95%CI -3.3% to -0.3%; Move-It: -1.8%, 95%CI -3.3% to -0.3%; Move-It plus support: -2.0%, 95%CI -3.7% to -0.4%, P < 0.05). We also observed a tendency towards improvement in the VO₂peak, handgrip strength, and blood pressure variable values 10 min after the exercise-stress test in these three groups.

CONCLUSIONS

The program improved the body composition, regardless of the way it is implemented.

PRACTICE IMPLICATIONS

A mixed physical exercise program lasting for three months, combined with a Mediterranean diet, improves the body composition of children and adolescents with overweight/obesity.

Effects of exercise intervention on visceral fat in obese children and adolescents

INTRODUCTION

This meta-analysis study was aimed to assess the effects of exercise intervention on visceral fat in obese children and adolescents.

EVIDENCE ACQUISITION

Electronic database searches were performed in Academic Search Complete, CINAHL, Healthsource, MEDLINE, and SportDiscus, and from the earliest record to November 2017. Keywords included "exercise or training," "visceral fat," and "child or adolescent or youth." The inclusion criteria for eligible studies were as follows: 1) subjects were obese at baseline; 2) aged 6-19 years; 3) visceral fat was reported at baseline and after an intervention; and 4) studies were published in peer-reviewed journals written in English.

EVIDENCE SYNTHESIS

A total of 207 studies were observed at the initial search and 73 effect sizes (ESs) were derived from the 34 selected studies. The overall exercise intervention effect was large (Cohen's d [ES]=-1.003, 95% CI=-1.114, -0.892). Moderator analyses results showed that gender (Qb=8.23, df=2, P=0.016), exercise type (Qb=10.68, df=2, P=0.005), and intervention length (Qb=24.71, df=2, P<0.001) influenced the overall ES.

CONCLUSIONS

The group of both boys and girls (ES=-0.95) who participated combined exercise program (Aerobic + Resistance training; ES=-1.17) for 12 months (ES=-1.24) appeared to be the most effective exercise strategy for reducing visceral fat in obese youth.

New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT

OBJECTIVE

To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS).

METHOD

search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition).

RESULTS

1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m² and BW (body weight) in kg.

CONCLUSIONS

Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.

Efficacy of Exercise Intervention for Weight Loss in Overweight and Obese Adolescents: Meta-Analysis and Implications

BACKGROUND

The global rise in obesity prevalence among children and adolescents has been linked to modifiable lifestyle factors, including lack of physical activity. However, no known meta-analysis has been conducted on the effects of exercise intervention on body composition and cardiometabolic risk factors in overweight and obese adolescents.

OBJECTIVES

The aim of this study was to (1) estimate whether exercise intervention meaningfully improves body composition and cardiometabolic risk factors in overweight and obese adolescents; and (2) discuss the implications of the findings in terms of primary healthcare provision and public health policy, using New Zealand as an exemplar context.

DATA SOURCES

Electronic databases (PubMed, Web of Science, SPORTDiscus, Google Scholar) from inception to May 2015. The reference lists of eligible articles and relevant reviews were also checked.

STUDY SELECTION

Inclusion criteria were (1) randomized controlled trial; (2) structured exercise intervention, alone or combined with any other kind of intervention; (3) control group received no structured exercise or behavioural modification designed to increase physical activity; (4) participants overweight or obese (body mass index [BMI] ≥85th percentile); and (5) participants aged between 10 and 19 years.

APPRAISAL AND SYNTHESIS METHODS

Initially, 1667 articles were identified. After evaluation of study characteristics, quality and validity, data from 13 articles (15 trials) involving 556 participants (176 male, 193 female, 187 unknown) were extracted for meta-analysis. Meta-analyses were completed on five body composition parameters and ten cardiometabolic parameters. Effect sizes (ESs) were calculated as mean differences, as well as standardized mean differences in order to determine effect magnitude.

