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Hanssen H, Moholdt T, Bahls M, Biffi A, Siegrist M, Lewandowski AJ, Biondi-Zoccai G, Cavarretta E, Kokkvoll A, Løchen ML, Maestrini V, Pinto RS, Palermi S, Thivel D, Wojcik M, Hansen D, Van Craenenbroeck EM, Weghuber D, Kraenkel N, Tiberi M. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group. Eur J Prev Cardiol 2023; 30:1462-1472. [PMID: 37491406 DOI: 10.1093/eurjpc/zwad152] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Martin Bahls
- Department of Internal Medicine B University Medicine Greifswald, University of Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Monika Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Ane Kokkvoll
- Department of Paediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Stefano Palermi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nicolle Kraenkel
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care, Campus Benjamin-Franklin (CBF), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Friede Springer- Cardiovascular Prevention Center @ Charité, Charite- Universitätsmedizin Berlin, Berlin, Germany
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
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Marsigliante S, Ciardo V, Di Maglie A, My G, Muscella A. Efficacy of school-based intervention programs in reducing overweight: A randomized trial. Front Nutr 2022; 9:1001934. [PMID: 36245531 PMCID: PMC9557174 DOI: 10.3389/fnut.2022.1001934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Childhood obesity represents a serious public health problem and this study evaluates the effectiveness of a 6-month educational intervention on lifestyle, nutrient adequacy, and diet quality in the school setting in improving the knowledge and behavior of primary school children regarding correct eating habits. The strategy was implemented over a 6-month period and participants were randomly assigned to either the intervention group (n = 200) or the non-intervention group (control group, n = 197). Participants had a mean body mass index of 18.3 ± 2.7 kg/m2 and its variation in the intervention group (−2.7 ± 0.5 kg/m2) was significantly different from that in the control group (3.41 ± 0.8 kg/m2). In the experimental group, there were significant differences between the proportion of children who were overweight, underweight, normal weight, or obese before and after intervention (p < 0.05). The best results were seen in the female sex, and after the intervention, there were no more girls with obesity. Furthermore, there were significant waist circumference decrement effects in the intervention group compared to the control group (p < 0.05). Finally, many of the participating children acquired healthy eating habits. Therefore, the quantitative results obtained suggest that a school intervention program represents an effective strategy to prevent and improve the problem of childhood overweight and obesity.
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Affiliation(s)
- Santo Marsigliante
- Department of Biological and Environmental Science and Technologies (DiSTeBA), University of Salento, Lecce, Italy
| | - Vito Ciardo
- Department of Biological and Environmental Science and Technologies (DiSTeBA), University of Salento, Lecce, Italy
| | - Antonio Di Maglie
- Department of History, Society and Human Studies, University of Salento, Lecce, Italy
| | - Giulia My
- Department of Biological and Environmental Science and Technologies (DiSTeBA), University of Salento, Lecce, Italy
| | - Antonella Muscella
- Department of Biological and Environmental Science and Technologies (DiSTeBA), University of Salento, Lecce, Italy
- *Correspondence: Antonella Muscella
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El-Medany AY, Birch L, Hunt LP, Matson RI, Chong AH, Beynon R, Hamilton-Shield J, Perry R. What Change in Body Mass Index Is Required to Improve Cardiovascular Outcomes in Childhood and Adolescent Obesity through Lifestyle Interventions: A Meta-Regression. Child Obes 2020; 16:449-478. [PMID: 32780648 PMCID: PMC7575353 DOI: 10.1089/chi.2019.0286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Using meta-regression, this article aims at establishing the minimum change in BMI-standard deviation score (SDS) needed to improve lipid profiles and blood pressure in children and adolescents with obesity, to aid future trials and guidelines. Methods: Studies with participants involved in lifestyle interventions, aged 4-19 years, with a diagnosis of obesity according to defined BMI thresholds, were considered for inclusion in a large systematic review. Interventions had to report pre- and post-intervention (or mean change in) BMI-SDS, plus either systolic blood pressure (SBP), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and/or triglycerides (TGs). Random-effects meta-regression quantified the relationship between mean change in BMI-SDS and mean change in cardiovascular outcomes. Results: Seventy-one papers reported various cardiovascular measurements and mean change in BMI-SDS. Fifty-four, 59, 46, and 54 studies were analyzed, reporting a change in SBP, HDL, LDL, and TG, respectively. Reduction in mean BMI-SDS was significantly related to improvements in SBP, LDL, TG, and HDL (p < 0.05); BMI-SDS reductions of 1, 1.2, and 0.7 ensured a mean reduction of SBP, LDL, and TG, respectively, although an equivalent value for HDL improvement was indeterminate. Conclusion: Reductions in mean BMI-SDS of >1, >1.2, or >0.7 are likely to reduce SBP, LDL, and TG, respectively. Further studies are needed to clarify the optimal duration, intensity, and setting for interventions. Consistency is required regarding derived BMI values to facilitate future systematic reviews and meta-analyses.
