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Araújo D, Morgado C, Correia-Pinto J, Antunes H. Predicting Insulin Resistance in a Pediatric Population With Obesity. J Pediatr Gastroenterol Nutr 2023; 77:779-787. [PMID: 37608437 DOI: 10.1097/mpg.0000000000003910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Insulin resistance (IR) affects children and adolescents with obesity and early diagnosis is crucial to prevent long-term consequences. Our aim was to identify predictors of IR and develop a multivariate model to accurately predict IR. METHODS We conducted a cross-sectional analysis of demographical, clinical, and biochemical data from a cohort of patients attending a specialized Paediatric Nutrition Unit in Portugal over a 20-year period. We developed multivariate regression models to predict IR. The participants were randomly divided into 2 groups: a model group for developing the predictive models and a validation group for cross-validation of the study. RESULTS Our study included 1423 participants, aged 3-17 years old, randomly divided in the model (n = 879) and validation groups (n = 544). The predictive models, including uniquely demographic and clinical variables, demonstrated good discriminative ability [area under the curve (AUC): 0.834-0.868; sensitivity: 77.0%-83.7%; specificity: 77.0%-78.7%] and high negative predictive values (88.9%-91.6%). While the diagnostic ability of adding fasting glucose or triglycerides/high density lipoprotein cholesterol index to the models based on clinical parameters did not show significant improvement, fasting insulin appeared to enhance the discriminative power of the model (AUC: 0.996). During the validation, the model considering demographic and clinical variables along with insulin showed excellent IR discrimination (AUC: 0.978) and maintained high negative predictive values (90%-96.3%) for all models. CONCLUSION Models based on demographic and clinical variables can be advantageously used to identify children and adolescents at moderate/high risk of IR, who would benefit from fasting insulin evaluation.
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Affiliation(s)
- Daniela Araújo
- From the Pediatrics Department, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
| | - Carla Morgado
- the Department of Neurology, Hospital of Braga, Braga, Portugal
- CEREBRO - Brain Health Center, Braga, Portugal
- ISAVE, Higher Institute of Health, Braga, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- the Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
- ICVS/3B's Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
| | - Henedina Antunes
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- the Gastroenterology, Hepatology and Nutrition Unit, Pediatric Department and Academic Clinical Center (2CA Braga), Hospital de Braga, Braga, Portugal
- ICVS/3B's Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
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Dragoumani K, Troumbis A, Bacopoulou F, Chrousos G. Childhood and Adolescent Obesity with Somatic Indicators of Stress, Inflammation, and Dysmetabolism before and after Intervention: A Meta-Analysis. J Pers Med 2023; 13:1322. [PMID: 37763090 PMCID: PMC10532912 DOI: 10.3390/jpm13091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
There have been numerous attempts to establish a correlation between obesity and stress, inflammatory, and dysmetabolism biomarkers in children and adolescents. Here, we performed a meta-analysis of existing studies to shed light on the elusive correlations of childhood and adolescent obesity with physiological indicators of stress, inflammation, and metabolism before and after lifestyle interventions. Observational studies, meta-analyses, narrative and systematic reviews were excluded. From a total of 53 articles, 11 were selected according to specific criteria. The biomarkers examined were circulating glucose, insulin, HDL, LDL, triglycerides, adiponectin, leptin, CRP, TNF-alpha, interleukin (IL)-6, systolic and diastolic blood pressure, and HOMA-IR. All analyses were performed using IBM SPSS Statistics Version 28.0.1.0 (142). The current meta-analysis provides evidence of a beneficial effect of a lifestyle intervention and/or drugs in children and adolescents living with obesity or overweight, consistent with a significant reduction in body fat-but not in BMI or waist circumference-an increase in circulating adiponectin and/or a reduction in serum insulin levels and diastolic blood pressure, and a trend towards a reduction of circulating leptin and glucose levels, as well as of the HOMA-IR. This meta-analysis indicates that lifestyle interventions could reduce overweight-/obesity-associated systemic inflammation and dysmetabolism even without an apparent decrease in BMI.
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Affiliation(s)
- Konstantina Dragoumani
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece
| | - Andreas Troumbis
- Department of Environmental Studies, University of the Aegean, 81100 Mytilene, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Tomaç H, Malkoç M, Angın E. A pilot study of the effects of supervised exercise training on body composition, cardiometabolic risk factors, muscle strength and functional capacity in individuals with bariatric surgery. Heliyon 2023; 9:e19032. [PMID: 37649847 PMCID: PMC10462818 DOI: 10.1016/j.heliyon.2023.e19032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
The main objective of this pilot study was to evaluate the effects of functional exercise training (FET) and home exercise training (HET) on body composition, cardiometabolic risk factors, muscle strength, and functional capacity in individuals with bariatric surgery. The sample of the study included 30 individuals who underwent bariatric surgery. The FET group had functional exercise training consisting of stretching, aerobic, strengthening, and balance exercises assigned by a physiotherapist (n = 15), and the HET group had the same exercises under supervision (n = 15). The training sessions were planned as × 3 per week for a period of 8 weeks. Body composition, cardiometabolic risk factors, cardiometabolic risk status, muscle strength, and functional capacity of all individuals were evaluated before and after training. According to the measurements, body weight (BW), body mass index (BMI), body fat mass (BFM), C-reactive protein, glycated hemoglobin, insulin resistance, cardiovascular risk total score, and ten-year cardiovascular percentage risk decreased significantly (p < 0.05), while HDL-C, leg, back, and hand grip strength (right-left), and walking distance increased significantly (p < 0.05) in the FET group. In the HET group, there were significant increases in body fat percentage (BFM %), BFM, and body muscle mass percentage (BMM %) (p < 0.05), while body muscle mass (BMM), right hand grip strength, leg and back muscle strength, and walking distance scores significantly decreased (p < 0.05). It was concluded that personalized and supervised FET has a positive effect on body composition, cardiometabolic risk factors, muscle strength, and functional capacity, and it can be recommended as a safe exercise model for bariatric surgery patients.
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Affiliation(s)
- Hayriye Tomaç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin 10, Turkey
| | - Mehtap Malkoç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin 10, Turkey
| | - Ender Angın
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin 10, Turkey
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Peña A, Olson ML, Ayers SL, Sears DD, Vega-López S, Colburn AT, Shaibi GQ. Inflammatory Mediators and Type 2 Diabetes Risk Factors before and in Response to Lifestyle Intervention among Latino Adolescents with Obesity. Nutrients 2023; 15:nu15112442. [PMID: 37299403 DOI: 10.3390/nu15112442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is associated with chronic inflammation that may contribute to T2D among youth. We examined the association between inflammatory biomarkers and insulin sensitivity and β-cell function and response to lifestyle intervention among Latino youth with obesity. Latino youth (n = 64) were randomized to six months of lifestyle intervention (INT, n = 40) or usual care (UC, n = 24). INT included nutrition education and physical activity. UC involved meeting with a pediatric endocrinologist and registered dietitian to discuss healthy lifestyles. At baseline, multiple linear regression assessed fasting serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), high-molecular weight adiponectin (HMW Adpn), IL-10, IL-1 receptor antagonist (IL-1ra) as predictors of insulin sensitivity (whole-body insulin sensitivity index, WBISI) and β-cell function (oral disposition index, oDI). Changes in outcomes between groups were assessed using covariance pattern models. At baseline, MCP-1 (β ± SE, -0.12 ± 0.05, p = 0.027) and IL-1ra (-0.03 ± 0.01, p = 0.005) were negatively associated with WBISI. Treatment effects were not observed for inflammatory markers. WBISI was significantly increased among both INT (from 1.8 ± 0.2 to 2.6 ± 0.4, p = 0.005) and UC (from 1.6 ± 0.2 to 2.8 ± 0.5, p = 0.002) with no significant differences between the groups. Obesity-related inflammatory mediators were associated with T2D risk factors but were unaffected by lifestyle intervention among Latino youth.
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Affiliation(s)
- Armando Peña
- Department of Health and Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
| | - Stephanie L Ayers
- Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA
| | - Dorothy D Sears
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA
| | - Abigail T Colburn
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- John B. Pierce Laboratory, Yale School of Medicine, New Haven, CT 06519, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
- Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA
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Tadiotto MC, Corazza PRP, Menezes-Junior FJD, Moraes-Junior FBD, Tozo TAA, Purim KSM, Mota J, Leite N. Effects and individual response of continuous and interval training on adiponectin concentration, cardiometabolic risk factors, and physical fitness in overweight adolescents. Eur J Pediatr 2023:10.1007/s00431-023-04974-6. [PMID: 37055629 DOI: 10.1007/s00431-023-04974-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
This study aimed to evaluate the effect and individual responsiveness after 12 weeks of high-intensity interval training (HIIT) and moderate-intensity of continuous training (MICT) on adiponectin, cardiometabolic risk factors and physical fitness in overweight adolescents. This study was participated by 52 adolescents, both sexes, 11 and 16 years old, separated into HIIT (n = 13), MICT (n = 15), and control group (CG, n = 24). Body mass, height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), blood pressure, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides, glucose, insulin, adiponectin, and C-reactive protein (CRP) were evaluated. Body mass index z-score (BMI-z), waist-to-height ratio (WHtR), insulin resistance, and insulin sensitivity were calculated. Resting heart rate (HRrest), peak oxygen consumption (VO2peak), right handgrip strength (HGS-right), left handgrip strength (HGS-left), and abdominal resistance (ABD) was evaluated. HIIT session lasted around 35 min and MICT of 60 min of exercises on stationary bicycle, three times a weekday for 12 weeks. ANOVA, effect size, and prevalence of responders were used for statistical analysis. HIIT reduced BMI-z, WHtR, LDL-c, and CRP, while increased of physical fitness. MICT reduced HDL-c, while increased of physical fitness. CG reduced FM, HDL-c, and CRP, while increased FFM and HRrest. Frequencies of respondents in HIIT were observed for CRP, VO2peak, HGS-right, and HGS-left. Frequencies of respondents in MICT were observed for CRP and HGS-right. Frequencies of no-respondents in CG were observed for WC, WHtR, CRP, HRrest, and ABD. Conclusion: Interventions with exercises were effective to adiposity, metabolic health, and physical fitness improvements. Individual responses were observed in inflammatory process and physical fitness, important changes in overweight adolescent's therapy. Trial registration number and date of registration: This study was registered with the Brazilian Registry of Clinical Trials (REBEC), the number RBR-6343y7, date of registration May 3, 2017. What is Known: • Effect of regular physical exercise positively affects overweight, comorbidities, and metabolic diseases, recommended mainly for children and adolescents. What is New: • Due to the great inter-individual variability, the same stimulus can provide different responses; adolescents who benefit from the stimulus are considered responsive. • Intervention of HIIT and MICT did not alter the concentrations of adiponectin; however, the adolescents presented responsiveness to the inflammatory process and physical fitness.