RESULTS

Exercise intervention reduced BMI (mean 2.0 kg/m², 95 % CI 1.5-2.5; ES moderate), body weight (mean 3.7 kg, 95 % CI 1.7-5.8; ES small), body fat percentage (3.1 %, 95 % CI 2.2-4.1; ES small), waist circumference (3.0 cm, 95 % CI 1.3-4.8; ES small), but the increase (improvement) in lean mass was trivial (mean 1.6 kg, 95 % CI 0.5-2.6). The response to an oral glucose tolerance test following exercise intervention was for a decrease in the area under the curve for insulin (mean 162 μU/μl, 95 % CI 93-231; ES large) and blood glucose (mean 39 mg/dl, 95 % CI 9.4-69; ES moderate). Improvements in the homeostatic model assessment were also noted (mean 1.0, 95 % CI 0.7-1.4; ES moderate) and systolic blood pressure (mean 7.1 mmHg, 95 % CI 3.5-10.7; ES moderate). The effects of exercise on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting insulin and fasting blood glucose were inconclusive.

LIMITATIONS

Most of the included trials were short term (6-36 weeks) and 13 had methodological limitations. Additionally, the meta-analyses for some of the secondary outcomes had a small number of participants or substantial statistical heterogeneity.

CONCLUSIONS

The current evidence suggests that exercise intervention in overweight and obese adolescents improves body composition, particularly by lowering body fat. The limited available evidence further indicates that exercise intervention may improve some cardiometabolic risk factors.

Exercise Therapy for Patients With Type 2 Diabetes: A Narrative Review

To achieve excellent glycemic control in patients with type 2 diabetes, an adequate prescription of exercise therapy is required. The meta-analyses proposed that high-intensity training improves metabolic parameters in patients with pre-diabetes or type 2 diabetes and low physical activity is associated with an increased risk of incident type 2 diabetes. Here, we would introduce literatures about effects of physical activity on mortality, cardiovascular events, and metabolic parameters, to encourage understanding of exercise therapy, and then describe how to prescribe exercise therapy for patients with type 2 diabetes. We also show the usefulness of non-exercise activity thermogenesis for diabetic patients who cannot perform volitional sporting-like exercise because of diabetic complication and/or comorbidity, by presenting results of our previous studies.

Physical activity in the therapy of overweight and obesity in children and adolescents. Needs and recommendations for intervention programs

Overweight and obesity may lead to serious health problems, and negatively affect everyday functioning in physical, psychological and social spheres. The high prevalence of overweight and obesity in children and adolescents constitutes a huge public health burden. One way of designing and implementing behavioral interventions aimed at the reduction of adipose tissue is to promote physical activity. In this review we present recommendations regarding the planning, monitoring and implementation of intervention programs involving controlled physical activity. Considering specific individual determinants and needs in terms of improving children's health, physical condition and physical performance, we have separately discussed recommendations for interventions involving aerobic and anaerobic exercises with moderate and high intensity, including high-intensity interval training (HIIT). We have also focused on the role of resistance training. Finally, we have emphasized that children and adolescents with overweight or obesity should also be motivated to undertake activities referred to as non-exercise activity thermogenesis (NEAT).

The Therapeutic Potential of Anti-Inflammatory Exerkines in the Treatment of Atherosclerosis

Although many cardiovascular (CVD) medications, such as antithrombotics, statins, and antihypertensives, have been identified to treat atherosclerosis, at most, many of these therapeutic agents only delay its progression. A growing body of evidence suggests physical exercise could be implemented as a non-pharmacologic treatment due to its pro-metabolic, multisystemic, and anti-inflammatory benefits. Specifically, it has been discovered that certain anti-inflammatory peptides, metabolites, and RNA species (collectively termed “exerkines”) are released in response to exercise that could facilitate these benefits and could serve as potential therapeutic targets for atherosclerosis. However, much of the relationship between exercise and these exerkines remains unanswered, and there are several challenges in the discovery and validation of these exerkines. This review primarily highlights major anti-inflammatory exerkines that could serve as potential therapeutic targets for atherosclerosis. To provide some context and comparison for the therapeutic potential of exerkines, the anti-inflammatory, multisystemic benefits of exercise, the basic mechanisms of atherosclerosis, and the limited efficacies of current anti-inflammatory therapeutics for atherosclerosis are briefly summarized. Finally, key challenges and future directions for exploiting these exerkines in the treatment of atherosclerosis are discussed.

