Childhood obesity treatment; Effects on BMI SDS, body composition, and fasting plasma lipid concentrations

OBJECTIVE

The body mass index (BMI) standard deviation score (SDS) may not adequately reflect changes in fat mass during childhood obesity treatment. This study aimed to investigate associations between BMI SDS, body composition, and fasting plasma lipid concentrations at baseline and during childhood obesity treatment.

METHODS

876 children and adolescents (498 girls) with overweight/obesity, median age 11.2 years (range 1.6-21.7), and median BMI SDS 2.8 (range 1.3-5.7) were enrolled in a multidisciplinary outpatient treatment program and followed for a median of 1.8 years (range 0.4-7.4). Height and weight, body composition measured by dual-energy X-ray absorptiometry, and fasting plasma lipid concentrations were assessed at baseline and at follow-up. Lipid concentrations (total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL, and triglycerides (TG)) were available in 469 individuals (264 girls). Linear regressions were performed to investigate the associations between BMI SDS, body composition indices, and lipid concentrations.

RESULTS

At baseline, BMI SDS was negatively associated with concentrations of HDL (p = 6.7*10-4) and positively with TG (p = 9.7*10-6). Reductions in BMI SDS were associated with reductions in total body fat percentage (p<2*10-16) and percent truncal body fat (p<2*10-16). Furthermore, reductions in BMI SDS were associated with improvements in concentrations of TC, LDL, HDL, non-HDL, LDL/HDL-ratio, and TG (all p <0.0001). Changes in body fat percentage seemed to mediate the changes in plasma concentrations of TC, LDL, and non-HDL, but could not alone explain the changes in HDL, LDL/HDL-ratio or TG. Among 81 individuals with available lipid concentrations, who increased their BMI SDS, 61% improved their body composition, and 80% improved their lipid concentrations.

CONCLUSION

Reductions in the degree of obesity during multidisciplinary childhood obesity treatment are accompanied by improvements in body composition and fasting plasma lipid concentrations. Even in individuals increasing their BMI SDS, body composition and lipid concentrations may improve.

Estimates of insulin sensitivity and β-cell function in children and adolescents with and without components of the metabolic syndrome

INTRODUCTION

The accumulation of components of the metabolic syndrome (MetS) is associated with a disturbed glucose metabolism in obese children.

AIM OF STUDY

The aim of the present study was to evaluate the association between MetS and estimates of insulin sensitivity and β-cell function obtained from oral glucose tolerance test (OGTT)-derived indices in lean and obese children.

MATERIAL AND METHODS

A 2-hour OGTT was administered in 83 children aged 7-17 years. 47 children were obese and recruited from a childhood obesity clinic and 36 were lean age- and sex-matched controls. Surrogate measures of insulin sensitivity and β-cell function were assessed by the OGTT-derived indices: the Matsuda index, the insulinogenic index, and the oral disposition index. The severity of MetS was assessed by measures of waist circumference, blood pressure, and fasting levels of triglycerides, high-density lipoprotein cholesterol, and glucose.

RESULTS

The 83 children were allocated to one of three groups according to the number of components of MetS: the median body mass index standard deviation score was 0.2 (range -0.6-2.9) in the low MetS risk group (n=36), 2.8 (0.1-4.1) in the high MetS risk group (n=25), and 2.9 (2.1-4.4) in the MetS group (n=22). An increasing number of MetS components were associated with a lower insulin sensitivity and an altered β-cell function according to the Matsuda index (p<0.0001), the insulinogenic index (p<0.0001), and the oral disposition index (p=0.005).

CONCLUSIONS

Children burdened by the accumulation of components of MetS exhibited a disturbed glucose metabolism as expressed by lowered peripheral insulin sensitivity and β-cell function.

A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting

BACKGROUND

Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed.

METHODS

In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations. Changes in BMI SDS and WC were analyzed using linear mixed models based upon the repeated measures in each child.

RESULTS

From June 2012 to January 2015, 1,001 children (455 boys) were consecutively enrolled in the community-based treatment program. Upon entry, the median age was 11 years (range: 3-18), and the median BMI SDS was 2.85 (range: 1.26-8.96) in boys and 2.48 (range: 1.08-4.41) in girls. After 1.5 years of treatment BMI SDS was reduced in 74% of the children. BMI SDS was reduced by a mean of 0.38 (95% confidence interval (CI): 0.30-0.45, p<0.0001) in boys and 0.18 (95% CI: 0.12-0.25, p<0.0001) in girls after 1.5 years of treatment, independently of baseline age, BMI SDS, and Tanner stage (all p>0.08). WC was reduced by a mean of 3.8 cm (95% CI: 2.7-4.9, p>0.0001) in boys and 5.1 cm (95% CI: 4.0-6.2, p>0.0001) in girls. The dropout rate was 31% after 1.5 years. A median of 4.5 consultation hours was invested per child per year.

CONCLUSION

BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility.

No influence of sugar, snacks and fast food intake on the degree of obesity or treatment effect in childhood obesity

BACKGROUND

Increased consumption of sweetened beverages has previously been linked to the degree of childhood obesity.

OBJECTIVE

The aim of the present study was to assess whether the intake of sweetened beverages, candy, snacks or fast food at baseline in a multidisciplinary childhood obesity treatment program was associated with the baseline degree of obesity or the treatment effect.

METHODS

This prospective study included 1349 overweight and obese children (body mass index standard deviation scores (BMI SDS) ≥ 1.64) enrolled in treatment at The Children's Obesity Clinic, Copenhagen University Hospital Holbaek. The children were evaluated at baseline and after up to 5.9 years of treatment (median 1.3 years).

RESULTS

Both boys and girls decreased their BMI SDS during treatment with a mean decrease in boys of 0.35 (p < 0.0001) and in girls of 0.22 (p < 0.0001) after 1 year of treatment. There were no associations between the baseline intake of sweetened beverages, candy, snacks, and/or fast food and BMI SDS at baseline or the change in BMI SDS during treatment.

CONCLUSIONS

The intake of sweetened beverages, candy, snacks or fast food when entering a childhood obesity treatment program was not associated with the degree of obesity at baseline or the degree of weight loss during treatment.