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Affiliation(s)
- Maiara Cristina Tadiotto
- Department of Physical Education, Federal University of Paraná, Col. Francisco H. dos Santos, Curitiba, Brazil, 81531-980.
| | - Patricia Ribeiro Paes Corazza
- Department of Physical Education, Federal University of Paraná, Col. Francisco H. dos Santos, Curitiba, Brazil, 81531-980
| | | | | | | | | | - Jorge Mota
- Faculty of Sport, University of Porto, Porto, Portugal
| | - Neiva Leite
- Department of Physical Education, Federal University of Paraná, Col. Francisco H. dos Santos, Curitiba, Brazil, 81531-980
- Faculty of Sport, University of Porto, Porto, Portugal
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Zhao H, Cheng R, Teng J, Song G, Huang C, Yuan S, Lu Y, Shen S, Liu J, Liu C. A Meta-Analysis of the Effects of Different Training Modalities on the Inflammatory Response in Adolescents with Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13224. [PMID: 36293806 PMCID: PMC9603579 DOI: 10.3390/ijerph192013224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to investigate the effect of different training modalities on improving the inflammatory response in adolescents with obesity. For the study methodology, the databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data, Pubmed, Web of Science, and EBSCO were selected for searching. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) tool, and statistical analysis was performed by applying RevMan 5.4.1 analysis software. A total of 14 studies with 682 subjects were included. The results of this meta-analysis showed that aerobic training (AT) and aerobic plus resistance training (AT + RT) reduced the levels of IL-6 and CRP in adolescents with obesity. Among them, AT + RT was more effective than other training modalities in reducing IL-6 and CRP in adolescents with obesity. Different training modalities have no effect on the TNF-α level in adolescents with obesity. However, regarding the increase in IL-6, CRP, and TNF-α in adolescents with obesity, resistance training (RT) did not lead to significant differences. In conclusion, long-term regular AT, AT + RT, and HIIT are all helpful in improving the inflammatory state of adolescents with obesity, with AT + RT being the best training modality to combat inflammation in adolescents with obesity.
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Affiliation(s)
- Haotian Zhao
- Department of Physical Education, Jiangnan University, Wuxi 214122, China
| | - Ruihong Cheng
- School of Sports Engineering, Beijing Sport University, Beijing 100084, China
| | - Jin Teng
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Ge Song
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Chenjian Huang
- Department of Physical Education, Jiangnan University, Wuxi 214122, China
| | - Shuo Yuan
- Department of Physical Education, Jiangnan University, Wuxi 214122, China
| | - Yuxuan Lu
- Department of Physical Education, Jiangnan University, Wuxi 214122, China
| | - Siqin Shen
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Pannonia, 8200 Veszprém, Hungary
| | - Jingqi Liu
- School of Sports Engineering, Beijing Sport University, Beijing 100084, China
| | - Chang Liu
- School of Sport Science, Beijing Sport University, Beijing 100084, China
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Hejazi K, Ferrari F. Effects of Physical Exercise on Cardiometabolic Biomarkers and Inflammatory Markers in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2022; 24:519-529. [PMID: 35506158 DOI: 10.1177/10998004221099573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of obesity among children as well as the beneficial effects of physical exercise (PE) on weight loss has been determined by modulating the secretory factors of adipose tissue. PE has also been shown to have beneficial effects on obesity. OBJECTIVE The objective of this systematic review and meta-analysis was to investigate the effects of physical exercise (PE) on adiponectin and other important health markers in children. DATA SOURCES We searched 6 electronic databases (PubMed/Medline, Embase, Cochrane Library, Cinahl, Scopus, and Web of Science) and Google Scholar for randomized controlled trials from inception to December 15, 2021. We used random-effects models to estimate weighted mean difference (WMD) with 95% confidence intervals (CI). STUDY SELECTION Fourteen studies were included (N = 468 participants; mean age: 14 years). RESULTS In general, PE increased adiponectin (WMD: 0.91 µg/mL; 95% CI, 0.27 to 1.55, p = 0.005), high-density lipoprotein cholesterol (HDL-C) (WMD: 1.01 mg/dL; 95% CI, 0.33 to 1.69, p = 0.004), and VO2max (WMD: 2.52 mL.kg.min; 95% CI, 1.41 to 3.62, p = 0.00,001). The levels of c-reactive protein (WMD: -0.37 mg/L; 95% CI, -0.57 to -0.17, p = 0.0003), insulin (WMD: -4.61 μIU/ml; 95% CI, -5.46 to -3.76, p = 0.00,001), fasting glucose (WMD: -5.11 mg/dL; 95% CI, -7.88 to -2.34, p = 0.0003), and insulin resistance index (WMD: -1.44; 95% CI, -1.92 to -0.96, p = 0.00,001), decreased significantly. CONCLUSION Our study showed that PE may increase the level of adiponectin, HDL-C, and VO2max in children.
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Affiliation(s)
- Keyvan Hejazi
- Department of Physical Education and Sport Sciences, 185150Hakim Sabzevari University, Sabzevar, Iran
| | - Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Choe S, Sa J, Chaput JP, Kim D. Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis. Clin Exp Pediatr 2022; 65:98-107. [PMID: 34809417 PMCID: PMC8841970 DOI: 10.3345/cep.2021.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/14/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Various interventions have been tested to prevent or treat childhood obesity in South Korea. However, the overall effect of those interventions is unclear, as very few reviews and meta-analyses were specific to Korean children and adolescents. PURPOSE We aimed to examine the overall effect of obesity interventions among Korean children and adolescents, while also examining differences by sex, age group, baseline weight category, intervention duration, number of intervention components, and type of intervention components. METHODS A meta-analysis was conducted for all intervention studies sampling Korean children and adolescents, with at least one control group and one month of follow-up, published between January 2000 and August 2020. Cohen d was calculated as an effect size for treatment effect, using the standardized difference between intervention group's body mass index (BMI) change and control group's BMI change. RESULTS The final sample included 19 intervention studies with 2,140 Korean children (mean age, 12.2 years). Overall, interventions were strongly favored over their controls (d=1.61; 95% confidence interval [CI], 1.12-2.09). The subgroup analysis showed that interventions with at least one physical activity component (d=2.43; 95% CI, 1.63-3.24) were significantly better than those that did not include physical activity (d=0.02; 95% CI, -0.26 to 0.31). CONCLUSION Type of intervention component appeared important, though no differential association was observed by sex, age, baseline weight category, intervention duration, and number of intervention components. Korean and non-Korean interventions may be substantively different. Additional studies are needed to understand why and how Korean interventions differ from non-Korean interventions.
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Affiliation(s)
- Siyoung Choe
- Department of Kinesiology and Health, Miami University, Oxford, OH, USA
| | - Jaesin Sa
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Deokjin Kim
- Department of Sport & Health Care, Namseoul University, Cheonan, Korea
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Tagi VM, Samvelyan S, Chiarelli F. An update of the consensus statement on insulin resistance in children 2010. Front Endocrinol (Lausanne) 2022; 13:1061524. [PMID: 36465645 PMCID: PMC9709113 DOI: 10.3389/fendo.2022.1061524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
In our modern society, where highly palatable and calorie-rich foods are readily available, and sedentary lifestyle is common among children and adolescents, we face the pandemic of obesity, nonalcoholic fatty liver disease, hypertension, atherosclerosis, and T2D. Insulin resistance (IR) is known to be the main underlying mechanism of all these associated health consequences; therefore, the early detection of IR is fundamental for preventing them.A Consensus Statement, internationally supported by all the major scientific societies in pediatric endocrinology, was published in 2010, providing all the most recent reliable evidence to identify the definition of IR in children, its measurement, its risk factors, and the effective strategies to prevent and treat it. However, the 2010 Consensus concluded that further research was necessary to assess some of the discussed points, in particular the best way to measure insulin sensitivity, standardization of insulin measurements, identification of strong surrogate biomarkers of IR, and the effective role of lifestyle intervention and medications in the prevention and treatment of IR.The aim of this review is to update each point of the consensus with the most recent available studies, with the goal of giving a picture of the current state of the scientific literature regarding IR in children, with a particular regard for issues that are not yet fully clarified.
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Affiliation(s)
- Veronica Maria Tagi
- Department of Pediatrics, University of Chieti, Chieti, Italy
- *Correspondence: Veronica Maria Tagi,
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10
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Truong K, Park S, Tsiros MD, Milne N. Physiotherapy and related management for childhood obesity: A systematic scoping review. PLoS One 2021; 16:e0252572. [PMID: 34125850 PMCID: PMC8202913 DOI: 10.1371/journal.pone.0252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. METHOD A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. RESULTS From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. CONCLUSION When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.
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Affiliation(s)
- Kim Truong
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Sandra Park
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Margarita D. Tsiros
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
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Cardiovascular Effects of Aerobic Exercise With Self-Selected or Predetermined Intensity in Adolescents With Obesity. Pediatr Exerc Sci 2021; 33:125-131. [PMID: 34010805 DOI: 10.1123/pes.2020-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid-femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = -9 mm Hg; PEI, Δ = -4 mm Hg; P < .01), central systolic BP (SEI, Δ = -4 mm Hg; PEI, Δ = -4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = -4 mm Hg; PEI, Δ = -3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid-femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.