Concurrent aerobic plus resistance exercise versus aerobic exercise alone to improve health outcomes in paediatric obesity: a systematic review and meta-analysis

OBJECTIVE

To determine if the combination of aerobic and resistance exercise is superior to aerobic exercise alone for the health of obese children and adolescents.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Computerised search of 3 databases (MEDLINE, EMBASE, and Cochrane Controlled Trials Registry).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies that compared the effect of supervised concurrent exercise versus aerobic exercise interventions, with anthropometric and metabolic outcomes in paediatric obesity (6-18 years old). The mean differences (MD) of the parameters from preintervention to postintervention between groups were pooled using a random-effects model.

RESULTS

12 trials with 555 youths were included in the meta-analysis. Compared with aerobic exercise alone, concurrent exercise resulted in greater reductions in body mass (MD=-2.28 kg), fat mass (MD=-3.49%; and MD=-4.34 kg) and low-density lipoprotein cholesterol (MD=-10.20 mg/dL); as well as greater increases in lean body mass (MD=2.20 kg) and adiponectin level (MD=2.59 μg/mL). Differences were larger for longer term programmes (>24 weeks).

SUMMARY

Concurrent aerobic plus resistance exercise improves body composition, metabolic profiles, and inflammatory state in the obese paediatric population.

TRIAL REGISTRATION NUMBER

CRD42016039807.

Multidisciplinary programs for obesity treatment in Brazil: A systematic review

ABSTRACT This study aimed to conduct a systematic review of publications addressing the multidisciplinary treatment of obesity in Brazil and analyze their main results. A search was conducted in the databases SciELO, Lilacs, and Pubmed/Medline using the following search terms: 'obesidade', 'intervenção', 'tratamento', 'Brasil', for the search in Portuguese, and 'obesity', 'intervention', 'treatment', 'Brazil', for the search in English. Based on these terms, the following combination of words was used: 'Intervenção multiprofissional da obesidade', 'tratamento multidisciplinar da obesidade, tratamento multiprofissional da obesidade' and 'multidisciplinary obesity intervention', 'multidisciplinary obesity treatment', 'Multiprofessional obesity treatment'. Inclusion criteria were as follows: original studies carried out in Brazil involving human beings and that reported an intervention including two or more health care professionals. Articles published between January 2005 and July 2015 were analyzed independently by two reviewers. At the end of the analysis, out of 355 articles initially selected, 26 met all inclusion criteria. The following results were found: 23 studies involved children and adolescents and 03 involved adults 20-60 years of age. It was also found that the 26 studies analyzed had an impact on anthropometric parameters, 10 on physical fitness parameters, 16 on biochemical parameters, 10 on the reduction in comorbidities, 6 on nutritional parameters, and 4 on the psychological/social aspects. Based on evidence presented in the studies reviewed, it can be said that the multidisciplinary treatment for obesity greatly contributed to the reduction in the anthropometric indicators, especially BMI and the biochemical, social, and psychological parameters. Thus, these findings demonstrate that there is a need to expand the range of this type of treatment since it has proven to be effective in the fight against obesity and its comorbidities.

An Integrative Analysis of the Effect of Lifestyle and Pharmacological Interventions on Glucose Metabolism in the Prevention and Treatment of Youth-Onset Type 2 Diabetes

Preventing and managing youth-onset type 2 diabetes are a major challenge. This paper reviews the evidence of lifestyle and drug therapies in improving glucose, insulin, and insulin sensitivity. Forty-four interventions were analyzed, of which 11 were drug (mainly metformin) interventions combined with lifestyle while the remainder used lifestyle strategies only. Fewer than a dozen out of 44 interventions reported significant improvements in glucose-related outcomes. Metformin in addition to lifestyle therapy did not necessarily enhance intervention effects. The overall lack of findings can be partially attributed to the heterogeneity of study populations, the lack of intervention intensity, under-powered study design, and the challenging lives of at-risk populations. New treatment options in both drugs and lifestyle strategies are direly needed.

