Obesity is characterised by low-grade inflammation, which increases the metabolic syndrome (MetS) and cardiovascular risks. The aim of the present study was to verify the role of multicomponent therapy in controlling the MetS, inflammation and carotid intima-media thickness (cIMT) in obese adolescents. The second aim was to investigate the relationships between adipokines, the MetS parameters and cIMT. A total of sixty-nine obese adolescents participated in the present study and completed 1 year of multicomponent therapy (a combination of strategies involving nutrition, psychology, physical exercise and clinical therapy), and were divided according to their MetS diagnosis as follows: MetS (n 19); non-MetS (n 50). Blood analyses of glucose, lipid and adipokine concentrations (adiponectin, leptin, plasminogen activator inhibitor 1 (PAI-1) and C-reactive protein) were collected. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index and homeostasis model assessment-adiponectin. cIMT and visceral and subcutaneous fat were estimated using ultrasonography. At baseline, the MetS group presented higher waist circumference, glucose and insulin levels, and systolic and median blood pressures compared with the non-MetS group. After therapy, both groups showed improvements in the anthropometric profile, body composition, insulin level, insulin resistance, insulin sensibility, TAG and VLDL-cholesterol, adiponectin, leptin and PAI-1 levels, blood pressure and cIMT. The prevalence of the MetS was reduced from 27·5 to 13·0 %. Metabolic syndrome patients showed resistance in the attenuation of total cholesterol and LDL-cholesterol (LDL-C) levels and leptin:adiponectin and adiponectin:leptin ratios. In the MetS group, the variation in the adiponectin:leptin ratio was correlated with variations in glucose, insulin sensibility, total cholesterol, LDL-c and systolic blood pressure. Additionally, the number of MetS parameters was correlated with the carotid measurement. Moreover, the variation in cIMT was correlated with the variations in insulin sensibility, total cholesterol and LDL-c. For the entire group, the number of MetS alterations was correlated with the leptin level and leptin:adiponectin ratio and adiponectin:leptin ratio after therapy. In conclusion, multicomponent therapy was effective in controlling the MetS, inflammation and cIMT in the obese adolescents. However, the MetS patients showed resistance in the attenuation of the atherogenic lipid profile and leptin:adiponectin ratio and adiponectin:leptin ratio. These results suggest that the MetS patients have increased cardiovascular risks, and that it is important to attempt to control the inflammatory process that occurs due to obesity in clinical practice in order to improve the health of adolescents.

Obese adolescents with moderate and high reduction in SFA presented improvements on pro/anti-inflammatory biomarkers and cIMT, leading to reduction in cardiovascular risks.

Participants in the present study appeared to develop a healthier dietary pattern by 6 mo after RYGB. These results show that a healthier dietary pattern is associated with a significant improvement of metabolic profile and weight loss.

Several studies have sought to clarify the association between adolescent obesity and psychological distress. Recently, a biological link between leptin resistance and depression has been proposed. The aim of the present study was to examine changes in leptin concentrations as a potential predictor of reduced depression symptoms in obese adolescents during long-term interdisciplinary weight loss therapy. Seventy-five obese adolescents (age: 16.28±2.37 years; BMI: 35.65±4.64 kg/m2) engaged in a long-term interdisciplinary therapy for weight loss. They were evaluated at baseline and after 1 year of treatment for body composition, serum analyses and depression symptomatology. After therapy, body mass BMI, fat mass (% and kg), waist circumference, visceral, subcutaneous and visceral/subcutaneous fat and depression symptoms decreased and lean mass (%) increased significantly. There was an improvement in inflammatory profiles with a significant reduction in leptin and increase in adiponectin. Regression analyses showed that decreased leptin predicted amelioration in depression symptoms independent of age, gender and changes in visceral fat, body mass, fat mass (%) and leptin/adiponectin ratio. These associations appear stronger in girls than boys. The attenuation of hyperleptinemia appears to play an important role in the association between weight loss and depression, particularly in obese girls.

We observed that individuals with obesity that have hyperleptinemia have higher circulating PAI-1 levels, which could indicate increased risk for cardiovascular disease. The biomarkers of inflammation and thrombosis measured in this study decreased after RYGB, suggesting that the surgery may be effective in reducing pro-inflammatory and thrombotic risk in individuals with extreme obesity.

Objective:To assess the relationship between the degree of waist circumference (WC) and nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders, analyzed according to quartiles of WC.Methods:Cross-sectional study that involved 247 obese adolescents aged 12–19 years. Mean values of the nutritional parameters and serum analyses were compared with the groups using the independent t-test. Pearson correlation coefficient was used to determine the relationship of the parameters studied. Chi-square test for trend was used to determine the relationship between the prevalence of the NAFLD and WC quartile by gender.Results:NAFLD were presented in 60% of the study participants. Obese adolescents in the 3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared with that in the 1st quartile in both genders. The NAFLD patients had significantly higher values for body weight, BMI (body mass index), BAZ-score (BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin resistance index (HOMA-IR), aspartate aminotransferase and alanine aminotransferase, when compared with non-NAFLD obese adolescents.Conclusions:In conclusion, the results presented here suggest that an increase in WC can reliably predict the risk of NAFLD in obese adolescents. This is a low cost and easy-to-use tool that can help in screening in adolescents.

Background Bariatric surgery influences the intake and absorption of nutrients, which, when associated with vomiting, can damage the oral cavity. The serum concentrations of vitamin C and myeloperoxidase (MPO) and oral clinical manifestations were examined in patients 2 years after Roux‐en‐Y gastric bypass (RYGB). Methods Clinical prospective study with control group (CG; n = 26), assessed only once, and the bariatric group (BG; n = 26), assessed in the basal period and at 12 and 24 months after surgery. The mean ages in the CG and BG were 37.8 ± 1.51 and 39.6 ± 1.93 years, respectively, and their body mass indices were 22.07 ± 0.29 and 45.62 ± 1.46 kg/m2, respectively. Results At 12 months after surgery, increased episodes of vomiting (P < .001) and dental hypersensitivity (P = .012) were observed, with a reduction in the saliva‐buffering capacity of 21.3% ± 2.9% (P = .004). At 24 months after RYGB, a significant reduction in serum vitamin C was detected (32.9% ± 5.3%, P < .001), and MPO values were higher than in the basal period (P = .032). With regard to oral hygiene habits, 92.3% of patients reported frequent tooth brushing and 96.1% used fluoride, which were similar across the 2 years. However, dental hypersensitivity (P = .048) was significantly increased than baseline. Conclusions The results demonstrated that vitamin C deficiency and increased vomiting after gastric bypass for morbid obesity may contribute to increased periodontal disease. The fact that it is impossible to determine which factor or factors (diet, poor compliance with supplementation, vomiting, poor oral hygiene) contributed to the dental problems in these patients is a shortcoming of the report.

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