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Affiliation(s)
- Ahmed Y.M. El-Medany
- Cardiology Department, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,Address correspondence to: Ahmed Y.M. El-Medany, MSc, Cardiology Department, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol BS2 8HW, United Kingdom
| | - Laura Birch
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Linda P. Hunt
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Rhys I.B. Matson
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Amanda H.W. Chong
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Rhona Beynon
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Julian Hamilton-Shield
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom.,Level 6 University Hospitals Bristol Education Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rachel Perry
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
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Antioxidants and Oxidative Stress in Children: Influence of Puberty and Metabolically Unhealthy Status. Antioxidants (Basel) 2020; 9:antiox9070618. [PMID: 32679739 PMCID: PMC7402162 DOI: 10.3390/antiox9070618] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
Oxidative stress could help explain the relationship between childhood obesity and a metabolically unhealthy (MU) status. Moreover, puberty could also influence this relationship, since it entails physiological cardiometabolic changes. We aimed to evaluate plasma antioxidants and oxidative stress biomarkers in MU and metabolically healthy (MH) prepubertal and pubertal children and their associations with pro-inflammatory and endothelial damage biomarkers, taking puberty into account. A total of 1444 Spanish children aged 3-17 years (48.9% males, 66% prepubertal, 47.1% with obesity) were recruited. Blood pressure, anthropometric and biochemical parameters were measured, and children were categorized as having a MU or MH status according to risk factors. Retinol, carotenes, tocopherols, total antioxidant capacity (TAC), oxidized low-density lipoprotein and selected pro-inflammatory and endothelial damage biomarkers were analyzed. General linear models adjusted for age, sex, recruitment center and body mass index, partial correlations and stepwise linear regressions were performed. Lower carotenes and tocopherols levels were found in MU than in MH children. Plasma TAC was lower in prepubertal and higher in pubertal children with obesity compared to normal-weight children. Antioxidants and oxidative stress biomarkers showed novel associations with several pro-inflammatory and endothelial damage biomarkers, with pubertal differences, supporting the importance of considering both the antioxidant and oxidative stress status and puberty in the prevention of metabolic diseases in childhood.
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Matson RI, Perry R, Hunt LP, Chong AH, Beynon R, Hamilton-Shield J, Birch L. Change in obesity-related metabolic abnormalities associated with body mass index improvement through life-style intervention: A meta-regression. Pediatr Diabetes 2020; 21:173-193. [PMID: 31820534 DOI: 10.1111/pedi.12955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/28/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
The reduction in body mass index standard deviation score (BMI-SDS) associated with improvement in biomarkers relating to metabolic health in obese children is unknown. We aimed to establish the change in BMI-SDS associated with improved inflammation, liver function, and insulin resistance to inform clinical guidelines for pediatric weight management interventions and to assess the efficacy of future trials. A large-scale systematic review was conducted to identify relevant studies. Studies of children with a diagnosis of obesity according to defined BMI thresholds, participating in lifestyle interventions to reduce obesity, were included. Studies must have reported baseline (pre-) and postintervention (or change of) BMI-SDS and either fasting glucose, homeostatic model of insulin resistance (HOMA-IR), alanine aminotransferase (ALT), C-reactive protein (CRP), or interleukin-6 (IL-6). A series of meta-regressions were conducted to establish links between BMI-SDS change scores and change in metabolic markers of health. Sixty-eight articles were identified. From the meta-regression analyses, across all study subsets, greater mean falls in all four parameters, (HOMA-IR, Glucose, ALT, and CRP) were observed with greater mean loss of BMI-SDS, but the trends were only statistically significant for HOMA-IR and CRP (P = .003; P = .021). However, we could not find minimum changes in BMI-SDS that would ensure a fall in these outcomes. At this time, we are unable to recommend a definitive value of BMI-SDS reduction needed to improve the markers of metabolic health. Future trials should aim to report additional indices of derived BMI values, which may better reflect changes in actual adiposity.