The role of free fatty acids in the inflammatory and cardiometabolic profile in adolescents with metabolic syndrome engaged in interdisciplinary therapy

The purpose of the present study was to evaluate if interdisciplinary therapy can influence the cardiometabolic and serum free fatty acid profile. The second aim was to evaluate if there is an association between serum free fatty acids, inflammation and cardiometabolic biomarkers in obese adolescents with and without metabolic syndrome submitted to a long-term interdisciplinary therapy. The study involved 108 postpuberty obese adolescents, who were divided according to metabolic syndrome (MetS) diagnosis: MetS (n=32) and Non-MetS (n=76). The interdisciplinary therapy consisted of a 1-year period of nutrition, psychology, physical exercise and clinical support. After therapy, both groups improved metabolic, inflammatory (leptin, adiponectin, leptin/adiponectin ratio, adiponectin/leptin ratio and C-reactive protein) and cardiometabolic profile (PAI-1 and ICAM). Metabolic syndrome prevalence reduced from 28.70% to 12.96%. Both groups reduced myristic acid (C14:0) and increased docosahexaenoic acid (DHA, C22:6n3), heneicosapentaenoic acid (HPA, C21:5n3) and arachidonic acid (C20:4n6). After adjustment for metabolic syndrome and the number of metabolic syndrome parameters, multiple regression analysis showed that changes in VCAM and PAI-1 were negatively associated with changes in cis-linoleic acid (C18:2n6c). Additionally, changes in trans-linoleic acid (C18:2n6t) were also positively associated with these biomarkers. Moreover, leptin and leptin/adiponectin ratio were negatively associated with changes in docosapentaenoic acid (DPA, C22:5n3) and stearidonic acid (SDA, C18:4n3). Adiponectin/leptin ratio was positively associated with docosapentaenoic acid (DPA, C22:5n3). Changes in adiponectin were positively correlated with changes in omega 3, such as heneicosapentaenoic acid (HPA, C21:5n3) and docosapentaenoic acid (DPA, C22:5n3). Results support that interdisciplinary therapy can control inflammatory and cardiometabolic profile in obese adolescents. Moreover, serum fatty acids can be influenced by lifestyle changes and are able to modulate these biomarkers.

Combined dyslipidemia in childhood

Combined dyslipidemia (CD) is now the predominant dyslipidemic pattern in childhood, characterized by moderate-to-severe elevation in triglycerides and non-high-density lipoprotein cholesterol (non-HDL-C), minimal elevation in low-density lipoprotein cholesterol (LDL-C), and reduced HDL-C. Nuclear magnetic resonance spectroscopy shows that the CD pattern is represented at the lipid subpopulation level as an increase in small, dense LDL and in overall LDL particle number plus a reduction in total HDL-C and large HDL particles, a highly atherogenic pattern. In youth, CD occurs almost exclusively with obesity and is highly prevalent, seen in more than 40% of obese adolescents. CD in childhood predicts pathologic evidence of atherosclerosis and vascular dysfunction in adolescence and young adulthood, and early clinical cardiovascular events in adult life. There is a tight connection between CD, visceral adiposity, insulin resistance, nonalcoholic fatty liver disease, and the metabolic syndrome, suggesting an integrated pathophysiological response to excessive weight gain. Weight loss, changes in dietary composition, and increases in physical activity have all been shown to improve CD significantly in children and adolescents in short-term studies. Most importantly, even small amounts of weight loss are associated with significant decreases in triglyceride levels and increases in HDL-C levels with improvement in lipid subpopulations. Diet change focused on limitation of simple carbohydrate intake with specific elimination of all sugar-sweetened beverages is very effective. Evidence-based recommendations for initiating diet and activity change are provided. Rarely, drug therapy is needed, and the evidence for drug treatment of CD in childhood is reviewed.

