Abstract
Childhood obesity is an increasing health care problem associated with insulin resistance and low-level systemic inflammation, which can ultimately lead to diabetes. Evidence for efficacy of therapeutic intervention programs on the early development of obesity associated sequelae is moderate. This paper investigates the effect of a multidisciplinary short-term intervention program on insulin resistance and metaflammation in childhood obesity. Two hundred and 36 overweight or obese children and adolescents between the ages of 10 and 14 were included in a prospective 5 months intervention study, which included sports, psychotherapy, and nutritional counseling. Primary endpoints were the effects on body mass index standard deviation score (BMI-SDS) and homeostatic model assessment of insulin resistance (HOMA-IR), key secondary endpoints were the levels of C-reactive protein (CRP), leptin, and adiponectin. At baseline, a substantial proportion of participants showed signs of insulin resistance (mean HOMA-IR 5.5 ± 3.4) despite not meeting the diagnostic criteria for diabetes, and low-level inflammation (mean CRP 3.9 mg/l ± 3.8 mg/l). One hundred and 95 participants (83%) completed the program resulting in a significant reduction in BMI-SDS, HOMA-IR, CRP, and leptin and a significant increase in adiponectin (mean change compared to baseline −0.14, −0.85, −1.0 mg/l, −2.8 ng/ml, and 0.5 μg/ml, respectively; p < 0.001 each). Effects on BMI-SDS, HOMA-IR, CRP, and adiponectin were largely independent whereas leptin was positively correlated with BMI-SDS and total fat mass before and after intervention (r = 0.56 and 0.61, p < 0.001 each). Short-term multidisciplinary intervention successfully improved body composition, insulin sensitivity, low-level systemic inflammation, and the adipokine profile in childhood obesity. Our findings highlight the immediate connection between obesity and the pathophysiology of its sequelae, and emphasize the importance of early intervention. Continued lifestyle modification is likely necessary to consolidate and augment the long-term effects.
Highlights
Recent worldwide trends revealed that previously rising prevalence rates for children with obesity have plateaued in many high-income countries, but accelerated in low- and middle-income countries
We evaluated the effect of the program on BMI-SDS and used HOMA-insulin resistance (IR) as the primary endpoint reflecting IR and glucose metabolism
Therapy responders lowered BMI-SDS by 0.21 and homeostasis assessment model for insulin resistance (HOMA-IR) as marker for IR by 2.03, raising the ratio of participants without IR to two thirds after intervention. This is comparable with other studies, which achieved BMI-SDS decreases between 0.12 and 0.4 [21, 25, 26], and HOMA-IR decreases from 0.1 to 2.4 within an amount of time ranging from 8 weeks to 1 year [27, 28]
Summary
Recent worldwide trends revealed that previously rising prevalence rates for children with obesity have plateaued in many high-income countries, but accelerated in low- and middle-income countries. Obesity-associated low-level systemic inflammation (metaflammation) is an important pathophysiological mechanism of atherosclerosis and diabetes and contributes to the early development of insulin resistance (IR) in obesity [2]. IR affects up to 25% of non-diabetic children with obesity [3] and amplifies the risk for metabolic syndrome in adulthood [4]. Elevated levels of C-reactive protein (CRP) represent a surrogate parameter of a systemic low-level inflammation in obesity and have been associated with atherosclerosis, metaflammation, and increasing body fat percentage [8]. Adiponectin acts on the liver and skeletal muscle, reducing glucose production and increasing insulin sensitivity and energy expenditure [9]. We investigated the short-term effect of a multidisciplinary intervention program on BMI-SDS, IR, and metaflammation and their association in children and adolescents affected by overweight and obesity
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