A Multidisciplinary Intervention in Childhood Obesity Acutely Improves Insulin Resistance and Inflammatory Markers Independent From Body Composition

Frontiers in Pediatrics

article

Ernst Mayerhofer¹  Klaus Schmetterer¹  Rodrig Marculescu¹  Thomas Szekeres¹  Thomas Perkmann¹  Martina Fondi³  Oswald Wagner¹  Harald Esterbauer¹  Matthias Mayerhofer⁴  Stefana Holocher-Ertl⁵  Claudia Wojnarowski⁶  Franz Ratzinger¹  Gregor Hoermann¹  Nina Elvira Kienreich⁶  Annika Stiel⁶  Nadine Witzeneder¹  Eva Schrefl¹  Georg Greiner¹  Christoph Wegscheider¹  Irene Graf¹ 

[1] Department of Laboratory Medicine, Medical University of Vienna;Department of Neurology and Neurophysiology, Medical Center, University of Freiburg;University of Applied Sciences;Ludwig Boltzmann Institute of Osteology, Hanusch Hospital;Psychology Institute of the University Outpatient Department for Children and Adolescents, Sigmund Freud Private University;Austrian Social Health Insurance Fund;Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck;Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna

关键词: childhood obesity;    insulin resistance;    inflammation;    BMI;    HOMA-IR;    adipokines;   

DOI  :  10.3389/fped.2020.00052

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY