Long-term effects of a non-intensive weight program on body mass index and metabolic abnormalities of obese children and adolescents

International Journal of Pediatric Endocrinology

Francesco De Luca¹  Debika Nandi-Munshi²  Christopher Dunne¹  Rita Ann Kubicky¹ 

[1] St. Christopher’s Hospital for Children, Section of Endocrinology and Diabetes, 3601 A Street, Suite 3303, Philadelphia, PA, 19134, USA;Section of Endocrinology and Diabetes, St. Christopher’s Hospital for Children, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA

关键词: Insulin resistance;    Impaired glucose tolerance;    Dyslipidemia;    Weight loss;    Obesity;   

Others  :  813510
DOI  :  10.1186/1687-9856-2012-16

 received in 2011-12-20, accepted in 2012-06-08,  发布年份 2012

【 摘 要 】

Background

Previous studies have demonstrated positive effects of short-term, intensive weight-loss programs in obese children.

Objectives

We evaluated the long-term effects of a non-intensive weight management program on the BMI, glycemic measures and lipid profiles of obese youth.

Methods

Retrospective chart review of 61 obese children followed at our Weight Management Center. During visits, dietary changes and regular physical activity were recommended. Anthropometric and laboratory parameters were evaluated.

Results

At the initial visit, the mean age was 11.1 ± 2.6 years. The follow-up period was 47.3 ± 11.1 months; the number of outpatient visits per year (OV/yr) was 2.9 ± 0.9. At the end of the follow-up, the whole group exhibited decreased BMI z-score and LDL-cholesterol when compared to the initial visit. In the subset of subjects in whom OGTT was performed, 2-hour glucose and peak insulin were decreased. Compared to children with ≤ 2 OV/year, those with > 2 OV/year (3.19 ± 0.7) exhibited a significant decrease in their BMI z-score, LDL-cholesterol, 2-hour glucose, and peak insulin.

Conclusions

Our study suggests that a periodical (~ 3 OV/yr) evaluation in a non-intensive, long-term weight management program may significantly improve the degree of obesity and cardiovascular risk factors in childhood.