Linear and undulating periodized strength plus aerobic training promote similar benefits and lead to improvement of insulin resistance on obese adolescents

The present study compares the effectiveness of three types of physical training for obesity control in adolescents submitted to a long-term interdisciplinary therapy. Forty-five post-puberty obese adolescents (15-18yo) were randomly placed in three different groups of physical trainings: aerobic training (AT n=20), aerobic plus strength training with linear periodization (LP n=13) and aerobic plus strength training with daily undulating periodization (DUP n=12). The body composition was evaluated by air-displacement plethysmography; the rest metabolic rate was measured by indirect calorimetry; serum analysis was collected after an overnight fasting. The most important finding of this study was that both LP and DUP groups improved lipid profile, insulin sensitivity and adiponectin concentration (p<0.01). The linear regression showed a negative association between delta (%) adiponectin and delta (%) insulin (p<0.05). Each group presented a significant reduction in body mass, body mass index and fat mass (kg) after short and long-term intervention (p<0.01). However, the AT group reduced the fat-free mass after short-term intervention (p<0.01) and enhanced protein oxidation (p<0.01), whereas only LP group was able to increase the fat-free mass and maintain the rest metabolic rate (RMR). There was a negative correlation between percentage of protein oxidation and RMR (r=-0.75) in all groups. The interdisciplinary therapy models that included aerobic plus strength training were more effective than only aerobic training to improve lipid profile and insulin sensitivity, as well as the inflammatory state by increasing adiponectin. In all groups were observed an improvement on anthropometric profile.

Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse

Childhood obesity and the early development of type 2 diabetes (T2 DM) place students at risk for chronic health problems. The school nurse is uniquely situated to promote school health initiatives that influence health behavior. The purpose of this review was to determine effective nonpharmacological interventions for prevention of T2 DM in youth. Researchers from 35 reports modified T2 DM risk factors. These nonpharmacological interventions often include increasing daily activity, decreasing caloric intake, and increasing muscle mass. Some researchers also included psychological and social support interventions intended to strengthen initiating and/or maintaining health behavior. Characteristics of effective nonpharmacological T2 DM prevention interventions are discussed. Findings from this review are a useful guide for the implementation of T2 DM prevention strategies in the school setting. Few school-based studies included high school students; therefore, further research is needed among older adolescents on the efficacy of nonpharmacological interventions in the high school.

What is the effect of resistance training on the strength, body composition and psychosocial status of overweight and obese children and adolescents? A Systematic review and meta-analysis

BACKGROUND

Overweight and obese children and adolescents face many physical and psychosocial hardships. Resistance training is a modality of exercise which allows this at-risk group to excel and therefore has the potential to positively affect not only their physical but also psychosocial health.

OBJECTIVE

To systematically review and meta-analyse the peer-reviewed literature to determine the effect of resistance training on the strength, body composition and psychosocial status of overweight and/or obese children and/or adolescents.

DATA SOURCES

Relevant databases (MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, CINAHL, PsycINFO, Cochrane library, ProQuest) were searched up to and including 30 January 2013.

STUDY SELECTION

Included studies (n = 40, from the 2,247 identified) were randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs) and uncontrolled trials (UCTs) which had run an exercise intervention, with a resistance training component, for overweight and/or obese children and/or adolescents, and which had examined the effect of resistance training on either strength, body composition or psychosocial outcomes.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies were initially critically appraised for risk of bias by the lead author, following which both co-authors critically appraised five randomly selected studies to assess reliability.

RESULTS

Randomised controlled trials and NRCTs were analysed separately from UCTs. To determine the overall intervention effect for each outcome variable for each study design group, standardised mean differences were calculated with each individual study/data set weighted by the inverse of the pooled variance. The overall intervention effect reported for RCTs and NRCTs was relative to the control group whereas the effect reported for UCTs shows an overall post-intervention effect. Subgroup analyses, which determined whether the overall intervention effect was influenced by intervention type, training volume, age, sex, risk of bias or study design (for RCT/NRCT group only), were run using the same summary measure. Typically, resistance training had very small to small effects on body composition and moderate to large effects on strength in favour of the intervention. However, the magnitude and direction of the effect of resistance training on psychological outcomes are still unclear given the limited number of studies which looked at psychosocial outcomes and the inconclusive results shown by this review. Uncontrolled trials typically showed larger intervention effects than RCTs and NRCTs; however, these results may be greatly influenced by maturational changes rather than the intervention itself.

LIMITATIONS

The included studies employed a number of different exercise intervention types (e.g. resistance training, resistance plus aerobic training etc.) that ranged from 6 to 52 weeks in duration. Studies also employed a number of different methodologies to assess similar outcome measures (e.g. dual energy X-ray absorptiometry versus skinfolds to assess body composition; one-repetition maximum testing versus hand grip strength to assess strength). However, by completing subgroup analyses and using a standardised summary measure these limitations have been accounted for.

