Abstract
Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.
Highlights
The worldwide rising prevalence of childhood obesity is of public health concern [1]
Participants were divided into control and exercise groups, in which the main difference was that whereas children in the control group participated exclusively in the family-based healthy lifestyle program, the ones in the exercise group besides participating in the previous one did in the exercise program (3 sessions per week)
The current study showed interesting findings regarding the effect of a 22-week family-based healthy lifestyle intervention program on changes in dietary habits and adiposity markers in children with overweight/obesity
Summary
The worldwide rising prevalence of childhood obesity is of public health concern [1]. Childhood obesity is associated with greater cardiometabolic risk later in life [2], and already in early ages [3]. With 26% and 12.6% of 8–17 years-old children presenting overweight and obesity, respectively, is one of the European countries with the highest prevalence of childhood obesity, reporting a worse situation in 8–13 years-old boys from low socioeconomic and educational families [4]. Abdominal adiposity is strongly associated with non-alcoholic fatty liver disease (NAFLD) [6], which consists of the accumulation of triglycerides within hepatocytes with the absence of alcohol consumption [7]. NAFLD is considered as the hepatic manifestation of metabolic syndrome [8]
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