Danielle Arisa Caranti

Metabolic and Nutritional Profile of Obese Adolescents With Nonalcoholic Fatty Liver Disease

Background: The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing due to its prevalence in obesity, diabetes, and insulin-resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention can improve and prevent it. The aim of the present study was to evaluate the dietary and metabolic profiles of obese adolescents with NAFLD who participated in a multidisciplinary program. Patients and Methods: We studied 43 adolescents ages 15 to 19 years (17.18 ± 1.66 years) with a body mass index (BMI) ≥30, consisting of 30 patients without NAFLD (BMI = 35.80 ± 3.44 kg/m2) and 13 with NAFLD (BMI = 33.47 ± 2.34 kg/m2). The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic aminotransferase levels, and lipid profiles. Insulin resistance was measured by homeostasis model assessment insulin-resistance index (HOMA-IR). The analyses of baseline and postintervention food intake were made by a 3-day inquiry. Results: At baseline conditions, the patients with NAFLD showed significant differences in body mass, BMI, and visceral and subcutaneous fat. Glucose and visceral and subcutaneous fat presented a significant reduction after treatment in patients with NAFLD. Analyzing the food intake, at baseline we observed a positive correlation between the visceral obesity and lipid consumption only in patients with NAFLD. We also observed significant decrease in energy and cholesterol consumption in patients with NAFLD after the multidisciplinary therapy. Conclusions: The intervention promoted a decrease in the prevalence of NAFLD, a significant decrease in visceral obesity, and improved HOMA-IR, glycemia, and serum lipid levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.

Relationship between bone mineral density, leptin and insulin concentration in Brazilian obese adolescents

Despite the epidemic of adolescent obesity, the effect of obesity and hormones on bone mineral accrual during growth is poorly understood. Studies using dual-energy X-ray to examine the effect of obesity on bone mass in children and adolescents have yielded conflicting results. The aim of this study was to explore the combined and independent contributions of body mass index, body composition, leptin, insulin, glucose levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) to bone mineral density (BMD) and bone mineral content in a group of Brazilian obese adolescents. This study included 109 post-pubescent obese adolescents. A whole-body dual-energy X-ray absorptiometry scan was performed,using a HOLOGIC QDR4200, to determine whole-body BMD and body composition. Blood samples were collected in the outpatient clinic after an overnight fast, and evaluated for fasting blood glucose and immunoreactive insulin. Leptin levels were assessed with a radioimmunoassay kit. Insulin resistance was assessed by HOMA-IR and the quantitative insulin sensitivity check index. Our results showed that insulin levels and HOMA-IR correlated negatively with BMD and a linear regression analysis showed that serum leptin is inversely associated to BMD adjusted for body mass. In conclusion, our data support the hypothesis that leptin, insulin and HOMA-IR are inversely associated with BMD and play a significant direct role in bone metabolism.

The effect of weight loss magnitude on pro-/anti-inflammatory adipokines and carotid intima-media thickness in obese adolescents engaged in interdisciplinary weight loss therapy.

Obesity is a chronic disease defined by an excess amount of adipose tissue and presents a low‐grade inflammatory state, increasing cardiovascular risk.

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy.

BackgroundObesity has adverse physical, social, and economic consequences that can negatively affect quality of life (QOL). Thus the aim of this study was to verify the effects of a long-term multidisciplinary lifestyle intervention on QOL, body image, anxiety, depression and binge eating in obese adolescents.MethodsSixty-six obese adolescents (41 girls and 25 boys; BMI: 35.62 ± 4.18 kg/m2) were recruited from the Multidisciplinary Obesity Intervention Program outpatient clinic, and were submitted to a multidisciplinary lifestyle therapy (short-term = 12 weeks and long-term = 24 weeks), composed of medical, dietary, exercise and psychological programs. Validated self-report questionnaires were used to assess symptoms of anxiety Trait/State (STAI); depression (BDI); binge eating (BES), body image dissatisfaction (BSQ) and QOL (SF-36). Data were analyzed by means of scores; comparisons were made by ANOVA for repeated measures, and Tukeys test as post-hoc and Students T test.ResultsLong-term therapy decreased depression and binge eating symptoms, body image dissatisfaction, and improved QOL in girls, whereas, for boys, 24 weeks, were effective to reduce anxiety trait/state and symptoms of binge eating, and to improve means of dimensions of QOL (p < .05).ConclusionA long-term multidisciplinary lifestyle therapy is effective to control psychological aspects and to improve QOL in obese adolescents.

Prevalence and risk factors of metabolic syndrome in Brazilian and Italian obese adolescents: a comparison study

Background:  Metabolic syndrome (MS) prevalence between different populations in obese adolescents is scanty to date.

Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents

Abstract The purpose of this study was to determine whether aerobic plus resistance training (AT + RT) is more effective than aerobic training (AT) at reducing inflammatory markers and cardiovascular risk in obese adolescents. A total of 139 obese adolescents were enrolled, aged 15–19 years, body mass index (BMI) ≥ 95th percentile and participated in 1 year of interdisciplinary intervention. They were randomised into two groups: AT (n = 55), AT + RT (n = 61). Blood samples were collected to analyse glycaemia, insulin, the lipid profile, leptin and adiponectin concentrations. Insulin resistance was measured by homeostasis model assessment of insulin resistance index (HOMA-IR). The AT + RT group showed better results with regard to decreased body fat mass, low-density lipoprotein concentration (LDL-c) levels, subcutaneous and visceral fat and increased body lean mass. Indeed, a reduction of hyperleptinaemia and an increase in adiponectin concentrations, promoting an improvement in the leptin/adiponectin ratio, was observed. Important clinical parameters were improved in both types of exercise; however, AT + RT was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than AT alone, suggesting clinical applications for the control of intra-abdominal obesity and cardiovascular risk in the paediatric population.

Tratamento multidisciplinar reduz o tecido adiposo visceral, leptina, grelina e a prevalência de esteatose hepática não alcoólica (NAFLD) em adolescentes obesos

O objetivo do presente estudo foi avaliar as alteracoes promovidas, por intervencao multidisciplinar, nas concentracoes plasmaticas de grelina e leptina, adiposidade visceral e prevalencia de esteatose hepatica nao alcoolica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m2) e 12 meninos (IMC 37,08 ± 3,17kg/m2), com idade entre 15 e 19 anos, quanto a concentracao de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnostico de NAFLD pelo metodo de ultra-sonografia. Os resultados demonstraram reducao significante na concentracao circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda reducao percentual na prevalencia de NAFLD, sendo este um resultado relevante, visto que esta doenca pode progredir para cirrose, tanto em criancas quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabolico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

Multidisciplinary approach to the treatment of obese adolescents: effects on cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance.

The prevention of obesity and health concerns related to body fat is a major challenge worldwide. The aim of this study was to investigate the role of a medically supervised, multidisciplinary approach, on reduction in the prevalence of obesity related comorbidities, inflammatory profile, and neuroendocrine regulation of energy balance in a sample of obese adolescents. A total of 97 postpuberty obese adolescents were enrolled in this study. Body composition, neuropeptides, and adipokines were analysed. The metabolic syndrome was defined by the International Diabetes Federation (IDF). The abdominal ultrasonography was performed to measure visceral, subcutaneous fat and hepatic steatosis. All measures were performed at baseline and after one year of therapy. The multidisciplinary management promoted the control of obesity reducing body fat mass. The prevalence of metabolic syndrome, asthma, nonalcoholic fatty liver disease (NAFLD), binge eating, and hyperleptinemia was reduced. An improvement in the inflammatory profile was demonstrated by an increase in anti-inflammatory adiponectin and reduction in proinflammatory adipokines, plasminogen activator inhibitor-1, interleukin-6 concentrations, and in the Lep/Adipo ratio. Moreover, a reduction in the AgRP and an increase in the alfa-MSH were noted. The multidisciplinary approach not only reduced obesity but also is efficacious in cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance.

Aerobic training (AT) is more effective than aerobic plus resistance training (AT+RT) to improve anorexigenic/orexigenic factors in obese adolescents.

BACKGROUND The regulation of energy balance is influenced by physical exercise. Although some studies show a stimulation of hormones related to food intake, others show that exercise provides satiety. AIM The aim of this study was to compare the effects of aerobic training (AT) and aerobic plus resistance training (AT+RT) on anorexigenic and orexigenic factors in obese adolescents undergoing interdisciplinary weight loss therapy. METHODS A total of 26 obese adolescents, aged 15-19 years with BMI≥P95 were submitted to 12 months of interdisciplinary intervention (clinical support, nutrition, psychology and physical exercise) and divided into two groups, aerobic training (AT) (n=13) or aerobic plus resistance training (AT+RT) (n=13), which were matched according to gender and body mass. Blood samples were collected to analyze orexigenic factors (AgRP, NPY, MCH) and the anorexigenic factor alpha-MSH. RESULTS The AT and AT+RT groups significantly reduced body mass, body mass index and body fat mass (kg) during the therapy. The AT group showed no significant changes in body lean mass (kg), whereas the AT+RT group showed an increase in body lean mass (kg) during the interdisciplinary intervention. There was an increase in AgRP levels (ng/ml) only in the AT+RT group after 6 months of interdisciplinary intervention compared with baseline condition. Conversely, α-MSH levels (ng/ml) increased only in the AT group after 12 months of interdisciplinary intervention compared with baseline condition. CONCLUSION Aerobic training (AT) as part of an interdisciplinary therapy is more effective than aerobic plus resistance training (AT+RT) to improve secretion of anorexigenic/orexigenic factors in obese adolescents.

Is the neck circumference an emergent predictor for inflammatory status in obese adults

Background:  Plasminogen Activator Inhibitor 1 (PAI‐1) is a prothrombotic adipokine involved in the coagulation cascade and fibrinolysis that associated with proinflammatory adipokines may increase the risk related to obesity. Anthropometric measures are commonly used in clinical practice and, currently, neck circumference (NC) has been used as a marker of cardiovascular risk that can favour inflammatory factors.