CONCLUSION

While the effect of resistance training on the body composition and strength of overweight and obese children and adolescents is clear, given the paucity of conclusive data more studies are needed to fully understand the effect of resistance training on the psychosocial status of this population.

Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents

The purpose of this study was to determine whether aerobic plus resistance training (AT + RT) is more effective than aerobic training (AT) at reducing inflammatory markers and cardiovascular risk in obese adolescents. A total of 139 obese adolescents were enrolled, aged 15-19 years, body mass index (BMI) ≥ 95th percentile and participated in 1 year of interdisciplinary intervention. They were randomised into two groups: AT (n = 55), AT + RT (n = 61). Blood samples were collected to analyse glycaemia, insulin, the lipid profile, leptin and adiponectin concentrations. Insulin resistance was measured by homeostasis model assessment of insulin resistance index (HOMA-IR). The AT + RT group showed better results with regard to decreased body fat mass, low-density lipoprotein concentration (LDL-c) levels, subcutaneous and visceral fat and increased body lean mass. Indeed, a reduction of hyperleptinaemia and an increase in adiponectin concentrations, promoting an improvement in the leptin/adiponectin ratio, was observed. Important clinical parameters were improved in both types of exercise; however, AT + RT was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than AT alone, suggesting clinical applications for the control of intra-abdominal obesity and cardiovascular risk in the paediatric population.

Childhood Obesity and the Metabolic Syndrome

There have been dramatic increases over the past several decades in the prevalence of childhood obesity and childhood metabolic syndrome in the United States and other industrialized nations. Since the 2 conditions carry negative health implications, both during childhood and later in life, it is important for health care professionals to stay abreast of the current literature relative to both conditions. This review will examine definitional issues, prevalence rates, causative factors, and health consequences associated with childhood obesity and the metabolic syndrome, as well as current thinking regarding prevention and treatment efforts. The review will conclude with recommendations relative to future research needs.

Aerobic training (AT) is more effective than aerobic plus resistance training (AT+RT) to improve anorexigenic/orexigenic factors in obese adolescents

BACKGROUND

The regulation of energy balance is influenced by physical exercise. Although some studies show a stimulation of hormones related to food intake, others show that exercise provides satiety.

AIM

The aim of this study was to compare the effects of aerobic training (AT) and aerobic plus resistance training (AT+RT) on anorexigenic and orexigenic factors in obese adolescents undergoing interdisciplinary weight loss therapy.

METHODS

A total of 26 obese adolescents, aged 15-19 years with BMI≥P95 were submitted to 12 months of interdisciplinary intervention (clinical support, nutrition, psychology and physical exercise) and divided into two groups, aerobic training (AT) (n=13) or aerobic plus resistance training (AT+RT) (n=13), which were matched according to gender and body mass. Blood samples were collected to analyze orexigenic factors (AgRP, NPY, MCH) and the anorexigenic factor alpha-MSH.

RESULTS

The AT and AT+RT groups significantly reduced body mass, body mass index and body fat mass (kg) during the therapy. The AT group showed no significant changes in body lean mass (kg), whereas the AT+RT group showed an increase in body lean mass (kg) during the interdisciplinary intervention. There was an increase in AgRP levels (ng/ml) only in the AT+RT group after 6 months of interdisciplinary intervention compared with baseline condition. Conversely, α-MSH levels (ng/ml) increased only in the AT group after 12 months of interdisciplinary intervention compared with baseline condition.

CONCLUSION

Aerobic training (AT) as part of an interdisciplinary therapy is more effective than aerobic plus resistance training (AT+RT) to improve secretion of anorexigenic/orexigenic factors in obese adolescents.

The Combating Obesity in Māori and Pasifika Adolescent School-Children Study: COMPASS Methodology and Study Protocol

BACKGROUND

Lifestyle modifications including, physical activity can reduce obesity-related morbidity and subsequent cardiovascular disease in youth. This study will investigate the efficacy of a culturally-sensitive, non-contact, boxing-orientated training program on obesity and related cardio-metabolic conditions in Māori and Pasifika adolescents. Details of the methodological aspects of recruitment, inclusion criteria, randomization, cultural sensitivity, intervention program, assessments, process evaluation, and statistical analyses are described.