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Affiliation(s)
- Rhys Ib Matson
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK.,Swansea University Medical School, Grove Building, Swansea University, Singleton Park Swansea, Swansea, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Linda P Hunt
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Amanda Hw Chong
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Rhona Beynon
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK
| | - Julian Hamilton-Shield
- NIHR Bristol Biomedical Research Centre - Nutrition, University Hospitals Bristol Education Centre, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, University Hospitals Bristol Education Centre, Bristol, UK
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Cazzola R, Rondanelli M. N-Oleoyl-Phosphatidyl-Ethanolamine and Epigallo Catechin-3-Gallate Mitigate Oxidative Stress in Overweight and Class I Obese People on a Low-Calorie Diet. J Med Food 2020; 23:319-325. [PMID: 31928490 DOI: 10.1089/jmf.2019.0145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Oxidative stress and lipid peroxidation are considered key factors linking obesity with its associated complications. Epigallo catechin-3-gallate (EGCG) and oleoylethanolamide, together with its phospholipid precursor N-oleoyl-phosphatidylethanolamine (NOPE), are nutritional compounds that might improve the oxidative stress status of obese people. Unfortunately, the bioavailability of these compounds is low; however, the coadministration of NOPE with EGCG has been shown to ameliorate both the plasma availability of EGCG and the intestinal levels of NOPE in rats. This double-blind placebo-controlled study investigated the effects of 2 months' supplementation with EGCG complexed with NOPE, combined with moderate energy restriction, on plasma oxidative status of overweight and class I obese subjects. A total of 138 subjects (body mass index: 25-35 kg/m2) were recruited and randomized into two groups: the first (n = 67) received caps of placebo and the second (n = 71) caps of an oily dispersion of EGCG complexed with NOPE for 2 months. Subjects' supplementation was combined with moderate energy restriction (-800 kcal/day). Plasma oxidative status was determined by measuring the levels of oxidized low-density lipoprotein (Ox-LDL), malondialdehyde and reactive oxygen metabolites, and by calculating the lag time and the slope of Cu-induced lipid peroxidation kinetics. In total 116 subjects (27 M/89 F) completed the supplementation period, 49 in the placebo group and 67 in the treated group. Treatment induced a similar significant weight reduction in the two groups. Moreover, we found the mean changes of Ox-LDL significantly lower and the mean changes of antioxidant capacity (lag time) significantly higher in NOPE-EGCG group than in placebo group (treatment effect mean difference: -3.15 UL, P < .044 and +5.37 min, P < .0347, respectively). EGCG plasma levels were detectable only after 2 months of NOPE-EGCG diet. The NOPE-EGCG integration to a low-energy diet seems, therefore, useful for ameliorating oxidative stress-related markers, which are concomitant causes of obesity-induced disorders.
