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

Frontiers in Pediatrics

Nina Elvira Kienreich¹  Claudia Wojnarowski¹  Annika Stiel¹  Gregor Hoermann²  Harald Esterbauer³  Thomas Szekeres³  Georg Greiner³  Thomas Perkmann³  Oswald Wagner³  Christoph Wegscheider³  Klaus Schmetterer³  Nadine Witzeneder³  Franz Ratzinger³  Rodrig Marculescu³  Ernst Mayerhofer⁴  Irene Graf⁵  Eva Schrefl⁶  Martina Fondi⁶  Matthias Mayerhofer⁷  Stefana Holocher-Ertl⁸ 

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

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

DOI  :  10.3389/fped.2020.00052

来源: DOAJ

【 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】

Unknown