METHODS

This study will be a community based, New Zealand, randomized control trial (RCT). Male and female obese (body mass index >95(th) percentile) Māori and Pasifika adolescents aged 14-16 years will be recruited and the sample size will be confirmed through a feasibility study. Combating Obesity in Māori and Pasifika Adolescent School-children Study (COMPASS) is a 6-month, theory-based program, conducted 3-times/week in a culturally appropriate setting. Each session includes 40 min boxing-orientated training and 30 min resistance training. Assessments will be made at baseline, 3-months, 6-months, 12-months, and 24-months. Main outcomes include abdominal obesity, endothelial function, and insulin resistance. Other outcomes include arterial stiffness, lipid profile, inflammatory biomarkers, well-being, and aerobic fitness. Control measures include physical activity, sleep behavior, and dietary intake.

RESULTS

As a protocol paper there are no specific results to present, our purpose is to share our RCT design with the scientific community.

CONCLUSIONS

COMPASS will be used to provide direction for exercise prescription policy in at-risk Māori and Pasifika adolescents.

Multidisciplinary therapy reduces risk factors for metabolic syndrome in obese adolescents

This study aims to assess the effects of a 16-week multidisciplinary program of obesity treatment on the control of metabolic syndrome (MS) and dyslipidemia in obese adolescents. Eighty-six adolescents aged 10-18 years were allocated in either the intervention group (IG; n = 44) or control group (CG; n = 42). IG was submitted to a multidisciplinary intervention based on cognitive behavioral therapy that aimed to modify eating habits and exercise behavior. We analyzed, before and after the intervention period, anthropometric parameters, body composition, bone mineral density, cardiorespiratory fitness, blood pressure, glucose, insulin, and lipid profile of the subjects. MS was classified according to International Diabetes Federation (2007) and the presence of dyslipidemia according to Back et al. (Arq Bras Cardiol 85:4-36, 2005). In the beginning of the intervention, the median number (range) of risk factors for MS present was 2.0 (0.0-5.0) in the IG and 2.0 (0.0-4.0) in the CG. After the intervention, this parameter reduced significantly in the IG (1.0 (0.0-5.0); p = 0.004) while no change was observed in the CG (2.0 (0.0-4.0); p = 0.349). In addition, we observed improvements in body mass index, waist circumference, hip circumference, maximal oxygen uptake, absolute and relative body fat, systolic blood pressure, diastolic blood pressure, and total cholesterol in the IG which was not identified in the CG. Conclusio n: We suggest that a 16-week multidisciplinary intervention based on cognitive behavioral therapy was adequate to reduce risk factors for MS in obese adolescents.

Long-term effects of aerobic plus resistance training on the adipokines and neuropeptides in nonalcoholic fatty liver disease obese adolescents

OBJECTIVE

To compare the effects of aerobic training (AT) with aerobic plus resistance training (AT+RT) in nonalcoholic fatty liver disease (NAFLD) obese adolescents.

DESIGN

Long-term interdisciplinary weight-loss therapy (1 year of clinical, nutritional, psychological, and exercise-related intervention).

PARTICIPANTS

Fifty-eight postpubertal obese adolescents were randomized to AT or AT+RT according to NAFLD diagnosis. Adipokine and neuropeptide concentrations were measured by enzyme-linked immunosorbent assay, visceral fat by ultrasound, and body composition by plethysmography.