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Affiliation(s)
- Roberta Cazzola
- Department of Clinical and Biomedical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Birch L, Perry R, Hunt LP, Matson R, Chong A, Beynon R, Shield JP. What change in body mass index is associated with improvement in percentage body fat in childhood obesity? A meta-regression. BMJ Open 2019; 9:e028231. [PMID: 31473614 PMCID: PMC6720247 DOI: 10.1136/bmjopen-2018-028231] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/12/2019] [Accepted: 06/25/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using meta-regression this paper sets out the minimum change in body mass index-SD score (BMI-SDS) required to improve adiposity as percentage body fat for children and adolescents with obesity. DESIGN Meta-regression. SETTING Studies were identified as part of a large-scale systematic review of the following electronic databases: AMED, Embase, MEDLINE via OVID, Web of Science and CENTRAL via Cochrane library. PARTICIPANTS Individuals aged 4-19 years with a diagnosis of obesity according to defined BMI thresholds. INTERVENTIONS Studies of lifestyle treatment interventions that included dietary, physical activity and/or behavioural components with the objective of reducing obesity were included. Interventions of <2 weeks duration and those that involved surgical and/or pharmacological components (eg, bariatric surgery, drug therapy) were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES To be included in the review, studies had to report baseline and post-intervention BMI-SDS or change measurements (primary outcome measures) plus one or more of the following markers of metabolic health (secondary outcome measures): adiposity measures other than BMI; blood pressure; glucose; inflammation; insulin sensitivity/resistance; lipid profile; liver function. This paper focuses on adiposity measures only. Further papers in this series will report on other outcome measures. RESULTS This paper explores the potential impact of BMI-SDS reduction in terms of change in percentage body fat. Thirty-nine studies reporting change in mean percentage body fat were analysed. Meta-regression demonstrated that reduction of at least 0.6 in mean BMI-SDS ensured a mean reduction of percentage body fat mass, in the sense that the associated 95% prediction interval for change in mean percentage body fat was wholly negative. CONCLUSIONS Interventions demonstrating reductions of 0.6 BMI-SDS might be termed successful in reducing adiposity, a key purpose of weight management interventions. TRIAL REGISTRATION NUMBER CRD42016025317.
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Affiliation(s)
- Laura Birch
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Linda P Hunt
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Rhys Matson
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Amanda Chong
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Rhona Beynon
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
| | - Julian Ph Shield
- NIHR Bristol Biomedical Research Centre-Nutrition theme, Level 3 University Hospitals Bristol Education Centre, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Level 6 University Hospitals Bristol Education Centre, Bristol, UK
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The effect of green coffee extract supplementation on serum oxidized LDL cholesterol and total antioxidant capacity in patients with dyslipidemia: A randomized, double-blind, placebo-controlled trial. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Morell-Azanza L, Ojeda-Rodríguez A, Giuranna J, Azcona-SanJulián MC, Hebebrand J, Marti A, Hinney A. Melanocortin-4 Receptor and Lipocalin 2 Gene Variants in Spanish Children with Abdominal Obesity: Effects on BMI-SDS After a Lifestyle Intervention. Nutrients 2019; 11:E960. [PMID: 31035493 PMCID: PMC6566731 DOI: 10.3390/nu11050960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Abstract
Mutations leading to a reduced function of the melanocortin-4 receptor (MC4R) exert a major gene effect on extreme obesity. Recently it was shown that the bone derived hormone lipocalin 2 (LCN2) binds to the MC4R and activates a MC4R dependent anorexigenic pathway. We identified mutations in both genes and screened the effects of MC4R and LCN2 mutations on eating behavior and weight change after a lifestyle intervention. One hundred and twelve children (11.24 ± 2.6 years, BMI-SDS 2.91 ± 1.07) with abdominal obesity participated in a lifestyle intervention. MC4R and LCN2 coding regions were screened by Sanger sequencing. Eating behavior was assessed at baseline with the Children Eating Behavior Questionnaire (CEBQ). We detected three previously described non-synonymous MC4R variants (Glu42Lys, Thr150Ile, and Arg305Gln) and one non-synonymous polymorphism (Ile251Leu). Regarding LCN2, one known non-synonymous variant (Thr124Met) was detected. Eating behavior was described in carriers of the MC4R and LCN2 mutation and in non-carriers. MC4R and LCN2 mutations were detected in 2.42% and 0.84%, respectively, of Spanish children with abdominal obesity. A number of subjects with functional mutation variants in MC4R and LCN2 were able to achieve a reduction in BMI-SDS after a lifestyle intervention.
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Affiliation(s)
- Lydia Morell-Azanza
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, c/Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, c/Irunlarrea, 3. 31008, Pamplona , Spain.
| | - Ana Ojeda-Rodríguez
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, c/Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, c/Irunlarrea, 3. 31008, Pamplona , Spain.
| | - Johanna Giuranna
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, D-45147, Essen,Germany.
| | - Mª Cristina Azcona-SanJulián
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, c/Irunlarrea, 3. 31008, Pamplona , Spain.
