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Boqué N, Tarro L, Rosi A, Torrell H, Saldaña G, Luengo E, Rachman Z, Pires A, Tavares NT, Pires AS, Botelho MF, Mena P, Scazzina F, Del Rio D, Caimari A. Study Protocol of a Multicenter Randomized Controlled Trial to Tackle Obesity through a Mediterranean Diet vs. a Traditional Low-Fat Diet in Adolescents: The MED4Youth Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4841. [PMID: 34062731 PMCID: PMC8125034 DOI: 10.3390/ijerph18094841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/26/2022]
Abstract
Youth obesity is a strong predictor of adult obesity, which has well-known negative health consequences. Thus, addressing adult obesity requires tackling youth obesity. MED4Youth's main objective is to strengthen the link between the Mediterranean Diet (MD) and the health benefits against youth obesity and associated cardiovascular disease (CVD) risk factors, identifying positive effects exerted by an MD including sourdough bread and healthy products from the Mediterranean basis (chickpeas/hummus, nuts, and pomegranate juice). For this purpose, a multicenter randomized controlled trial in which an MD-based intervention will be compared to a traditional low-fat diet intervention will be carried out with 240 overweight and obese adolescents (13-17 years) from Spain, Portugal, and Italy. Both interventions will be combined with an educational web-application addressed to engage the adolescents through a learning-through-playing approach, using both educational materials and games. To assess the interventions, adherence to the MD, dietary records, physical activity, food frequency, sociodemographic, and quality of life questionnaires as well as classical anthropometric and biochemical parameters will be evaluated. Furthermore, an omics approach will be performed to elucidate whether the interventions can shape the gut microbiota and gut-derived metabolites to gain knowledge on the mechanisms through which the MD can exert its beneficial effects.
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Affiliation(s)
- Noemi Boqué
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, 43204 Reus, Spain; (N.B.); (L.T.)
| | - Lucía Tarro
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, 43204 Reus, Spain; (N.B.); (L.T.)
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43125 Parma, Italy; (A.R.); (P.M.); (F.S.); (D.D.R.)
| | - Helena Torrell
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (Joint Unit Eurecat-Universitat Rovira i Virgili), Unique Scientific and Technical Infrastructures (ICTS), 43204 Reus, Spain;
| | - Guillermo Saldaña
- NOVAPAN S.L, Research & Development Department, 50014 Zaragoza, Spain; (G.S.); (E.L.)
| | - Elisa Luengo
- NOVAPAN S.L, Research & Development Department, 50014 Zaragoza, Spain; (G.S.); (E.L.)
| | - Zeev Rachman
- SHIKMA Field Crops, 8531500 Kibbutz Mishmar HaNegev, Israel;
| | - António Pires
- Pediatric Cardiology Department, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal;
| | - Nuno Tiago Tavares
- Institute of Biophysics, Faculty of Medicine, Institute for Clinical and Biomedical Research (iCBR) Area of CIMAGO, University of Coimbra, 3000-548 Coimbra, Portugal; (N.T.T.); (A.S.P.); (M.F.B.)
- Centre for Inovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Ana Salomé Pires
- Institute of Biophysics, Faculty of Medicine, Institute for Clinical and Biomedical Research (iCBR) Area of CIMAGO, University of Coimbra, 3000-548 Coimbra, Portugal; (N.T.T.); (A.S.P.); (M.F.B.)
- Centre for Inovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Maria Filomena Botelho
- Institute of Biophysics, Faculty of Medicine, Institute for Clinical and Biomedical Research (iCBR) Area of CIMAGO, University of Coimbra, 3000-548 Coimbra, Portugal; (N.T.T.); (A.S.P.); (M.F.B.)