RESULTS

The NAFLD group that followed the AT+RT protocol presented lower insulin, homeostasis model assessment-insulin resistance (HOMA-IR), and alanine transaminase (ALT) values after intervention compared with AT. It was verified that there was a higher magnitude of change in the subcutaneous fat, glycemia, total cholesterol (TC), low-density lipoprotein-cholesterol, ALT, and adiponectin in response to AT+RT than in the control group (AT). All patients who underwent the AT+RT exhibited significantly higher adiponectin, leptin, and Δadiponectin and lower melanin-concentrating hormone (MCH) concentrations after therapy compared with the AT group. In the simple linear regression analysis, changes in glycemia, insulin, and HOMA-IR were independent predictors of significant improvement in adiponectin concentration. Indeed, ΔAST (aspartate transaminase) and ΔGGT (γ-glutamyl transpeptidase) were independent predictors of ΔALT, while Δfat mass and ΔAgRP (agouti-related protein) were independent predictors of ΔMCH. Although the number of patients was limited, we showed for the first time the positive effects of AT+RT protocol in a long-term interdisciplinary therapy to improve inflammatory biomarkers and to reduce orexigenic neuropeptide concentrations in NAFLD obese adolescents.

CONCLUSION

The long-term interdisciplinary therapy with AT+RT protocol was more effective in significantly improving noninvasive biomarkers of NAFLD that are associated with the highest risk of disease progression in the pediatric population.

Long-term interdisciplinary therapy reduces endotoxin level and insulin resistance in obese adolescents

AIM

The purpose of the present study was to assess the dietary fat intake, glucose, insulin, Homeostasis model assessment for insulin resistance HOMA-IR, and endotoxin levels and correlate them with adipokine serum concentrations in obese adolescents who had been admitted to long-term interdisciplinary weight-loss therapy.

DESIGN

The present study was a longitudinal clinical intervention of interdisciplinary therapy. Adolescents (n = 18, aged 15-19 y) with a body mass index > 95th percentile were admitted and evaluated at baseline and again after 1 year of interdisciplinary therapy. We collected blood samples, and IL-6, adiponectin, and endotoxin concentrations were measured by ELISA. Food intake was measured using 3-day diet records. In addition, we assessed glucose and insulin levels as well as the homeostasis model assessment for insulin resistance (HOMA-IR).

RESULTS

The most important finding from the present investigation was that the long-term interdisciplinary lifestyle therapy decreased dietary fat intake and endotoxin levels and improved HOMA-IR. We observed positive correlations between dietary fat intake and endotoxin levels, insulin levels, and the HOMA-IR. In addition, endotoxin levels showed positive correlations with IL-6 levels, insulin levels and the HOMA-IR. Interestingly, we observed a negative correlation between serum adiponectin and both dietary fat intake and endotoxin levels.

CONCLUSIONS

The present results indicate an association between dietary fat intake and endotoxin level, which was highly correlated with a decreased pro-inflammatory state and an improvement in HOMA-IR. In addition, this benefits effect may be associated with an increased adiponectin level, which suggests that the interdisciplinary therapy was effective in improving inflammatory pathways.

Food restriction and refeeding induces changes in lipid pathways and fat deposition in the adipose and hepatic tissues in rats with diet-induced obesity

The aim of this study was to determine the effects of successive cycles of a moderately restrictive diet and refeeding with a high-fat diet on the metabolism of the adipose and hepatic tissues of obese rats. Rats were assigned to the following groups: a chow diet; a high-fat diet; a moderate caloric restriction; or a moderate caloric restriction plus refeeding. Some animals in each group were given [1-(14)C]triolein intragastrically, while others received an intraperitoneal injection of 3 mCi (3)H(2)O. All animals were killed by decapitation. The retroperitoneal, visceral epididymal and omental white adipose tissues, brown adipose tissue, liver and blood were immediately removed. The lipid uptake from the diet, in vivo rate of lipogenesis, percentage of fat, lipid profile and leptin concentration were analysed. The high-fat diet promoted an increase in fatty liver (P ≤ 0.05), adiposity mass (P ≤ 0.05) and the plasma concentration of leptin (P ≤ 0.05) and a decreased lipid uptake in white adipose tissue depots (P ≤ 0.05) in relation to the chow diet. The moderate caloric restriction did not reverse the changes promoted by the high-fat diet but induced a small decrease in adiposity, which was reversed after refeeding, and the animals maintained a dyslipidaemic profile and high fat deposition in the liver. We can conclude that the high-fat diet and subsequent moderate caloric restriction plus refeeding increased the risks of developing visceral obesity, dyslipidaemia and non-alcoholic fatty liver disease, which suggests that this type of experimental protocol can be used to study mechanisms related to the metabolic syndrome.