A randomized controlled trial on a multicomponent intervention for overweight school-aged children – Copenhagen, Denmark

BMC Pediatrics

Rikke Krogh-Madsen¹  Bente Klarlund Pedersen¹  Lars Bo Andersen²  Anders Juul³  Mathias Ried-Larsen¹  Nina Marie Birk¹  Nina Majlund Harder-Lauridsen¹ 

[1] Department of Infectious Diseases The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, the Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark;Department of Growth and Reproduction, Rigshospitalet, the Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

关键词: Insulin resistance;    Insulin;    Blood glucose;    Body mass index;    Diet counseling;    Physical activity;    Multicomponent intervention;    Randomized controlled trial;    Obesity;    Overweight children;   

Others  :  1118905
DOI  :  10.1186/1471-2431-14-273

 received in 2014-05-15, accepted in 2014-10-09,  发布年份 2014

【 摘 要 】

Background

Obesity amongst children is a growing problem worldwide. In contrast to adults, little is known on the effects of controlled weight loss on components of the metabolic syndrome in children. The primary aim of the study was to evaluate the effects of a 20-week exercise and diet guidance intervention on body mass index (BMI) in a group of overweight children. Our hypothesis was an observed reduction in BMI and secondarily in body fat content, insulin insensitivity, and other components of the metabolic syndrome in the intervention group.

Methods

School children from Copenhagen were randomly allocated to an intervention group (n = 19) or a control group (n = 19). Anthropometric assessment, whole body dual-energy X-ray absorptiometry scan, two hours oral glucose tolerance test, steps measured by pedometer, and fitness tests were measured at baseline and at 20 weeks.

Results

Thirty-seven children (30 girls) participated at baseline, aged 8.7 ± 0.9 years with a BMI of 21.8 ± 3.7 kg/m² (mean ± SD), and 36 children completed the study. The intervention group decreased their BMI (the intervention effect is the difference in change between the groups adjusted for the respective baseline values (DELTA) = -2.0 kg/m², 95% CI: -2.5; -1.5, P <0.001), total body mass (DELTA = -4.0 kg, 95% CI: -4.9; -3.0, P <0.001), and fat mass (DELTA = -3.3 kg, 95% CI: -4.2; -2.7, P <0.001) compared to the control group after the intervention. The intervention group displayed decreased waist, hip and waist-to-height ratio (WHtR) (all three variables; P <0.001), area under curve for plasma insulin (P <0.05), and increased mean and minimum steps/day (P <0.05 and P <0.01, respectively).

Conclusions

The multicomponent intervention had significant favorable effects on BMI, weight, WHtR, mean and minimum steps/day, and fat mass. In addition, similar beneficial metabolic effects were found in the children as shown in adults, e.g. increase in peripheral insulin sensitivity.

Trial registration

Clinicaltrials.gov Identifier number NCT01660789.