- Paediatric Endocrinology Unit, Department of Paediatrics, Clínica Universidad de Navarra,c/ Pío XII, 36. 31008 Pamplona, Spain.
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, D-45147, Essen,Germany.
| | - Amelia Marti
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, c/Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, c/Irunlarrea, 3. 31008, Pamplona , Spain.
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain.
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, D-45147, Essen,Germany.
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Morell-Azanza L, Ojeda-Rodríguez A, Ochotorena-Elicegui A, Martín-Calvo N, Chueca M, Marti A, Azcona-San Julian C. Changes in objectively measured physical activity after a multidisciplinary lifestyle intervention in children with abdominal obesity: a randomized control trial. BMC Pediatr 2019; 19:90. [PMID: 30947686 PMCID: PMC6448302 DOI: 10.1186/s12887-019-1468-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Physical activity (PA) is associated with changes in body composition that affect insulin sensitivity and leptin levels. Few studies have assessed the effect of lifestyle interventions on changes in objectively measured PA levels in obese children. To evaluate the effects of a multidisciplinary lifestyle intervention on anthropometric indices, biochemical parameters and accelerometer measured PA in abdominal obese children. METHODS A randomized control trial was performed in 106 children and adolescents with abdominal obesity. Participants were randomly assigned to usual or intensive care group for 8-week. PA was measured by accelerometry over four days including, at least, two weekdays in all participants. Both groups were encouraged to accumulate an extra time of 200 min per week in their PA. RESULTS At baseline, 75% of subjects do not fulfill the WHO recommendation of being more than 60 min/day on moderate-to-vigorous PA (MVPA). The intensive care group achieved a significant reduction in anthropometric indexes compared to the usual care but no significant change was found in biochemical or PA parameters. Both groups achieved a significant reduction in light PA. Interestingly, intensive care participants significantly increased MVPA in 5.5 min/day. Moreover, an inverse association between changes in MVPA and leptin levels was found. CONCLUSION The two lifestyle intervention reduced anthropometric indexes and lowered light PA in abdominal obese children. No significant differences were observed between intensive care and usual care in regard to PA. Intensive care participants significantly increase physical activity (MVPA) and, changes in MVPA were inversely associated with changes in leptin levels after the intervention. TRIAL REGISTRATION ClinicalTrials.gov , Identifier: NCT03147261 . Registered 10 May 2017. Retrospectively registered.
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Affiliation(s)
- Lydia Morell-Azanza
- Department of Nutrition, Food Science and Physiology, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra Spain
- IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - Ana Ojeda-Rodríguez
- Department of Nutrition, Food Science and Physiology, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra Spain
- IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - Amaia Ochotorena-Elicegui
- Paediatric Endocrinology Unit, Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Nerea Martín-Calvo
- IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
- Department of Preventive Medicine & Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Center of Biomedical Research in Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - María Chueca
- IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
- Paediatric Endocrinology Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Amelia Marti
- Department of Nutrition, Food Science and Physiology, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra Spain
- IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
- Center of Biomedical Research in Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Cristina Azcona-San Julian
- Paediatric Endocrinology Unit, Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
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11
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Ojeda-Rodríguez A, Zazpe I, Morell-Azanza L, Chueca MJ, Azcona-Sanjulian MC, Marti A. Improved Diet Quality and Nutrient Adequacy in Children and Adolescents with Abdominal Obesity after a Lifestyle Intervention. Nutrients 2018; 10:nu10101500. [PMID: 30322156 PMCID: PMC6213517 DOI: 10.3390/nu10101500] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
High rates of childhood obesity require integral treatment with lifestyle modifications that achieve weight loss. We evaluated a lifestyle intervention on nutrient adequacy and diet quality in children and adolescents with abdominal obesity. A randomized controlled trial was performed on 107 participants, assigned either to a usual care group or to an intensive care group that followed a moderate hypocaloric Mediterranean diet and received nutritional education. Intake adequacy was evaluated using Dietary Reference Intakes and diet quality through the Diet Quality Index for Adolescents (DQI-A), the Healthy Lifestyle Diet-Index (HLD-I) and the Mediterranean Diet Quality Index (KIDMED). Both groups achieved a significant reduction in BMI standard deviation score (BMI-SDS), glucose and total cholesterol levels. Intake of Calcium, Iodine and vitamin D were higher in the intensive care group, with enhanced compliance with recommendations. Higher dietary scores were associated with lower micronutrient inadequacy. DQI-A and HLD-I were significantly higher in the intensive care group vs. usual care group after the treatment. In conclusion, we observed that an intensive lifestyle intervention was able to reduce BMI-SDS in children with abdominal obesity. Furthermore, participants significantly improved dietary indices getting closer to the nutritional recommendations. Therefore, these diet quality indices could be a valid indicator to evaluate micronutrient adequacy.