- Centre for Inovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Pedro Mena
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43125 Parma, Italy; (A.R.); (P.M.); (F.S.); (D.D.R.)
| | - Francesca Scazzina
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43125 Parma, Italy; (A.R.); (P.M.); (F.S.); (D.D.R.)
| | - Daniele Del Rio
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43125 Parma, Italy; (A.R.); (P.M.); (F.S.); (D.D.R.)
| | - Antoni Caimari
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Avinguda Universitat, 1, 43204 Reus, Spain
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Truby H, Baxter K, Ware RS, Jensen DE, Cardinal JW, Warren JM, Daniels L, Davies PSW, Barrett P, Blumfield ML, Batch JA. A Randomized Controlled Trial of Two Different Macronutrient Profiles on Weight, Body Composition and Metabolic Parameters in Obese Adolescents Seeking Weight Loss. PLoS One 2016; 11:e0151787. [PMID: 27022913 PMCID: PMC4811557 DOI: 10.1371/journal.pone.0151787] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 02/27/2016] [Indexed: 02/06/2023] Open
Abstract
Objective Adolescent obesity is difficult to treat and the optimal dietary pattern, particularly in relation to macronutrient composition, remains controversial. This study tested the effect of two structured diets with differing macronutrient composition versus control, on weight, body composition and metabolic parameters in obese adolescents. Design A randomized controlled trial conducted in a children’s hospital. Methods Eighty seven obese youth (means: age 13.6 years, BMI z-score 2.2, waist: height ratio 0.65, 69% female) completed a psychological preparedness program and were then randomized to a short term ‘structured modified carbohydrate’ (SMC, 35% carbohydrate; 30% protein; 35% fat, n = 37) or a ‘structured low fat’ (SLF, 55% carbohydrate; 20% protein; 25% fat, n = 36) or a wait listed control group (n = 14). Anthropometric, body composition and biochemical parameters were measured at randomization and after 12 weeks, and analyzed under the intention to treat principle using analysis of variance models. Results After 12 weeks, data was collected from 79 (91%) participants. BMI z-scores were significantly lower in both intervention groups compared to control after adjusting for baseline values, SLF vs. control, mean difference = -0.13 (95%CI = -0.18, -0.07), P<0.001; SMC vs. control, -0.14 (-0.19, -0.09), P<0.001, but there was no difference between the two intervention diet groups: SLF vs. SMC, 0.00 (-0.05, 0.04), P = 0.83. Conclusions Both dietary patterns resulted in similar changes in weight, body composition and metabolic improvements compared to control. The use of a structured eating system which allows flexibility but limited choices can assist in weight change and the rigid application of a low fat eating pattern is not exclusive in its efficacy. Trial Registration International Clinical Trials Registry ISRCTN49438757
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Affiliation(s)
- Helen Truby
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
- Children’s Nutrition Research Centre, The University of Queensland, Herston, Queensland, Australia
- * E-mail:
| | - Kimberley Baxter
- Children’s Nutrition Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Robert S. Ware
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Diane E. Jensen
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Lady Cilentro Children’s Hospital, South Brisbane, Queensland, Australia
| | - John W. Cardinal
- Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia
| | - Janet M. Warren
- Children’s Nutrition Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Lynne Daniels
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Peter S. W. Davies
- Children’s Nutrition Research Centre, The University of Queensland, Herston, Queensland, Australia
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Paula Barrett
- Pathways Health and Research Centre, West End, Brisbane, Queensland, Australia
| | - Michelle L. Blumfield
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - Jennifer A. Batch
- Children’s Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Lady Cilentro Children’s Hospital, South Brisbane, Queensland, Australia