【 授权许可】

   
2012 Kubicky et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP, et al.: Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents: A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, With the Council on Cardiovascular Nursing. Circulation 2007, 115:1948-1967.
• [2]Weiss R, Kaufman FR: Metabolic Complications of Childhood Obesity. Diabetes Care 2008, 31(Suppl 2):S310-S316.
• [3]Franks PW, Hanson RL, Knowler W, Sievers M, Bennett PH, Looker HC: Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. N Engl J Med 2010, 362(6):485-493.
• [4]Cook S, Auinger P, Huang TTK: Growth Curves for Cardio-Metabolic Risk Factors in Children and Adolescents. J Pediatr 2009, 155(3)):S6.e15-26.
• [5]Morrison JA, Friedman LA, Wang P, Glueck CJ: Metabolic Syndrome in Childhood Predicts Adult Metabolic Syndrome and Type 2 Diabetes Mellitus 25 to 30 Years Later. J Pediatr 2008, 152:201-206.
• [6]Morrison J, et al.: Metabolic Syndrome in Childhood Predicts Adult Cardiovascular Disease 25 years Later: The Princeton Lipid Research Clinics Follow-up Study. Pediatrics 2007, 120:340-345.
• [7]Wilfley DE, Stein RI, Saelens BE, Mockus DS, Matt GE, Hayden-Wade HA, et al.: Efficacy of Maintenance Treatment Approaches for Childhood Overweight: A Randomized Controlled Trial. JAMA 2007, 298(14):1661-1672.
• [8]Savoye M, Berry D, Dziura J, Shaw M, Serrecchia J, Barbetta G, et al.: Anthroprometric and Psychosocial Changes in Obese Adolescents Enrolled in a Weight Management Program. J Am Diet Assoc 2005, 105(3)):364-369.
• [9]Berry D, Savoye M, Melkus G, Grey M: An Intervention for multiethnic obese parents and overweight children. Appl Nurs Res 2007, 20:63-71.
• [10]Savoye M, Shaw M, Dziura J, Tamborlane W, Rose P, Guandalini C, et al.: Effects of a Weight Management Program on Body Composition and Metabolic Parameters in Overweight Children: A Randomized Controlled Trial. JAMA 2007, 297(24):2697-2704.
• [11]Gately PJ, Cooke CB, Barth JH, Bewick BM, Radley D, Hill AJ: Children’s Residential Weight-Loss Programs Can Work: A Prospective Cohort Study of Short-Term Outcomes for Overweight and Obese Children. Pediatrics 2005, 116:73-77.
• [12]Goldfield GS, Raynor HA: Epstein LH Treatment of pediatric obesity. In Handbook of Obesity Treatment. Edited by Wadden TA, Stunkard AJ. Guildford Press, New York; 2002:532-555.
• [13]Weiss EC, Galuska DA, Kettel Khan L, Gillespis C, Serdula MK: Weight regain in U.S. adults who experienced substantial weight loss, 1999–2002. Am J Prev Med 2007, 33:34-40.
• [14]Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM: Meta-analysis: The effect of dietary counseling for weight loss. Ann Intern Med 2007, 147:41-50.
• [15]Jeffery RW, Hinkle LK, Carr RE, Anderson DA, Lemmon CR, Engler LB, et al.: Long-Term Maintenance of Weight Loss: Current Status. Health Psychol 1997, 19:5-16.
• [16]Perri MG, Nezu AM, Patti ET, McCann KL: Effect of length of treatment on weight loss. J Consult Clin Psychol 1989, 57:450-452.
• [17]Kuczmarski RJ, Ogden CL, Grummer-Strawn HM, Flegal KM, Guo SS, We R, et al.: CDC growth charts: United States. Advance data from vital and health statistics, no. 314. National Center for Health Statistics, Hyattsville(MD); 2000.
• [18]Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997, 20:1183-1197.
• [19]Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis Model assessment: insulin resistance and [beta]-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia 1985, 28:412-419.
• [20]Reinehr T, de Sousa G, Toschke AM, Andler W: Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention. Am J Clin Nutr 2003, 84:490-496.
• [21]Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH: Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992, 327:1350-1355.
• [22]DiPietro L, Mossberg HO, Stunkard AJ: A 40-year history of overweight children in Stockholm: life-time overweight, morbidity, and mortality. Int J Obes Relat Metab Disord 1994, 18:585-590.
• [23]Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G: Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort. Am J Clin Nutr 1998, 67:1111-1118.
• [24]Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, Caprio S: Predictors of Changes in Glucose Tolerance Status in Obese Youth. Diabetes Care 2005, 28(4):902-909.
• [25]Lee ET, Welty TK, Cowan LD, Wang W, Rhoades DA, Devereux R, et al.: Incidence of Diabetes in American Indians of Three Geographic Areas: The Strong Heart Study. Diabetes Care 2002, 25:49-54.
• [26]Gerstein HC, Santaguida P, Raina P, Morrison KM, Balion C, Hunt D, et al.: Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies. Diabetes Res Clin Pract 2007, 78(3):305-312.
• [27]Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, et al.: Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 2007, 116(2):151-157.
• [28]Sourij H, Saely CH, Schmid F, Zweiker R, Marte T, Wascher TC, et al.: Post-challenge hyperglycaemia is strongly associated with future macrovascular events and total mortality in angiographied coronary patients. Eur Heart J 2010, 31(13):1583-1590.
• [29]Pinhas-Hamiel O, Lerner-Geva L, Copperman NM, Jacobson MS: Lipid and Insulin Levels in Obese Children: Changes with Age and Puberty. Obesity 2007, 15:2825-2831.
• [30]Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, et al.: Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003, 290(17):2277-2283.
• [31]Lawlor DA, Benfield L, Logue J, Tilling K, Howe LD, Fraser A, et al.: Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence: prospective cohort study. BMJ 2010, 341:c6224.
• [32]Juonala M, Magnussen CG, Venn A, Dwyer T, Burns TL, Davis PH, et al.: Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium. Circulation 2010, 122(24):2514-2520.
• [33]Reinehr T, Kersting M, Alexy U, Andler W: Long-Term Follow-Up of Overwight Children: After Training, After a Single Consultation, and Without Treatment. J Pediatr Gastroenterol Nutr 2003, 37:72-74.
• [34]D’Hondt E, Deforche B, Gentier I, De Bourdeaudhuij I, Vaeyens R, Philippaerts , Lenoir M: A longitudinal analysis of grow motor coordination in overweight and obese children versus normal-weight peers. Int J Obes 2012.,