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Headid Iii RJ, Park SY. The impacts of exercise on pediatric obesity. Clin Exp Pediatr 2021; 64:196-207. [PMID: 32777917 PMCID: PMC8103043 DOI: 10.3345/cep.2020.00997] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022] Open
Abstract
Over the last few decades, the rates of pediatric obesity have more than doubled regardless of sociodemographic categorization, and despite these rates plateauing in recent years there continues to be an increase in the severity of obesity in children and adolescents. This review will discuss the pediatric obesity mediated cardiovascular disease (CVD) risk factors such as attenuated levels of satiety and energy metabolism hormones, insulin resistance, vascular endothelial dysfunction, and arterial stiffness. Additionally, early intervention to combat pediatric obesity is critical as obesity has been suggested to track into adulthood, and these obese children and adolescents are at an increased risk of early mortality. Current suggested strategies to combat pediatric obesity are modifying diet, limiting sedentary behavior, and increasing physical activity. The effects of exercise intervention on metabolic hormones such as leptin and adiponectin, insulin sensitivity/resistance, and body fat in obese children and adolescents will be discussed along with the exercise modality, intensity, and duration. Specifically, this review will focus on the differential effects of aerobic exercise, resistance training, and combined exercise on the cardiovascular risks in pediatric obesity. This review outlines the evidence that exercise intervention is a beneficial therapeutic strategy to reduce the risk factors for CVD and the ideal exercise prescription to combat pediatric obesity should contain both muscle strengthening and aerobic components with an emphasis on fat mass reduction and long-term adherence.
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Affiliation(s)
- Ronald J Headid Iii
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
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Georgoulis M, Yiannakouris N, Tenta R, Fragopoulou E, Kechribari I, Lamprou K, Perraki E, Vagiakis E, Kontogianni MD. A weight-loss Mediterranean diet/lifestyle intervention ameliorates inflammation and oxidative stress in patients with obstructive sleep apnea: results of the "MIMOSA" randomized clinical trial. Eur J Nutr 2021; 60:3799-3810. [PMID: 33839919 DOI: 10.1007/s00394-021-02552-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Inflammation and oxidative stress are implicated in obstructive sleep apnea (OSA) pathophysiology. We aimed at exploring whether the combination of a weight-loss Mediterranean diet/lifestyle intervention with OSA standard care, i.e., continuous positive airway pressure (CPAP) prescription, can lead to greater improvements in inflammation and oxidative stress, compared to standard care alone. METHODS This was a randomized controlled clinical trial in 187 adult, overweight patients with moderate-to-severe OSA. Participants were randomized to a standard care (SCG, n = 65), a Mediterranean diet (MDG, n = 62) or a Mediterranean lifestyle group (MLG, n = 60). All groups received OSA standard care. Intervention arms participated in a 6-month behavioral weight-loss intervention based on the Mediterranean diet, while the MLG also received counselling on physical activity and sleep habits. RESULTS Seven patients were excluded and 53/180 were lost to follow-up. In intention to treat analysis (n = 180), the SCG did not exhibit changes in any of the markers assessed. Post-intervention age-, sex-, baseline- and CPAP use-adjusted plasma high sensitivity C-reactive protein levels (mg/L) were lower in the MDG and the MLG compared to the SCG (mean difference - 1.33, P = 0.039 and - 1.68, P = 0.007, respectively). The MLG also exhibited lower urinary 8-iso prostaglandin F2a levels (ng/mg creatinine) compared to the SCG and the MDG (mean difference - 1.10, P < 0.0001 and - 0.80, P = 0.001, respectively). Adiponectin and oxidized guanine levels were not altered in any of the study groups. Results were similar in per protocol analysis (n = 127). CONCLUSION A weight-loss Mediterranean diet/lifestyle intervention on top of CPAP has anti-inflammatory and antioxidant benefits in OSA. REGISTRATION The trial was prospectively registered at ClinicalTrials.gov (NCT02515357) on August 4, 2015.
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Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Nikos Yiannakouris
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Roxane Tenta
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Elizabeth Fragopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Ioanna Kechribari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Kallirroi Lamprou
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School of Athens University, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Eleni Perraki
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School of Athens University, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Emmanοuil Vagiakis
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School of Athens University, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece.
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Kim JY, Jeon JY. Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes? Ann Pediatr Endocrinol Metab 2020; 25:208-216. [PMID: 33401879 PMCID: PMC7788350 DOI: 10.6065/apem.2040140.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Justin Y. Jeon
- Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients, ICONS Yonsei University, Seoul, Korea,Address for correspondence: Justin Y. Jeon, PhD Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients, ICONS Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2123-6197 E-mail:
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Abstract
Despite plenty of currently available information on metabolic syndrome (MetS) in children and adolescents, there are still uncertainties regarding definition, prevention, management and treatment of MetS in children. The first approach to MetS in children consists of lifestyle interventions (nutritional education, physical activity). These recommendations are often difficult to achieve, especially for adolescents, therefore, there is usually a lack of successful outcomes. A pharmacological intervention in obese children may be needed in some cases, with the aim to improve the effects of these primary prevention interventions. Metformin seems to be safe and presents evident positive effects on insulin sensitivity, but long-term and consistent data are still missing to establish its role in the pediatric population and the possible effectiveness of other emergent treatments such as glucagon-like peptide-1 analogues, dipeptidylpeptidase-4 inhibitors, dual inhibitors of SGLT1 and SGLT2 and weight loss drugs. Bariatric surgery might be helpful in selected cases. The aim of this review is to present the most recent available treatments for the main components of metabolic syndrome, with a focus on insulin resistance. A short mention of management of congenital forms of insulin resistance will be included too.
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Han Y, Liu Y, Zhao Z, Zhen S, Chen J, Ding N, Ma Y, Wen D. Does Physical Activity-Based Intervention Improve Systemic Proinflammatory Cytokine Levels in Overweight or Obese Children and Adolescents? Insights from a Meta-Analysis of Randomized Control Trials. Obes Facts 2019; 12:653-668. [PMID: 31645033 PMCID: PMC6940473 DOI: 10.1159/000501970] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this research was to conduct a meta-analysis of the role that physical activity (PA) plays in influencing the critical proinflammatory cytokine levels associated with overweight/obese children and adolescents to explore the effectiveness of exercise intervention within this population. METHODS With searches of the PubMed, EMBASE, and CENTRAL databases, we updated our meta-analysis up to November 2018. The randomized controlled trials (RCT) evaluated the ability of exercise training to increase the following factors in children and/or adolescents classified as obese or overweight: tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP). RESULTS Eleven RCT comprising 623 children and/or adolescents who were obese or overweight (i.e., 393 with PA and 230 controls) were suitable for use in this study. The meta-analysis showed that PA in general was associated with a significant reduction of CRP levels (mean difference = -0.45 mg/L, p = 0.02) in overweight/obese children and adolescents. Based on 115 overweight and obese youths, this study suggests that PA does not significantly mitigate IL-6 levels (mean difference = -0.39 pg/mL, p = 0.08), although there was a trend towards a reduction. Additionally, no close connection was observed between PA and TNF-α levels at 0.04 pg/mL (p = 0.78). Moreover, meta-regression analysis revealed a statistical association between CPR levels and changes in BMI or changes in adiponectin; likewise, IL-6 levels dramatically impacted the effect of exercise on changes in adiponectin. CONCLUSIONS PA was associated with significantly reduced CRP levels, whereas there was no significant association with IL-6 or TNF-α in overweight/obese children or adolescents; however, there was a trend towards a reduction of IL-6.
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Affiliation(s)
- Yanshuo Han
- Institute of Health Science, China Medical University, Shenyang, China
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Liu
- Institute of Health Science, China Medical University, Shenyang, China
| | - Zhongyi Zhao
- Institute of Health Science, China Medical University, Shenyang, China
| | - Shihan Zhen
- Institute of Health Science, China Medical University, Shenyang, China
| | - Jianhua Chen
- Institute of Health Science, China Medical University, Shenyang, China
- No. 2 Orthopedic Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ning Ding
- Research Center of Medical Education, China Medical University, Shenyang, China
| | - Yanan Ma
- Institute of Health Science, China Medical University, Shenyang, China
- School of Public Health, China Medical University, Shenyang, China
| | - Deliang Wen
- Institute of Health Science, China Medical University, Shenyang, China,
- Research Center of Medical Education, China Medical University, Shenyang, China,
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Lucas-de la Cruz L, Martínez-Vizcaíno V, Cañete García-Prieto J, Arias-Palencia N, Diez-Fernandez A, Milla-Tobarra M, Notario-Pacheco B. Movement behaviors and cardiometabolic risk in schoolchildren. PLoS One 2018; 13:e0207300. [PMID: 30427939 PMCID: PMC6235312 DOI: 10.1371/journal.pone.0207300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022] Open
Abstract
Growing evidence has accumulated in recent years showing that movement behaviors have important implications for health in children, especially for cardiovascular health, whose risk factors could track from childhood to adulthood. However, these findings are mixed and inconsistent in children. The aim of this study was to examine the relationship between different movement behaviors (sedentary behavior, physical activity and sleep duration) and cardiometabolic risk in schoolchildren. The study shows cross-sectional results of baseline measurement from 146 Spanish schoolchildren, aged 8-to-11 years old, participating in the MOVI-2 study. Movement behaviors were determined using accelerometry combined with self-reported sleep time. Cardiometabolic risk was assessed using a validated metabolic syndrome index. Logistic regression analysis showed that higher levels of vigorous physical activity (OR = 0.110, p = 0.004) and sleeping more than 9 hours (OR = 0.269, p = 0.015) could be protective factors against metabolic syndrome risk in children. ANCOVA analysis showed associations between vigorous physical activity and waist circumference (p < 0.001), and sleep time with insulin resistance (p = 0.017) and lipid profile (p = 0.035). No association was observed between light and moderate physical activity, sedentary behavior and metabolic syndrome (index and components). No statistically significant differences were found for blood pressure and any of the movement behaviors. Our data suggest that both the amount of vigorous physical activity accumulated and sleep duration are independently associated with higher cardiometabolic risk in children.