【 授权许可】

   
2014 Harder-Lauridsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]WORLD HEALTH ORGANIZATION: Prioritizing areas for action in the field of population-based prevention of CHILDHOOD OBESITY. 2012. Available from: http://www.who.int/dietphysicalactivity/childhood/Childhood_obesity_Tool.pdf webcite [Retrieved 29 August 2014]
• [2]Pedersen BK: Muscles and their myokines. J Exp Biol 2011, 214:337-346.
• [3]Baker JL, Olsen LW, Sorensen TI: Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007, 357:2329-2337.
• [4]Juhola J, Magnussen CG, Viikari JS, Kahonen M, Hutri-Kahonen N, Jula A, Lehtimaki T, Akerblom HK, Pietikainen M, Laitinen T, Jokinen E, Taittonen L, Raitakari OT, Juonala M: Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. J Pediatr 2011, 159:584-590.
• [5]Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S, Anderssen SA: Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet 2006, 368:299-304.
• [6]Andersen LB: Physical activity, fitness and health in children. Scand J Med Sci Sports 2011, 21:155-156.
• [7]Bays HE: “Sick fat,” metabolic disease, and atherosclerosis. Am J Med 2009, 122:S26-S37.
• [8]Tanha T, Wollmer P, Thorsson O, Karlsson MK, Linden C, Andersen LB, Dencker M: Lack of physical activity in young children is related to higher composite risk factor score for cardiovascular disease. Acta Paediatr 2011, 100:717-721.
• [9]Krogh-Madsen R, Thyfault JP, Broholm C, Mortensen OH, Olsen RH, Mounier R, Plomgaard P, Van HG, Booth FW, Pedersen BK: A 2-wk reduction of ambulatory activity attenuates peripheral insulin sensitivity. J Appl Physiol 2010, 108:1034-1040.
• [10]Berenson GS: Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa Heart Study. Am J Cardiol 2002, 90:3L-7L.
• [11]Neovius M, Rossner SM, Vagstrand K, von Hausswolff-Juhlin YL, Hoffstedt J, Ekelund U: Adiposity measures as indicators of metabolic risk factors in adolescents. Obes Facts 2009, 2:294-301.
• [12]Caballero B: The global epidemic of obesity: an overview. Epidemiol Rev 2007, 29:1-5.
• [13]Parsons TJ, Power C, Logan S, Summerbell CD: Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord 1999, 23(Suppl 8):S1-S107.
• [14]European Commission: Diabesity - a world wide challenge. 2012. Available from http://ec.europa.eu/research/health/pdf/diabesity-conference-report-022012_en.pdf webcite [Retrieved 29 August 2014]
• [15]WORLD HEALTH ORGANIZATION: The challenge of obesity in the WHO European Region and the strategies for response. 2007. Available from http://www.euro.who.int/__data/assets/pdf_file/0008/98243/E89858.pdf webcite [Retrieved 29 August 2014]
• [16]Berenson GS: Health consequences of obesity. Pediatr Blood Cancer 2012, 58:117-121.
• [17]Oude LH, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, Summerbell CD: Interventions for treating obesity in children. The Cochrane Library 2009. Available from http://share.eldoc.ub.rug.nl/FILES/root2/2009/Intefotro/Oude_Luttikhuis_2009_Cochrane.pdf webcite [Retrieved 14 October 2014].
• [18]de Silva-Sanigorski AM, Bell AC, Kremer P, Nichols M, Crellin M, Smith M, Sharp S, De GF, Carpenter L, Boak R, Robertson N, Swinburn BA: Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program. Am J Clin Nutr 2010, 91:831-840.
• [19]Romon M, Lommez A, Tafflet M, Basdevant A, Oppert JM, Bresson JL, Ducimetiere P, Charles MA, Borys JM: Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes. Public Health Nutr 2009, 12:1735-1742.
• [20]Nysom K, Molgaard C, Hutchings B, Michaelsen KF: Body mass index of 0 to 45-y-old Danes: reference values and comparison with published European reference values. Int J Obes Relat Metab Disord 2001, 25:177-184.
• [21]Ministry of Food AaFDVaFA: The Official Dietary Guidelines. 2014. Available from http://www.foedevarestyrelsen.dk/english/Nutrition/The_dietary_recommendations/Pages/default.aspx webcite [Retrieved 2 September 2014]
• [22]Cole TJ, Lobstein T: Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 2012, 7:284-294.
• [23]National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004, 114:555-576.
• [24]Andersen LB, Andersen TE, Andersen E, Anderssen SA: An intermittent running test to estimate maximal oxygen uptake: the Andersen test. J Sports Med Phys Fitness 2008, 48:434-437.
• [25]Craig ME, Hattersley A, Donaghue KC: Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr Diabetes 2009, 10(Suppl 12):3-12.
• [26]Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C: Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005, 115:e500-e503.
• [27]Wallace TM, Levy JC, Matthews DR: Use and abuse of HOMA modeling. Diabetes Care 2004, 27:1487-1495.
• [28]Matsuda M, DeFronzo RA: Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999, 22:1462-1470.
• [29]Andersson AM, Juul A, Petersen JH, Muller J, Groome NP, Skakkebaek NE: Serum inhibin B in healthy pubertal and adolescent boys: relation to age, stage of puberty, and follicle-stimulating hormone, luteinizing hormone, testosterone, and estradiol levels. J Clin Endocrinol Metab 1997, 82:3976-3981.