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Jensen DE, Nguo K, Baxter KA, Cardinal JW, King NA, Ware RS, Truby H, Batch JA. Fasting gut hormone levels change with modest weight loss in obese adolescents. Pediatr Obes 2015; 10:380-7. [PMID: 25559355 DOI: 10.1111/ijpo.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 09/27/2014] [Accepted: 10/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gut hormones change with weight loss in adults but are not well studied in obese youth. OBJECTIVE The primary aim was to evaluate how gut hormones and subjective appetite measure change with dietary weight loss in obese adolescents. METHODS Participants were a subset of those taking part in the 'Eat Smart Study'. They were aged 10-17 years with body mass index (BMI) > 90th centile and were randomized to one of three groups: wait-listed control, structured reduced carbohydrate or structured low-fat dietary intervention for 12 weeks. Outcomes were fasting glucose, insulin, leptin, adiponectin, total amylin, acylated ghrelin, active glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide (GIP), pancreatic polypeptide (PP) and total peptide tyrosine-tyrosine. Pre- and postprandial subjective sensations of appetite were assessed using visual analogue scales. RESULTS Of 87 'Eat Smart' participants, 74 participated in this sub-study. The mean (standard deviation) BMI z-score was 2.1 (0.4) in the intervention groups at week 12 compared with 2.2 (0.4) in the control group. Fasting insulin (P = 0.05) and leptin (P = 0.03) levels decreased, while adiponectin levels increased (P = 0.05) in the intervention groups compared with control. The intervention groups were not significantly different from each other. A decrease in BMI z-score at week 12 was associated with decreased fasting insulin (P < 0.001), homeostatic model of assessment-insulin resistance (P < 0.001), leptin (P < 0.001), total amylin (P = 0.03), GIP (P = 0.01), PP (P = 0.02) and increased adiponectin (P < 0.001). There was no significant difference in appetite sensations. CONCLUSIONS Modest weight loss in obese adolescents leads to changes in some adipokines and gut hormones that may favour weight regain.
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Affiliation(s)
- D E Jensen
- Children's Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
| | - K Nguo
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - K A Baxter
- Children's Nutrition Research Centre, University of Queensland, Herston, Queensland, Australia
| | - J W Cardinal
- Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia
| | - N A King
- Institute of Health and Biomedical Innovation, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - R S Ware
- Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia.,School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - H Truby
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - J A Batch
- Children's Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
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Predicting success: factors associated with weight change in obese youth undertaking a weight management program. Obes Res Clin Pract 2014; 7:e147-e154. [PMID: 24331776 DOI: 10.1016/j.orcp.2011.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/27/2011] [Accepted: 09/29/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore which baseline physiological and psychosocial variables predict change in body mass index (BMI) z-score in obese youth after 12 weeks of a dietary weight management study. METHODS Participants were obese young people participating in a dietary intervention trial in Brisbane Australia. The outcome variable was change in BMI z-score. Potential predictors considered included demographic, physiological and psychosocial parameters of the young person, and demographic characteristics of their parents. A multivariable regression model was constructed to examine the effect of potential predictive variables. RESULTS Participants (n = 88) were predominantly female (69.3%), and had a mean(standard deviation) age of 13.1(1.9) years and BMI z-score of 2.2(0.4) on presentation. Lower BMI z-score (p < 0.001) and insulin resistance (p = 0.04) at baseline, referral from a paediatrician (p = 0.02) and being more socially advantaged (p = 0.046) were significantly associated with weight loss. Macronutrient distribution of diet and physical activity level did not contribute. CONCLUSIONS Early intervention in obesity treatment in young people improves likelihood of success. Other factors such as degree of insulin resistance, social advantage and referral source also appear to play a role. Assessing presenting characteristics and factors associated with treatment outcome may allow practicing clinicians to individualise a weight management program or determine the 'best-fit' treatment for an obese adolescent.
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Smith L, Ucci M, Marmot A, Spinney R, Laskowski M, Sawyer A, Konstantatou M, Hamer M, Ambler G, Wardle J, Fisher A. Active buildings: modelling physical activity and movement in office buildings. An observational study protocol. BMJ Open 2013; 3:e004103. [PMID: 24227873 PMCID: PMC3831099 DOI: 10.1136/bmjopen-2013-004103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Health benefits of regular participation in physical activity are well documented but population levels are low. Office layout, and in particular the number and location of office building destinations (eg, print and meeting rooms), may influence both walking time and characteristics of sitting time. No research to date has focused on the role that the layout of the indoor office environment plays in facilitating or inhibiting step counts and characteristics of sitting time. The primary aim of this study was to investigate associations between office layout and physical activity, as well as sitting time using objective measures. METHODS AND ANALYSIS Active buildings is a unique collaboration between public health, built environment and computer science researchers. The study involves objective monitoring complemented by a larger questionnaire arm. UK office buildings will be selected based on a variety of features, including office floor area and number of occupants. Questionnaires will include items on standard demographics, well-being, physical activity behaviour and putative socioecological correlates of workplace physical activity. Based on survey responses, approximately 30 participants will be recruited from each building into the objective monitoring arm. Participants will wear accelerometers (to monitor physical activity and sitting inside and outside the office) and a novel tracking device will be placed in the office (to record participant location) for five consecutive days. Data will be analysed using regression analyses, as well as novel agent-based modelling techniques. ETHICS AND DISSEMINATION The results of this study will be disseminated through peer-reviewed publications and scientific presentations. Ethical approval was obtained through the University College London Research Ethics Committee (Reference number 4400/001).
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Affiliation(s)
- Lee Smith
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Marcella Ucci
- Bartlett School of Graduate Studies, University College London, London, UK
| | - Alexi Marmot
- Bartlett School of Graduate Studies, University College London, London, UK
| | - Richard Spinney
- Bartlett School of Graduate Studies, University College London, London, UK
| | - Marek Laskowski
- Bartlett School of Graduate Studies, University College London, London, UK
| | - Alexia Sawyer
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Mark Hamer
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Abigail Fisher
- Department of Epidemiology and Public Health, University College London, London, UK
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Nambiar S, Truby H, Davies PSW, Baxter K. Use of the waist-height ratio to predict metabolic syndrome in obese children and adolescents. J Paediatr Child Health 2013; 49:E281-7. [PMID: 23521181 DOI: 10.1111/jpc.12147] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2012] [Indexed: 01/19/2023]
Abstract
AIM To demonstrate that the waist-height ratio (WHtR) is a simple and effective screening tool that could be used to identify obese children with the metabolic syndrome. METHODS Data from 109 obese boys and girls, aged 10.00-16.50 years, who were recruited as part of the Eat Smart study were analysed. Systolic (SBP) and diastolic (DBP) blood pressure, blood lipids (total cholesterol, triglycerides (TG), high- and low-density lipoproteins), insulin, glucose, height, weight and waist circumference (WC) were collected. These measurements were used to calculate WHtR, body mass index (BMI), Z-scores for BMI, WC, weight and homeostatic model assessment for insulin resistance (HOMA-IR). Correlations between anthropometric measures and blood pressure, lipids, insulin, glucose and HOMA-IR were assessed. Binary logistic regression was used to test which anthropometric measure was a significant predictor of the metabolic syndrome. RESULTS Among boys, WHtR was negatively correlated with glucose (P < 0.05); WHtR and BMI Z-score were positively correlated with insulin, HOMA-IR and TG (P < 0.05) and WC Z-score was significantly correlated with age. Among girls, WHtR, BMI Z-score and WC Z-score were positively correlated with insulin and HOMA-IR and negatively correlated with high-density lipoprotein-cholesterol (P < 0.05), whereas BMI Z-score was significantly correlated with SBP and DBP Z-scores. Twenty per cent of subjects were classified as having the metabolic syndrome, with WHtR, BMI Z-score and HOMA-IR being significant predictors. CONCLUSION The WHtR is a significant predictor of the metabolic syndrome in obese youth. The WHtR is the simplest index to calculate and interpret, making it an ideal non-invasive screening tool to use in clinical practice.
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Affiliation(s)
- Smita Nambiar
- Children's Nutrition Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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