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Affiliation(s)
- Lidia Lucas-de la Cruz
- Universidad de Castilla-La Mancha, Faculty of Nursing, Cuenca, Spain
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Jorge Cañete García-Prieto
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
- Universidad de Castilla-La Mancha, Faculty of Nursing, Albacete, Spain
| | - Natalia Arias-Palencia
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
- Universidad de Castilla-La Mancha, Faculty of Education, Cuenca, Spain
| | - Ana Diez-Fernandez
- Universidad de Castilla-La Mancha, Faculty of Nursing, Cuenca, Spain
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
- * E-mail:
| | - Marta Milla-Tobarra
- Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Universidad de Castilla-La Mancha, Cuenca
| | - Blanca Notario-Pacheco
- Universidad de Castilla-La Mancha, Faculty of Nursing, Cuenca, Spain
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
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Lewis KA, Brown SA. Searching for Evidence of an Anti-Inflammatory Diet in Children: A Systematic Review of Randomized Controlled Trials for Pediatric Obesity Interventions With a Focus on Leptin, Ghrelin, and Adiponectin. Biol Res Nurs 2017; 19:511-530. [PMID: 28743192 DOI: 10.1177/1099800417715734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PROBLEM To address the complex phenomenon of pediatric obesity, one must understand the physiological mechanisms regulating energy intake and inflammation. The peptide hormones leptin, ghrelin, and adiponectin are involved in both, but their functions are dysregulated in obesity. The purpose of this systematic review is (1) to characterize studies of nutrition interventions for weight management in children who measure these peptides as outcomes, (2) to assess risk of bias in the studies, and (3) to determine the relationships between these peptides and body mass index (BMI). Eligibility Criteria: Peer-reviewed articles written in English, published in 2001-2016, and describing randomized controlled trials of pediatric interventions involving a nutrition component with the outcome measures leptin, ghrelin, and/or adiponectin were included. Articles were excluded if the intervention involved pharmaceuticals, supplements, infant formula, breastfeeding, or surgery. SAMPLE The 25 international studies represented 2,153 obese children. RESULTS Ten diets were identified. Successful interventions included both structured exercise and hypocaloric dietary components, with or without counseling, resistance training, or medical components. Direct measures of adiposity were used in 69% of studies. Comparison group designs were disparate. Leptin levels decreased as BMI decreased. Evidence regarding the relationships of ghrelin and adiponectin with BMI was inconclusive. CONCLUSIONS Despite known effects of maturation on hormones, studies did not consistently differentiate findings by maturational stage. Common anti-inflammatory and disease risk modification diets were missing or underrepresented. Studies that include children with comorbidities are needed. BMI and leptin levels have a positive relationship, but evidence on ghrelin and adiponectin was inconclusive.
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Affiliation(s)
- Kimberly A Lewis
- 1 School of Nursing, The University of Texas at Austin, Austin, TX, USA.,2 Pediatric Clinical Research Enterprise, Dell Children's Medical Center, Seton Family of Hospitals, Austin, TX, USA
| | - Sharon A Brown
- 1 School of Nursing, The University of Texas at Austin, Austin, TX, USA
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Boff RDM, Liboni RPA, Batista IPDA, de Souza LH, Oliveira MDS. Weight loss interventions for overweight and obese adolescents: a systematic review. Eat Weight Disord 2017; 22:211-229. [PMID: 27542161 DOI: 10.1007/s40519-016-0309-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/26/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To determine what factors contribute to the efficacy of non-drug treatments designed to promote weight loss in overweight and obese adolescents. METHODS Data sources Medline/PubMed; Psychinfo; EMBASE; Web of Science (ISI); and Cochrane Central Register of Controlled Trials. Study selection Randomized clinical trials of treatments for obesity and overweight in adolescents aged 10-19 years with a minimum duration of 2 months. Data extraction 115 of the 12,948 publications retrieved met eligibility criteria and 26 were included in the final sample. Period of extraction January 2004 to November 2014. RESULTS The Delphi list was used to evaluate the methodological quality of the studies (M = 5.58, SD = 1.027). There was considerable variability between the interventions, but they were all multifactorial, with components such as nutritional education, physical activity, family support and psychological therapy. The number of contacts with subjects during the course of the intervention was a predictor of treatment efficacy when the groups were compared. Limitations This systematic review was limited to trials reported in English and by the lack of methodological rigor and shortcomings in reporting in the studies reviewed. CONCLUSIONS Multidisciplinary interventions including family support and guided behavior modification appear to be effective methods of reducing BMI in overweight and obese adolescents.
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Affiliation(s)
- Raquel de Melo Boff
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil.
| | - Ronald Patrick Araujo Liboni
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil
| | - Igor Pacheco de Azevedo Batista
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil
| | | | - Margareth da Silva Oliveira
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil
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García-Hermoso A, Ceballos-Ceballos RJM, Poblete-Aro CE, Hackney AC, Mota J, Ramírez-Vélez R. Exercise, adipokines and pediatric obesity: a meta-analysis of randomized controlled trials. Int J Obes (Lond) 2017; 41:475-482. [PMID: 28017965 PMCID: PMC5382285 DOI: 10.1038/ijo.2016.230] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/14/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVE Adipokines are involved in the etiology of diabetes, insulin resistance, and the development of atherosclerosis and other latent-onset complications. The objective of this meta-analysis was to determine the effectiveness of exercise interventions on adipokines in pediatric obesity. SUBJECTS/METHODS A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on adipokines (adiponectin, leptin, resistin and visfatin) in pediatric obesity (6-18 years old). Fourteen randomized controlled trials (347 youths) were included. Weighted mean difference (WMD) and 95% confidence intervals were calculated. RESULTS Exercise was associated with a significant increase in adiponectin (WMD=0.882 μg ml-1, 95% CI, 0.271-1.493) but did not alter leptin and resistin level. Likewise, exercise intensity and change in body fat; as well as total exercise program duration, duration of the sessions, and change in body fat all significantly influenced the effect of exercise on adiponectin and leptin, respectively. CONCLUSIONS Exercise seems to increase adiponectin levels in childhood obesity. Our results also suggested that exercise on its own, without the concomitant presence of changes in body composition levels, does not affect leptin levels.
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Affiliation(s)
- A García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - R J M Ceballos-Ceballos
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - C E Poblete-Aro
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - A C Hackney
- Endocrine Section-Applied Physiology Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Mota
- CIAFEL–Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - R Ramírez-Vélez
- Centro de Estudios para la Medición de la Actividad Física «CEMA», Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
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Voskuil VR, Frambes DA, Robbins LB. Effect of Physical Activity Interventions for Girls on Objectively Measured Outcomes: A Systematic Review of Randomized Controlled Trials. J Pediatr Health Care 2017; 31:75-87. [PMID: 27130195 DOI: 10.1016/j.pedhc.2016.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Most girls are not meeting physical activity (PA) guidelines, and 30% are overweight or obese. The purpose of this systematic review was to evaluate the evidence for PA intervention effects on accelerometer-measured PA, body mass index (BMI), and percent body fat (% BF) among girls. METHODS The Cumulative Index of Nursing and Allied Health Literature, PubMed, PsychInfo, and SportDISCUS databases were searched for randomized controlled trials published from 1985-2014. Studies with a PA intervention and outcomes of accelerometer-measured PA, BMI, or % BF were included. RESULTS Fifteen studies were reviewed. PA, BMI, and % BF were measured in 5, 15, and 10 studies, respectively. Effect sizes (ES) were highly variable. In one intervention, PA increased (ES = -0.17 to 0.08); in two interventions, BMI was reduced (ES = -0.11 to 0.62); and in five interventions, % BF was lowered (ES = 0.12 to 0.93). DISCUSSION Future research should involve preadolescent girls, improve methods for handling missing data, include objective measures of PA, and increase intervention attendance rates.
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Gomes TN, Dos Santos FK, Katzmarzyk PT, Maia J. Active and strong: physical activity, muscular strength, and metabolic risk in children. Am J Hum Biol 2016; 29. [PMID: 27545106 DOI: 10.1002/ajhb.22904] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/20/2016] [Accepted: 07/29/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study explored the associations among physical activity, muscular strength, and metabolic risk among children. METHODS The sample included 378 Portuguese children (213 girls; 9-11 years). Moderate-to-vigorous physical activity was assessed by accelerometry and children were classified as active (≥60 min/day) or insufficiently active (<60 min/day). Static strength was expressed as the ratio of handgrip strength/body weight and used to classify children as having high (≥P50) or low (<P50) muscular strength. Children were classified into four groups: active and high strength, active and low strength, insufficiently active and high strength, insufficiently active and low strength. A continuous metabolic risk score was computed from cardiometabolic risk factors. RESULTS In general, the insufficiently active and low strength group had the worst metabolic risk score, and the active and high strength group had the best. Significant differences were found within physical activity groups for metabolic risk: children classified as "active and high strength" and "insufficiently active and high strength" had better metabolic risk scores than "active and low strength" and "insufficiently active and low strength", respectively. CONCLUSIONS Muscular strength has a relevant role in attenuating the association between physical inactivity and metabolic risk in children; a further benefit was identified in children with high physical activity and high muscular strength.
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Affiliation(s)
- Thayse Natacha Gomes
- CIFI2D, Kinanthropometry Lab, Faculty of Sport, University of Porto, Porto, Portugal
| | | | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - José Maia
- CIFI2D, Kinanthropometry Lab, Faculty of Sport, University of Porto, Porto, Portugal
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Exercise-based interventions and C-reactive protein in overweight and obese youths: a meta-analysis of randomized controlled trials. Pediatr Res 2016; 79:522-7. [PMID: 26690715 DOI: 10.1038/pr.2015.274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/03/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND One of the most commonly measured markers of inflammation in clinical settings is C-reactive protein (CRP). The purpose of this meta-analysis was to examine the evidence for the effectiveness of physical exercise interventions on modifying the levels of serum CRP in children and adolescents with excess of weight. METHODS Two independent reviewers assessed articles from seven databases. Studies were limited to physical exercise interventions in children and adolescents diagnosed as overweight or obese, and including a comparison control group. Weighted mean difference (WMD) was calculated using random-effects model and potential moderators were explored (i.e., weight status, ages, duration of study, frequency of exercise per week, and duration of session). The heterogeneity of the studies was estimated using Cochran's Q-statistic and I(2). RESULTS Nine randomized controlled trials met the inclusion criteria (n = 427 youths). Overall, results suggest a nonsignificant trend toward a reduction CRP levels (WMD = -0.72 mg/l; 95% confidence interval: -1.52 to 0.08; P = 0.077). Also, there were not significant moderators of exercise effects on CRP. CONCLUSION These results suggest that exercise programs in children and adolescents not mitigate the inflammatory effects of excess weight, although there was a trend toward reduction.