• [30]Sehested A, Juul AA, Andersson AM, Petersen JH, Jensen TK, Muller J, Skakkebaek NE: Serum inhibin A and inhibin B in healthy prepubertal, pubertal, and adolescent girls and adult women: relation to age, stage of puberty, menstrual cycle, follicle-stimulating hormone, luteinizing hormone, and estradiol levels. J Clin Endocrinol Metab 2000, 85:1634-1640.
• [31]Sorensen K, Aksglaede L, Petersen JH, Leffers H, Juul A: The exon 3 deleted growth hormone receptor gene is associated with small birth size and early pubertal onset in healthy boys. J Clin Endocrinol Metab 2010, 95:2819-2826.
• [32]Sorensen K, Aksglaede L, Petersen JH, Andersson AM, Juul A: Serum IGF1 and insulin levels in girls with normal and precocious puberty. Eur J Endocrinol 2012, 166:903-910.
• [33]Twisk J, Proper K: Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. J Clin Epidemiol 2004, 57:223-228.
• [34]Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001, 357:1191-1194.
• [35]Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, Karpyn A, Kumanyika S, Shults J: A policy-based school intervention to prevent overweight and obesity. Pediatrics 2008, 121:e794-e802.
• [36]Nielsen TR, Gamborg M, Fonvig CE, Kloppenborg J, Hvidt KN, Ibsen H, Holm JC: Changes in lipidemia during chronic care treatment of childhood obesity. Child Obes 2012, 8:533-541.
• [37]Allemand-Jander LD: Clinical diagnosis of metabolic and cardiovascular risks in overweight children: early development of chronic diseases in the obese child. Int J Obes (Lond) 2010, 34(Suppl 2):S32-S36.
• [38]Kissebah AH, Krakower GR: Regional adiposity and morbidity. Physiol Rev 1994, 74:761-811.
• [39]Fonvig CE, Bille DS, Chabanova E, Nielsen TR, Thomsen HS, Holm JC: Muscle fat content and abdominal adipose tissue distribution investigated by magnetic resonance spectroscopy and imaging in obese children and youths. Pediatr Rep 2012, 4:e11.
• [40]Krogh-Madsen R, Pedersen M, Solomon TP, Knudsen SH, Hansen LS, Karstoft K, Lehrskov-Schmidt L, Pedersen KK, Thomsen C, Holst JJ, Pedersen BK: Normal physical activity obliterates the deleterious effects of a high-caloric intake. J Appl Physiol 2014, 116(3):231-239.
• [41]Maher V, O’Dowd M, Carey M, Markham C, Byrne A, Hand E, Mc ID: Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors. Int J Obes (Lond) 2009, 33:136-143.
• [42]Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, Berenson GS: Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 2010, 10:73.
• [43]Yusuf S, Anand S: Body-mass index, abdominal adiposity, and cardiovascular risk. Lancet 2011, 378:226-227.
• [44]Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen CL, Lisheng L, Tanomsup S, Wangai P Jr, Razak F, Sharma AM, Anand SS: Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case–control study. Lancet 2005, 366:1640-1649.
• [45]Ding EL, Song Y, Manson JE, Hunter DJ, Lee CC, Rifai N, Buring JE, Gaziano JM, Liu S: Sex hormone-binding globulin and risk of type 2 diabetes in women and men. N Engl J Med 2009, 361:1152-1163.
• [46]Sorensen K, Aksglaede L, Munch-Andersen T, Aachmann-Andersen NJ, Petersen JH, Hilsted L, Helge JW, Juul A: Sex hormone-binding globulin levels predict insulin sensitivity, disposition index, and cardiovascular risk during puberty. Diabetes Care 2009, 32:909-914.
• [47]Agirbasli M, Agaoglu NB, Orak N, Caglioz H, Ocek T, Poci N, Salaj A, Maya S: Sex hormones and metabolic syndrome in children and adolescents. Metabolism 2009, 58:1256-1262.
• [48]Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V: School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med 2009, 37:418-427.
• [49]I’Allemand D, Wiegand S, Reinehr T, Muller J, Wabitsch M, Widhalm K, Holl R: Cardiovascular risk in 26,008 European overweight children as established by a multicenter database. Obesity (Silver Spring) 2008, 16:1672-1679.
• [50]Janssen I, Leblanc AG: Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 2010, 7:40. BioMed Central Full Text
• [51]Lara-Castro C, Garvey WT: Intracellular lipid accumulation in liver and muscle and the insulin resistance syndrome. Endocrinol Metab Clin North Am 2008, 37:841-856.
• [52]Fiuza-Luces C, Garatachea N, Berger NA, Lucia A: Exercise is the real polypill. Physiology (Bethesda ) 2013, 28:330-358.
• [53]Gesta S, Tseng YH, Kahn CR: Developmental origin of fat: tracking obesity to its source. Cell 2007, 131:242-256.
• [54]Kynde I, Heitmann BL, Bygbjerg IC, Andersen LB, Helge JW: Childhood hypo-adiponectinaemia but not hyper-leptinaemia is associated with insulin insensitivity 6 years later. Pediatr Diabetes 2010, 11:195-202.
• [55]Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343-1350.
• [56]Karstoft K, Winding K, Knudsen SH, Nielsen JS, Thomsen C, Pedersen BK, Solomon TP: The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 2013, 36:228-236.