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Affiliation(s)
- Ana Ojeda-Rodríguez
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/ Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
| | - Itziar Zazpe
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/ Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine-Clínica Universidad de Navarra, University of Navarra. C/ Irunlarrea, 1. 31008 Pamplona, Spain.
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III. Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain.
| | - Lydia Morell-Azanza
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/ Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
| | - María J Chueca
- IdiSNA, Instituto de Investigación Sanitaria de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
- Paediatric Endocrinology Unit, Complejo Hospitalario de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
| | - Maria Cristina Azcona-Sanjulian
- IdiSNA, Instituto de Investigación Sanitaria de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
- Paediatric Endocrinology Unit, Department of Paediatrics. Clínica Universidad de Navarra. Av. Pío XII, 36. 31008 Pamplona, Spain.
| | - Amelia Marti
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/ Irunlarrea, 1. 31008 Pamplona, Spain.
- IdiSNA, Instituto de Investigación Sanitaria de Navarra. C/Irunlarrea, 3. 31008 Pamplona, Spain.
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III. Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain.
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12
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Gajewska J, Ambroszkiewicz J, Weker H, Chełchowska M. Relations between oxidized low-density lipoproteins and fat-soluble vitamin concentrations in obese children - preliminary study. DEVELOPMENTAL PERIOD MEDICINE 2017; 21. [PMID: 29077566 PMCID: PMC8522945 DOI: 10.34763/devperiodmed.20172103.266271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although lipid peroxidation products are formed during normal cell metabolism, they appear mostly in pathological conditions via producing an excess of free radicals that can react with unsaturated fatty acids, in particular low-density lipoprotein (LDL). The aim of this study was to investigate the relations between oxidized LDL (oxLDL), the fat-soluble vitamin status and the anthropometric parameters in prepubertal obese children. MATERIAL AND METHODS Thirty-two obese (SDS-BMI >2) and 25 non-obese children (SDS-BMI <-1+1>) were included in the study. The concentration of oxLDL was determined in the serum by the ELISA assay. Vitamin A and E were measured by the high-pressure liquid chromatography method. Total cholesterol, LDL- and HDL-cholesterol, and triglyceride levels were determined by enzymatic methods. RESULTS The concentrations of oxLDL and vitamin A were higher in obese children than in normalweight controls by about 50% (p=0.01) and 40% (p=0.001), respectively. In obese children the significant positive correlation was found between oxLDL and vitamin A concentrations (<0.05). In addition, oxLDL correlated positively with BMI values (<0.05) and the amount of fat mass (kg) (<0.02) in these patients. Concentrations of vitamins A and E correlated with the level of total cholesterol (<0.05; <0.01, respectively).Moreover, a positive correlation between vitamin E and LDL-cholesterol was observed (<0.05). CONCLUSIONS Our preliminary study shows that oxLDL starts early during the prepubertal period and may precede atherosclerotic lesions. We suggest there is an occurrence of relationships between vitamin A and oxidized LDL in prepubertal obese children. Vitamin A and E concentrations are also associated with dyslipidemia in these patients.
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Affiliation(s)
- Joanna Gajewska
- Screening Department Institute of Mother and Child in Warsaw, WarsawPoland,Joanna Gajewska Screening Department Institute of Mother and Child Kasprzaka 17a, 01-211 Warsaw tel, (048 22) 32-77-260
| | | | - Halina Weker
- Department of Nutrition Institute of Mother and Child in Warsaw, WarsawPoland
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