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Friedemann Smith C, Heneghan C, Ward A. Moving Focus from Weight to Health. What Are the Components Used in Interventions to Improve Cardiovascular Health in Children? PLoS One 2015; 10:e0135115. [PMID: 26263386 PMCID: PMC4532360 DOI: 10.1371/journal.pone.0135115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Obesity in childhood impacts on many areas of the child’s current and future health, including their cardiovascular health. To date many attempts have been made to design interventions to tackle excess childhood weight but with limited success. We aimed to establish the components common to interventions in children that improve cardiovascular health parameters. Methods We searched the following databases: EMBASE 1974-week 3 November 2014, Ovid Medline 1946 Present, and PsychINFO 1967-Present for studies reporting interventions in healthy young people under the age of 18. Included interventions had to contain an education component and have been carried out in a community, school, or clinical setting. Papers had to report on at least one of the pre-specified CVD risk parameters and at least one non-biological outcome from knowledge, attitudes or behaviours. Results We retrieved 2451 papers, from which 12 studies (18 papers) of 3046 participants were included. From the selected papers we identified four component themes; Health Behaviours, Self-Concept, Practical and Cognitive Tools, and Intervention Characteristics. The subcomponents that made up these themes were fairly consistent across the studies analysed although the studies varied in their duration, settings and children with which they were carried out. Nine of the studies were able to bring about positive change in at least one biological and one non-biological aspect of child cardiovascular health. Conclusion The component themes identified here were common to intervention studies that had success in improving parameters of cardiovascular health. We suggest that the focus of childhood health interventions be moved from weight onto cardiovascular health parameters and that future interventions use the lessons learned by their predecessors to incorporate those components that are associated with successful interventions.
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Affiliation(s)
- Claire Friedemann Smith
- Health Behaviour Research Center, Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Carl Heneghan
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alison Ward
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes (Lond) 2015. [PMID: 26202452 DOI: 10.1038/ijo.2015.133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the effects of aerobic training, resistance training, or both on abdominal subcutaneous fat (subcutaneous adipose tissue (SAT)) (deep and superficial), visceral fat (visceral adipose tissue (VAT)), apolipoproteins A-1 and B (ApoA-1, ApoB), ApoB/ApoA-1 ratio and high-sensitivity C-reactive protein (HSCRP) in post-pubertal adolescents with obesity. PARTICIPANTS After a 4-week supervised moderate-intensity exercise run-in period, 304 postpubertal adolescents with overweight (body mass index (BMI) ⩾85th percentile for age and sex+diabetes risk factor) or obesity (⩾95th BMI percentile) aged 14-18 years were randomized to four groups for 22 weeks (5 months): aerobic training, resistance training, combined training or a non-exercising control. METHODS This study used a randomized controlled design. All groups received dietary counseling designed to promote healthy eating with a maximum daily energy deficit of 250 kcal. Abdominal fat (SAT and VAT) at the level of the fourth and fifth lumbar vertebrae (L4-L5) was measured by magnetic resonance imaging and ApoA-1, ApoB and HSCRP were measured after a 12-h fast at baseline and after 6 months. RESULTS Changes in SAT at L4-L5 were -16.2 cm(2) in aerobic (P=0.04 vs control), -22.7 cm(2) in resistance (P=0.009 vs control) and -18.7 cm(2) in combined (P=0.02 vs control). Combined training reduced ApoB levels from 0.81±0.02 to 0.78±0.02 g l(-1) (P=0.04 vs control) and ApoB/ApoA-1 ratio from 0.67±0.02 to 0.64±0.02 (P=0.02 vs control and P=0.04 vs aerobic). There were no significant differences in VAT, ApoA-1 or HSCRP levels between groups. CONCLUSIONS Aerobic and resistance training and their combination decreased abdominal SAT in adolescents with obesity. Combined training caused greater improvements in ApoB/ApoA-1 ratio compared with aerobic training alone.
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Do Overweight Adolescents Adhere to Dietary Intervention Messages? Twelve-Month Detailed Dietary Outcomes from Curtin University's Activity, Food and Attitudes Program. Nutrients 2015; 7:4363-82. [PMID: 26043035 PMCID: PMC4488789 DOI: 10.3390/nu7064363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/31/2023] Open
Abstract
Dietary components of adolescent obesity interventions are rarely evaluated with comprehensive reporting of dietary change. The objective was to assess dietary change in overweight adolescents, including adherence to dietary intervention. The dietary intervention was part of a multi-component intervention (CAFAP) targeting the physical activity, sedentary and healthy eating behaviors of overweight adolescents (n = 69). CAFAP was a staggered entry, within-subject, waitlist controlled clinical trial with 12 months of follow up. Diet was assessed using three-day food records and a brief eating behavior questionnaire. Changes in dietary outcomes were assessed using linear mixed models, adjusted for underreporting. Food record data suggested reduced adherence to dietary intervention messages over time following the intervention, despite conflicting information from the brief eating behavior questionnaire. During the intervention, energy intake was stable but favorable nutrient changes occurred. During the 12 month maintenance period; self-reported eating behaviors improved, energy intake remained stable but dietary fat and saturated fat intake gradually returned to baseline levels. Discrepancies between outcomes from brief dietary assessment methods and three-day food records show differences between perceived and actual intake, highlighting the need for detailed dietary reporting. Further, adherence to dietary intervention principles reduces over time, indicating a need for better maintenance support.
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Liu YL, Lu CW, Shi L, Liou YM, Lee LT, Huang KC. Low intensive lifestyle modification in young adults with metabolic syndrome a community-based interventional study in Taiwan. Medicine (Baltimore) 2015; 94:e916. [PMID: 26039125 PMCID: PMC4616347 DOI: 10.1097/md.0000000000000916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The study aims to find whether a low intensity lifestyle modification (LILM) program was effective to achieve weight reduction and improves metabolic syndrome in young adults. Our study prospectively enrolled young adults aged 30 to 45 years with metabolic syndrome in northeastern Taiwan from June 1, 2008 to December 31, 2009. The participants in the intervention group attended a LILM program for 6 months, which included 4 interactive group discussion sessions and weekly phone contact with volunteer counselors. Participants in the comparison group, however, attended only 1 noninteractive session on diet and physical activity. The main outcomes measured the weight reduction and prevalence of metabolic syndrome in intervention and comparison groups. Generalized estimating equation modeling was used to analyze the effects at baseline, during the study, and postcompletion of the program. Compared with comparison group, the intervention group showed significantly greater reductions in body weight (-2.95 ± 3.52 vs -0.76 ± 2.76 kg, P < 0.0001) and body mass index (-1.03 ± 1.25 vs -0.30 ± 1.16 kg/m(2), P < 0.0001). After adjustment for potential confounders, a modest decrease in body weight resulted in a statistically significant 43.32% resolution in the prevalence of metabolic syndrome in the intervention group compared with 33.64% in the comparison group (P < 0.01).The 6-month LILM program is not only effective in weight reduction but also an efficient intervention tool of metabolic syndrome in a community setting. The program with restricted manpower and limited medical resources can be practically transferred into primary care in rural area.
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Affiliation(s)
- Yi-Lien Liu
- From the Department of Family Medicine, National Taiwan University Hospital (Y-LL, C-WL, L-TL, K-CH); Department of Family Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan (Y-LL); Department of Health Policy and Management, Johns Hopkins School of Public Health, MD, USA (LS); Institute of Clinical and Community Health Nursing, and Laboratory of Physical Activity & Obesity Prevention, National Yang-Ming University Taipei (Y-ML); and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan (K-CH)
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Milano GE, Leite N, Chaves TJ, Milano GE, Souza RLRD, Alle LF. [Butyrylcholinesterase activity and cardiovascular risk factors in obese adolescents submitted to an exercise program]. ACTA ACUST UNITED AC 2014; 57:533-7. [PMID: 24232818 DOI: 10.1590/s0004-27302013000700006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 04/14/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of 12 weeks of physical exercise (PE) on cardiovascular risk factors and BChE activity in obese adolescents. SUBJECTS AND METHODS The sample consisted of 24 obese adolescents and 51 normal weight controls. The following variables were measured in the initial stage and after 12 weeks: weight, height, BMI, waist circumference (WC), fat percentage (% F), maximal oxygen uptake (VO2max), systolic (SBP) and diastolic (DBP) blood pressure, glucose (GLY) and insulin (INS) at baseline and after 120 min, triacylglycerol (TG), total cholesterol (TC), LDL cholesterol, HDL cholesterol, and BChE activity (kU/l). RESULTS After the intervention, there was significant reduction in BMI, WC, %F, TG, GLI 120, INS 120 min, and BChE activity. CONCLUSION The reduction in BChE activity, observed after physical exercise, was accompanied by the reduction of the variables associated with cardiovascular risk and obesity, indicating that BChE can be used as a secondary marker for the risk associated with early onset obesity.
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Acharya SD, Brooks MM, Evans RW, Linkov F, Burke LE. Weight loss is more important than the diet type in improving adiponectin levels among overweight/obese adults. J Am Coll Nutr 2014; 32:264-71. [PMID: 24024771 DOI: 10.1080/07315724.2013.816607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The study objective was to compare the effect of a standard calorie- and fat-restricted diet (STD-D) and a calorie- and fat-restricted lacto-ovo-vegetarian diet (LOV-D) on total and high-molecular-weight (HMW) adiponectin levels after 6 months of behavioral intervention. DESIGN This study is an ancillary study to a randomized clinical trial. SUBJECTS Subjects included 143 overweight/obese adults (STD-D = 79; LOV-D = 64). INTERVENTION Both groups received the same standard behavioral intervention; the only difference was that LOV-D participants were instructed to eliminate meat, poultry, and fish from their diet. MEASURES Weight, dietary intake with the 3-day food diary, and total and HMW adiponectin levels were measured. RESULTS Both groups significantly increased total (STD-D +7.2 ± 17.8%; LOV-D +9.4 ± 21.8%) and HMW adiponectin levels (STD-D +18.5 ± 32.9%; LOV-D +15.8 ± 34.5%; ps < 0.05) with no significant differences between the groups. We found significant associations between weight loss and increases in total (β (SE) = -.071(.27); p = 0.003) and HMW adiponectin (β (SE) = -1.37(.47); p = 0.001) levels independent of the diet type. Weight loss at the higher quartile was associated with improvements of adiponectin levels (p < 0.05). CONCLUSION Weight loss was associated with increased total and HMW adiponectin levels regardless of the diet type. Enhancing weight loss may be a means to improve adiponectin levels.
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Kang S, Kyung C, Park JS, Kim S, Lee SP, Kim MK, Kim HK, Kim KR, Jeon TJ, Ahn CW. Subclinical vascular inflammation in subjects with normal weight obesity and its association with body fat: an 18 F-FDG-PET/CT study. Cardiovasc Diabetol 2014; 13:70. [PMID: 24708764 PMCID: PMC3994236 DOI: 10.1186/1475-2840-13-70] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/22/2014] [Indexed: 12/16/2022] Open
Abstract
Background Although body mass index (BMI) is the most widely accepted parameter for defining obesity, recent studies have indicated a unique set of patients who exhibit normal BMI and excess body fat (BF), which is termed as normal weight obesity (NWO). Increased BF is an established risk factor for atherosclerosis. However, it is unclear whether NWO subjects already have a higher degree of vascular inflammation compared to normal weight lean (NWL) subjects; moreover, the association of BF with vascular inflammation in normal weight subjects is largely unknown. Methods NWO and NWL subjects (n = 82 in each group) without any history of significant vascular disease were identified from a 3-year database of consecutively recruited patients undergoing 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT) at a self-referred Healthcare Promotion Program. The degree of subclinical vascular inflammation was evaluated using the mean and maximum target-to-background ratios (TBRmean and TBRmax) of the carotid artery, which were measured by 18 F-FDG-PET/CT (a noninvasive tool for assessing vascular inflammation). Results We found that metabolically dysregulation was greater in NWO subjects than in NWL subjects, with a significantly higher blood pressure, higher fasting glucose level, and worse lipid profile. Moreover, NWO subjects exhibited higher TBR than NWL subjects (TBRmean: 1.33 ± 0.16 versus 1.45 ± 0.19, p < 0.001; TBRmax: 1.52 ± 0.23 versus 1.67 ± 0.25, p < 0.001). TBR was significantly associated with total BF (TBRmean: r = 0.267, p = 0.001; TBRmax: r = 0.289, p < 0.001), age (TBRmean: r = 0.170, p = 0.029; TBRmax: r = 0.165, p = 0.035), BMI (TBRmean: r = 0.184, p = 0.018; TBRmax: r = 0.206, p = 0.008), and fasting glucose level (TBRmean: r = 0.157, p = 0.044; TBRmax: r = 0.182, p = 0.020). In multiple linear regression analysis, BF was an independent determinant of TBRmean and TBRmax, after adjusting for age, BMI, and fasting glucose level (TBRmean: regression coefficient = 0.020, p = 0.008; TBRmax: regression coefficient = 0.028, p = 0.005). Compared to NWL, NWO was also independently associated with elevated TBRmax values, after adjusting for confounding factors (odds ratio = 2.887, 95% confidence interval 1.206–6.914, p = 0.017). Conclusions NWO is associated with a higher degree of subclinical vascular inflammation, of which BF is a major contributing factor. These results warrant investigations for subclinical atherosclerosis in NWO patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tae Joo Jeon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Korea.
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Farah BQ, Ritti-Dias RM, Balagopal PB, Hill JO, Prado WL. Does exercise intensity affect blood pressure and heart rate in obese adolescents? A 6-month multidisciplinary randomized intervention study. Pediatr Obes 2014; 9:111-20. [PMID: 23447453 DOI: 10.1111/j.2047-6310.2012.00145.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aerobic exercise improves cardiovascular health in general, but whether the impact varies with exercise intensity is not clear. OBJECTIVE The aim of the current study was to compare the effects of a high-intensity aerobic exercise training (HIT) vs. a low-intensity aerobic exercise training (LIT) on blood pressure (BP), heart rate (HR) and heart rate variability (HRV) in obese adolescents. METHODS Forty-three (13-18 years) Tanner stage (III-IV) matched obese adolescents were studied in a randomized trial of either HIT (corresponding to the ventilatory threshold I; n = 20) or LIT (corresponding to 20% below the ventilatory threshold I; n = 23) programme for a period of 6 months. All participants also received a multidisciplinary therapy that included nutritional, psychological and clinical counselling. Both HIT and LIT sessions were isocaloric, with energy expenditure set at 350 kcal. BP, HR and HRV were measured along with markers of body adiposity and insulin resistance before and after the respective interventions. RESULTS The participants in both groups had similar physical and clinical characteristics. After the 6-month intervention, systolic, diastolic and mean BP decreased (P < 0.05, for all) similarly in both groups, whereas waist circumference, HR and HRV showed beneficial changes only in the HIT group (P < 0.05). CONCLUSION Aerobic exercise training set at a high intensity compared with the low intensity appears to have additional benefits on abdominal obesity and cardiovascular health in that it enhances the parasympathetic and autonomic modulation of the heart in obese adolescents.
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Affiliation(s)
- B Q Farah
- School of Physical Education, University of Pernambuco, Recife, Pernambuco, Brazil
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Rendo-Urteaga T, García-Calzón S, Martínez-Ansó E, Chueca M, Oyarzabal M, Azcona-Sanjulián MC, Bustos M, Moreno-Aliaga MJ, Martínez JA, Marti A. Decreased cardiotrophin-1 levels are associated with a lower risk of developing the metabolic syndrome in overweight/obese children after a weight loss program. Metabolism 2013; 62:1429-36. [PMID: 23856329 DOI: 10.1016/j.metabol.2013.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiotrophin-1 (CT-1) shares some similarities with other cytokines, and participates in the control of energy metabolism. Higher circulating levels are observed in obese humans, but little information is gathered in weight loss (WL) programs. Therefore, we aimed to investigate the association of serum CT-1 levels with metabolic variables and the risk of developing metabolic syndrome (MetS) after a WL program in overweight/obese children. SUBJECTS AND METHODS Forty-four overweight/obese children (mean age 11.5 y; 50% males) undergoing a 10-week WL program were enrolled. Subjects were dichotomized at the median of Body Mass Index-Standard Deviation Score (BMI-SDS) change, as high and low responders after intervention. RESULTS CT-1 levels were significantly reduced (-48 fmol/mL, p=0.043) in the high responder group after the WL program. They had significantly lower body weight (-3.7 kg, p<0.001), body fat mass (-8%, p<0.001), BMI-SDS (-0.78, p<0.001) and waist circumference (-5.4 cm, p<0.001), and a significant improvement in lipid and glucose profiles (p<0.05). Interestingly, decreased CT-1 levels significantly predicted changes in total cholesterol (41%) and LDL-cholesterol (28%). Moreover, in our participants the lower the CT-1 levels, the higher the reduction in MetS risk components, after the 10-week intervention, (p-ANCOVA=0.040, p-trend=0.024). CONCLUSION We showed, for the first time, a reduction in serum CT-1 levels after a WL program and this decrease in CT-1 was strongly associated with a reduction in cholesterol levels and in MetS risk factors in overweight/obese children. Our findings may suggest that CT-1 could be an indirect marker for the diagnosis of MetS in this population.
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Affiliation(s)
- Tara Rendo-Urteaga
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain
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Sofer S, Eliraz A, Kaplan S, Voet H, Fink G, Kima T, Madar Z. Changes in daily leptin, ghrelin and adiponectin profiles following a diet with carbohydrates eaten at dinner in obese subjects. Nutr Metab Cardiovasc Dis 2013; 23:744-750. [PMID: 22901843 DOI: 10.1016/j.numecd.2012.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/05/2012] [Accepted: 04/19/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Our recently published randomised clinical trial evaluated the effect of a low-calorie diet with carbohydrates eaten at dinner. This dietary pattern led to lower hunger scores, and better anthropometric, biochemical and inflammatory outcomes compared to a standard low-calorie diet. In the same study, changes in diurnal secretion patterns of leptin, ghrelin and adiponectin were investigated. METHODS AND RESULTS Seventy-eight police officers (body mass index (BMI) > 30) were randomly allocated to experimental (carbohydrates at dinner) or control weight loss diets for 6 months. Sixty-three subjects finished the programme. On days 0, 7, 90 and 180 blood samples and hunger scores were collected every 4 h from 8:00 to 20:00. Hormonal profiles were available for 39. The dietary manipulation led to changes in daylight hormonal profiles in the experimental group. Leptin's secretion curve became convex, with a nadir later in the day (significant difference compared to baseline at morning and evening, p = 0.023, p = 0.021, respectively). Ghrelin's secretion curve became concave, peaking only in the evening hours. Adiponectin's curve was elevated only after the experimental diet (significant difference compared to baseline at afternoon, p = 0.044). CONCLUSIONS We propose that a low-calorie diet with carbohydrates eaten at dinner can modulate daytime hormonal profiles. Taken together with our earlier results, we believe this diet regime may prevent mid-day hunger, better support weight loss and improve metabolic outcomes compared to conventional weight loss diets. The trial is registered at controlled-trials.com, ISRCTN37829376, December 2009.
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Affiliation(s)
- S Sofer
- The Robert H Smith Faculty of Agriculture, Food and Environment, Institute of Biochemistry and Food Science, The Hebrew University of Jerusalem, PO Box 12, Rehovot 76100, Israel
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Dellert JC, Johnson P. Interventions with children and parents to improve physical activity and body mass index: a meta-analysis. Am J Health Promot 2013; 28:259-67. [PMID: 23875983 DOI: 10.4278/ajhp.120628-lit-313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Examine the effect of interventions with parents and children on children's physical activity and body mass index (BMI). DATA SOURCE Computerized searches for intervention studies published between 1990 and 2011 used multiple ProQuest databases, including unpublished dissertations and theses to minimize publication bias. STUDY INCLUSION AND EXCLUSION CRITERIA English-language, intervention-testing studies of children, parents, or families with outcomes of physical activity or BMI were retrieved from peer-reviewed journals, dissertations, and theses. Eliminated studies had no control or comparison group; had no continuous outcome variable; had no physical activity/exercise and/or BMI as outcomes; or had incomplete statistics necessary for meta-analysis (means, standard deviations, or confidence intervals). DATA EXTRACTION Twenty-one studies met inclusion criteria. Quality criteria were control group, objective outcome variable measure, clarity of variable definitions, and number and reason for subject withdrawal. DATA SYNTHESIS Meta-analysis on the raw difference of means estimated mean weighted effect size (MWES) assessed dispersion of effects and computed a summary effect. RESULTS MWES for interventions with parents and children on physical activity (Z = 2.92; confidence interval [CI] = .09 to .48; p = .002) and on BMI for interventions with children alone (Z = -2.10; CI = -.16 to -.01; p = .02) was significant. CONCLUSION A significant effect on physical activity but not on BMI was found when interventions included both parents and their children.
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Alberga AS, Frappier A, Sigal RJ, Prud'homme D, Kenny GP. A review of randomized controlled trials of aerobic exercise training on fitness and cardiometabolic risk factors in obese adolescents. PHYSICIAN SPORTSMED 2013; 41:44-57. [PMID: 23703517 DOI: 10.3810/psm.2013.05.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aerobic training is the most prescribed exercise modality for the management of pediatric obesity. There is strong evidence that it decreases waist circumference, percent body fat and visceral fat, increases cardiorespiratory fitness, and decreases blood pressure in obese adolescents. However, the independent effects of aerobic exercise training on other cardiometabolic risk factors (ie, insulin resistance markers, plasma lipid levels, and inflammatory markers) are limited and yield inconsistent findings. Our article reviews randomized controlled trials evaluating the effects of aerobic exercise training on body composition, fitness, lipid levels, and insulin resistance in obese adolescents (aged 13-18 years) and outlines future research directions for this population.
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Affiliation(s)
- A S Alberga
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, ON, Canada
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Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2013; 2013:CD007651. [PMID: 23450577 PMCID: PMC7197501 DOI: 10.1002/14651858.cd007651.pub2] [Citation(s) in RCA: 422] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades. OBJECTIVES The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. SEARCH METHODS The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. SELECTION CRITERIA To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate. DATA COLLECTION AND ANALYSIS Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured. MAIN RESULTS In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review. AUTHORS' CONCLUSIONS The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.
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Guerrero-Romero F, Rodríguez-Moran M. Metabolically obese normal-weight children. World J Clin Pediatr 2012; 1:37-9. [PMID: 25254167 PMCID: PMC4145648 DOI: 10.5409/wjcp.v1.i4.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/13/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023] Open
Abstract
Non-obese children with elevated serum insulin levels and metabolic disorders such as, hyperglycemia, hypertension, and/or hypertriglyceridemia are a subset of children in high risk of developing cardiovascular disease later in life. Since usually the health policies for the prevention of the obesity associated disorders in children are based on the screening focused on the obese, frequently the metabolically obese normal-weight (MONW) children are not identified in primary care setting. Given that characterization of the MONW children is an important public health issue, and that a large amount of resources might be unnecessarily used in the screening of metabolic risk of nonobese children; we review data regarding criteria for the early recognition of this subset of children in high risk of developing cardiovascular disease. Results of our review suggests that the presence of family history of type 2 diabetes and/or hypertension, the elevated percentage of body fat, and the high birth-weight should be taken into account as criteria of high cardiovascular risk, irrespective of obesity.
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Affiliation(s)
- Fernando Guerrero-Romero
- Fernando Guerrero-Romero, Martha Rodríguez-Moran Biomedical Research Unit, Mexican Social Security Institute, ZC 34067 Durango, Mexico
| | - Martha Rodríguez-Moran
- Fernando Guerrero-Romero, Martha Rodríguez-Moran Biomedical Research Unit, Mexican Social Security Institute, ZC 34067 Durango, Mexico
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Burrows T, Golley RK, Khambalia A, McNaughton SA, Magarey A, Rosenkranz RR, Alllman-Farinelli M, Rangan AM, Truby H, Collins C. The quality of dietary intake methodology and reporting in child and adolescent obesity intervention trials: a systematic review. Obes Rev 2012; 13:1125-38. [PMID: 22891692 DOI: 10.1111/j.1467-789x.2012.01022.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Assessing dietary intake is important in evaluating childhood obesity intervention effectiveness. The purpose of this review was to evaluate the dietary intake methods and reporting in intervention studies that included a dietary component to treat overweight or obese children. A systematic review of studies published in the English language, between 1985 and August 2010 in health databases. The search identified 2,295 papers, of which 335 were retrieved and 31 met the inclusion criteria. Twenty-three studies reported energy intake as an outcome measure, 20 reported macronutrient intakes and 10 studies reported food intake outcomes. The most common dietary method employed was the food diary (n = 13), followed by 24-h recall (n = 5), food frequency questionnaire (FFQ) (n = 4) and dietary questionnaire (n = 4). The quality of the dietary intake methods reporting was rated as 'poor' in 15 studies (52%) and only 3 were rated as 'excellent'. The reporting quality of FFQs tended to be higher than food diaries/recalls. Deficiencies in the quality of dietary intake methods reporting in child obesity studies were identified. Use of a dietary intake methods reporting checklist is recommended. This will enable the quality of dietary intake results to be evaluated, and an increased ability to replicate study methodology by other researchers.
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Affiliation(s)
- T Burrows
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.
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Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, Collins C. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics 2012; 130:e1647-71. [PMID: 23166346 DOI: 10.1542/peds.2012-1176] [Citation(s) in RCA: 343] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The effects of lifestyle interventions on cardio-metabolic outcomes in overweight children have not been reviewed systematically. The objective of the study was to examine the impact of lifestyle interventions incorporating a dietary component on both weight change and cardio-metabolic risks in overweight/obese children. METHODS English-language articles from 1975 to 2010, available from 7 databases, were used as data sources. Two independent reviewers assessed articles against the following eligibility criteria: randomized controlled trial, participants overweight/obese and ≤18 years, comparing lifestyle interventions to no treatment/wait-list control, usual care, or written education materials. Study quality was critically appraised by 2 reviewers using established criteria; Review Manager 5.1 was used for meta-analyses. RESULTS Of 38 eligible studies, 33 had complete data for meta-analysis on weight change; 15 reported serum lipids, fasting insulin, or blood pressure. Lifestyle interventions produced significant weight loss compared with no-treatment control conditions: BMI (-1.25kg/m(2), 95% confidence interval [CI] -2.18 to -0.32) and BMI z score (-0.10, 95% CI -0.18 to -0.02). Studies comparing lifestyle interventions to usual care also resulted in significant immediate (-1.30kg/m(2), 95% CI -1.58 to -1.03) and posttreatment effects (-0.92 kg/m(2), 95% CI -1.31 to -0.54) on BMI up to 1 year from baseline. Lifestyle interventions led to significant improvements in low-density lipoprotein cholesterol (-0.30 mmol/L, 95% CI -0.45 to -0.15), triglycerides (-0.15 mmol/L, 95% CI -0.24 to -0.07), fasting insulin (-55.1 pmol/L, 95% CI -71.2 to -39.1) and blood pressure up to 1 year from baseline. No differences were found for high-density lipoprotein cholesterol. CONCLUSIONS Lifestyle interventions can lead to improvements in weight and cardio-metabolic outcomes. Further research is needed to determine the optimal length, intensity, and long-term effectiveness of lifestyle interventions.
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Affiliation(s)
- Mandy Ho
- The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.
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Farah BQ, Berenguer MDF, Prado WLD, C. Júnior CG, Dias RMR. Efeito do treinamento físico na pressão arterial de adolescentes com obesidade. REVISTA PAULISTA DE PEDIATRIA 2012. [DOI: 10.1590/s0103-05822012000400020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever, por meio de uma revisão sistemática, os efeitos do treinamento físico sobre a pressão arterial em adolescentes com obesidade. FONTES DE DADOS: Recorreu-se à revisão sistemática de ensaios clínicos randomizados que analisaram o efeito do treinamento físico sobre a pressão arterial de adolescentes obesos, publicados em periódicos indexados nas bases de dados PubMed/Medline, Lilacs, SciELO e ISI Web of KnowledgeSM. Foram incluídos os estudos que avaliaram adolescentes publicados até 2010, e que possuíam Grupo Controle. SÍNTESE DOS DADOS: Oito estudos atenderam aos critérios de inclusão. Dois deles utilizaram exercícios de força combinados com aeróbios, enquanto seis empregaram apenas os aeróbios. Cinco estudos utilizaram intervenções complementares, sendo a nutricional a mais frequente. Quatro estudos observaram redução da pressão arterial sistólica no Grupo Exercício comparado ao Controle. Nesses quatro estudos, além da redução da pressão arterial, notou-se diminuição da massa corpórea. Todos aqueles que verificaram redução da pressão arterial utilizaram 12 a 24 semanas de exercícios aeróbios, três a seis sessões semanais, com duração de 50 a 90 minutos e intensidade entre 55 e 75% da frequência cardíaca máxima. CONCLUSÕES: O efeito do treinamento físico na pressão arterial de adolescentes obesos é controverso. A redução da pressão arterial parece ocorrer com programas de treinamento aeróbios que promovam também a redução da massa corpórea.
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Do Obese Children Have Chronic Inflammation & Could This Contribute to Future CVD Risk? CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0271-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kamal NN, Ragy MM. The effects of exercise on C-reactive protein, insulin, leptin and some cardiometabolic risk factors in Egyptian children with or without metabolic syndrome. Diabetol Metab Syndr 2012; 4:27. [PMID: 22691465 PMCID: PMC3536685 DOI: 10.1186/1758-5996-4-27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/06/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The prevalence and magnitude of obesity in the children and the adolescents have increased dramatically in the developing countries over the last 20-30 years. The prevalence of metabolic syndrome (MS) in children is increasing. AIM This study aimed to investigate the changes of C-reactive protein (CRP), leptin, insulin, and blood lipids before and after the exercise therapy in normal and obese children (with or without metabolic syndrome). METHODS The study covered 49 normal children (control), 32 obese children without metabolic syndrome and 12 obese children with metabolic syndrome. We examined the influence of exercise (3 times/week) for 12 weeks on the levels of serum CRP, leptin, insulin, homeostatic model assessment insulin resistance (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in all groups. RESULTS There were significant correlations between HOMA-IR and the individual components of the metabolic syndrome. After 12 weeks of exercise, both of the obese children groups, with and without metabolic syndrome, showed reduced body weight, body mass index (BMI), and CRP level, and increased HDL-C level. The percentage of metabolic syndrome decreased from 12.9% before the exercise training to 7.5% after training. Also, there was a significant reduction in BMI (from 47.3 to 32.6%), in systolic blood pressure (from 18.3 to 15.1%) and in HDL-C level (from 18.3 to 9.7%). CONCLUSION Overweight children have multiple risk factors associated with the metabolic syndrome. 12-week exercise may have a positive effect on reducing risk factors for the metabolic syndrome.
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Affiliation(s)
- Nashwa Nabil Kamal
- Lecturer of public health, Public health department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Merhan Mamdouh Ragy
- Lecturer of physiology, Physiology department, Faculty of Medicine, Minia University, Minia, Egypt
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Sofer S, Eliraz A, Kaplan S, Voet H, Fink G, Kima T, Madar Z. Greater weight loss and hormonal changes after 6 months diet with carbohydrates eaten mostly at dinner. Obesity (Silver Spring) 2011; 19:2006-14. [PMID: 21475137 DOI: 10.1038/oby.2011.48] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study was designed to investigate the effect of a low-calorie diet with carbohydrates eaten mostly at dinner on anthropometric, hunger/satiety, biochemical, and inflammatory parameters. Hormonal secretions were also evaluated. Seventy-eight police officers (BMI >30) were randomly assigned to experimental (carbohydrates eaten mostly at dinner) or control weight loss diets for 6 months. On day 0, 7, 90, and 180 blood samples and hunger scores were collected every 4 h from 0800 to 2000 hours. Anthropometric measurements were collected throughout the study. Greater weight loss, abdominal circumference, and body fat mass reductions were observed in the experimental diet in comparison to controls. Hunger scores were lower and greater improvements in fasting glucose, average daily insulin concentrations, and homeostasis model assessment for insulin resistance (HOMA(IR)), T-cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were observed in comparison to controls. The experimental diet modified daily leptin and adiponectin concentrations compared to those observed at baseline and to a control diet. A simple dietary manipulation of carbohydrate distribution appears to have additional benefits when compared to a conventional weight loss diet in individuals suffering from obesity. It might also be beneficial for individuals suffering from insulin resistance and the metabolic syndrome. Further research is required to confirm and clarify the mechanisms by which this relatively simple diet approach enhances satiety, leads to better anthropometric outcomes, and achieves improved metabolic response, compared to a more conventional dietary approach.
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Affiliation(s)
- Sigal Sofer
- The Robert H. Smith Faculty of Agriculture, Food and Environment, Institute of Biochemistry and Food Science, The Hebrew University of Jerusalem, Rehovot, Israel
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Rochefort GY, Rocher E, Aveline PC, Garnero P, Bab I, Chappard C, Jaffré C, Benhamou CL. Osteocalcin-insulin relationship in obese children: a role for the skeleton in energy metabolism. Clin Endocrinol (Oxf) 2011; 75:265-70. [PMID: 21521300 DOI: 10.1111/j.1365-2265.2011.04031.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Osteocalcin is a bone-specific protein secreted by osteoblasts and often used as a bone formation biomarker. Rodent studies have reported a hormonal role of osteocalcin on glucose metabolism, increasing insulin secretion and sensitivity and increasing energy expenditure. However, it is unknown whether osteocalcin fulfils the same function in humans. METHODS We investigated the relationship between serum osteocalcin and insulin concentrations in 27 prepubertal obese children (9-12 years old) randomly divided into two groups, one of which entered a physical training programme, and 16 nonobese control children. Whole body bone mineral density (WB-BMD), serum osteocalcin, circulating insulin and adiponectin were measured at baseline and after 6 months. RESULTS Trained and untrained obese children had higher WB-BMD than controls at baseline. Trained children also displayed a significant insulin increase and a significant adiponectin decrease while osteocalcin was increased compared to untrained obese children. Significant linear correlations between WB-BMD and adiponectin, delta BMD (variation between baseline and after-training values) and delta adiponectin, insulin and osteocalcin, delta insulin and delta osteocalcin, delta insulin and delta under-carboxylated osteocalcin were found only in trained obese children with no significant relationship in control and untrained obese children. CONCLUSIONS In trained obese children, correlations indicate that when BMD is increased, osteocalcin is increased and insulin lowered. This suggests that increased BMD is associated with increased energy metabolism and a decreased level of insulin. We thus report statistically significant relationships between the skeleton (osteocalcin) and energy metabolism (insulin), suggesting a regulatory hormonal loop including osteocalcin and insulin.
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Affiliation(s)
- Gaël Y Rochefort
- INSERM Research Unit 658, Centre Hospitalier Régional, Orleans, France.
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Doyle-Baker PK, Venner AA, Lyon ME, Fung T. Impact of a combined diet and progressive exercise intervention for overweight and obese children: the B.E. H.I.P. study. Appl Physiol Nutr Metab 2011; 36:515-25. [DOI: 10.1139/h11-042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The Biochemical Evaluation of a Health Intervention Programme (B.E. H.I.P.) investigated the impact of progressive exercise intensity in overweight and obese children. A 5-month prospective randomized crossover design (XA, immediate intervention; OB, control group; XB, delayed intervention, OA, postintervention follow-up) with a 10-week health intervention programme was employed. The intervention utilized a progressive increase in high-intensity exercise (≥75% maximum heart rate) and included 3 nutrition and 2 parent education sessions. Primary analysis was completed with (i) XA versus OB and (ii) all intervention participants (collapsed XA and XB = XAXB). Prepubertal overweight and obese male and female children (n = 27) between 5 and 10 years of age were randomly allocated to XA (n = 16; 11 females; waist circumference = 80.0 ± 10.6 cm) or OB (n = 11; 3 females; waist circumference = 76.6 ± 7.5 cm). The primary variables were heart rate and percent fat mass. All variables, including body composition, habitual activity, and serum lipids, were repeatedly measured for up to a maximum of 7 time points. Energy expenditure was quantitatively measured throughout each exercise class (n = 20). A significantly longer time in the exercise sessions was spent in high-intensity (35.1%–60.0%) versus low- to moderate-intensity (64.9%–40.0%) exercise as the intervention progressed from the first to the last attended exercise class (Fisher exact test, p < 0.0001). The percent fat mass decreased in all intervention participants (–2.2%, p < 0.0001). XA had a greater slope decrease than OB for percent fat mass (p = 0.00051) and triglycerides (p = 0.0467). In conclusion, high-intensity exercise, within a comprehensive health programme that includes nutrition education, improved the lipid and physiological health profiles of obese children.
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Affiliation(s)
- Patricia K. Doyle-Baker
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Allison A. Venner
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Medical Science, University of Calgary, AB T2N 1N4, Canada
| | - Martha E. Lyon
- Department of Pathology and Laboratory Medicine, University of Calgary, AB T2N 1N4, Canada
- Department of Pharmacology and Therapeutics, University of Calgary, AB T2N 1N4, Canada
- Department of Pediatrics, University of Calgary, AB T2N 1N4, Canada
- Calgary Laboratory Services, University of Calgary, AB T2N 1N4, Canada
- Department of Biochemistry and Molecular Biology, University of Calgary, AB T2N 1N4, Canada
| | - Tak Fung
- Department of Mathematics and Statistics, University of Calgary, AB T2N 1N4, Canada
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Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, Chiarelli F. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab 2010; 95:5189-98. [PMID: 20829185 PMCID: PMC3206517 DOI: 10.1210/jc.2010-1047] [Citation(s) in RCA: 265] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 08/06/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. PARTICIPANTS The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. EVIDENCE An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. CONSENSUS PROCESS The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. CONCLUSIONS Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.
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Affiliation(s)
- Claire Levy-Marchal
- Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France
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Singhal N, Misra A, Shah P, Gulati S, Bhatt S, Sharma S, Pandey RM. Impact of intensive school-based nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index, and subclinical inflammation among Asian Indian adolescents: a controlled intervention study. Metab Syndr Relat Disord 2010; 9:143-50. [PMID: 21118028 DOI: 10.1089/met.2010.0094] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The present study was designed to assess the impact of intensive and repetitive nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index (DI), and subclinical inflammation in Asian Indian adolescents (15-17 years) residing in North India. METHOD In this prospective study, two matched schools were randomly allocated to the intervention (n = 56; 31 boys and 25 girls) or control group (n = 50; 30 boys and 20 girls). The intervention consisted of seven components: (1) Dissemination of health-related information through lectures and focused group discussions, (2) planning of activities such as quizzes, (3) individual counseling of students, (4) promotion of physical activity, (5) change in the canteen menu to healthier alternatives, (6) conducting health camps involving parents and teachers, and (7) training of student volunteers for sustainability of the program in school. Impact of intervention was studied on surrogate markers of insulin resistance, β-cell function, disposition index, and subclinical inflammation. RESULTS At 6 months follow-up, significantly higher (P = 0.037) mean value of homeostasis model assessment denoting β-cell function (HOMA-βCF) was seen in the intervention group compared to the control group, whereas high sensitivity C-reactive protein (hs-CRP) was significantly lowered (P < 0.001). The increase (30.3 ± 73.4; P < 0.037) observed in the DI in adolescents in the intervention group was significantly higher compared to the control group. The Pearson's coefficient of correlation in the intervention group showed that the Δ-decrease in mean waist circumference was significantly correlated (r = 0.267, P < 0.05) with Δ-decrease in homeostasis model assessment of insulin resistance (HOMA-IR). CONCLUSION The intervention model developed by us could be used for amelioration of insulin resistance with potential of preventing type 2 diabetes mellitus in Asian Indian adolescents.
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Affiliation(s)
- Neha Singhal
- National Diabetes, Obesity and Cholesterol Foundation, SDA, New Delhi, India
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Oh EG, Bang SY, Hyun SS, Kim SH, Chu SH, Jeon JY, Im JA, Lee MK, Lee JE. Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome. Metabolism 2010; 59:1035-43. [PMID: 20045151 DOI: 10.1016/j.metabol.2009.10.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 10/22/2009] [Accepted: 10/27/2009] [Indexed: 01/22/2023]
Abstract
Although therapeutic lifestyle modification (TLM) has been recommended as a cornerstone treatment of metabolic syndrome (MetS), little is known about the biobehavioral effects of a TLM program for patients in a community. The purpose of this study was to examine the effects of a 6-month TLM program on MetS risk factors and health-related qualities of life (HRQOL) among middle-aged and older women in a community in Korea. Fifty-two women (mean age, 62.7 +/- 9.0 years) with MetS were recruited from 3 community health centers and were randomly assigned to the intervention (n = 31) or control (n = 21) groups. The patients in the intervention group participated in supervised TLM sessions for 6 months. The TLM program included health monitoring, counseling, health education, exercise, and dieting. Metabolic risk factors and HRQOL were measured at baseline, during the study (month 3), at completion (month 6), and post completion (month 12) of the TLM program. Compared with the control group, the TLM group showed significantly greater reductions in body weight (P < .001) and waist circumference (P < .001); these effects were sustained for 6 months after intervention. With regard to HRQOL, the TLM group showed greater improvements in physical function (P = .017), general health (P < .001), vitality (P = .008), and mental health (P = .027). These improvements, however, were not sustained after the intervention. The results indicate that a nurse-led systematic TLM program may be an effective strategy for managing middle-aged and older women with MetS at a community level.
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Affiliation(s)
- Eui Geum Oh
- College of Nursing, Nursing Policy and Research Institution, Yonsei University, Seoul, South Korea
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