The prevention of obesity and health concerns related to body fat is a major challenge worldwide. The aim of this study was to investigate the role of a medically supervised, multidisciplinary approach, on reduction in the prevalence of obesity related comorbidities, inflammatory profile, and neuroendocrine regulation of energy balance in a sample of obese adolescents. A total of 97 postpuberty obese adolescents were enrolled in this study. Body composition, neuropeptides, and adipokines were analysed. The metabolic syndrome was defined by the International Diabetes Federation (IDF). The abdominal ultrasonography was performed to measure visceral, subcutaneous fat and hepatic steatosis. All measures were performed at baseline and after one year of therapy. The multidisciplinary management promoted the control of obesity reducing body fat mass. The prevalence of metabolic syndrome, asthma, nonalcoholic fatty liver disease (NAFLD), binge eating, and hyperleptinemia was reduced. An improvement in the inflammatory profile was demonstrated by an increase in anti-inflammatory adiponectin and reduction in proinflammatory adipokines, plasminogen activator inhibitor-1, interleukin-6 concentrations, and in the Lep/Adipo ratio. Moreover, a reduction in the AgRP and an increase in the alfa-MSH were noted. The multidisciplinary approach not only reduced obesity but also is efficacious in cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance.

The long-term interdisciplinary therapy with AT+RT protocol was more effective in significantly improving noninvasive biomarkers of NAFLD that are associated with the highest risk of disease progression in the pediatric population.

The purpose of this study was to determine whether aerobic plus resistance training (AT + RT) is more effective than aerobic training (AT) at reducing inflammatory markers and cardiovascular risk in obese adolescents. A total of 139 obese adolescents were enrolled, aged 15-19 years, body mass index (BMI) ≥ 95th percentile and participated in 1 year of interdisciplinary intervention. They were randomised into two groups: AT (n = 55), AT + RT (n = 61). Blood samples were collected to analyse glycaemia, insulin, the lipid profile, leptin and adiponectin concentrations. Insulin resistance was measured by homeostasis model assessment of insulin resistance index (HOMA-IR). The AT + RT group showed better results with regard to decreased body fat mass, low-density lipoprotein concentration (LDL-c) levels, subcutaneous and visceral fat and increased body lean mass. Indeed, a reduction of hyperleptinaemia and an increase in adiponectin concentrations, promoting an improvement in the leptin/adiponectin ratio, was observed. Important clinical parameters were improved in both types of exercise; however, AT + RT was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than AT alone, suggesting clinical applications for the control of intra-abdominal obesity and cardiovascular risk in the paediatric population.

The metabolic syndrome is an emerging clinical problem and different kinds of interventions have emphasized that healthy eating and exercise are crucial to its control. The aim of this study was to identify whether aerobic training plus resistance training (AT+RT) is more effective than AT on improving features of the metabolic syndrome and adiponectinemia in obese adolescents. A total of 30 adolescents (aged 15-19 years, body mass index !95 percentile) were enrolled in the program. All patients were diagnosed with the metabolic syndrome and submitted to 1 year of interdisciplinary intervention. They were divided into two groups: AT (n=15) and AT+RT (n=15). Blood samples were collected to analyze glycemia and lipid profiles. Adiponectin was measured by enzyme-linked immunosorbent assay, and insulin resistance was measured by homeostasis model assessment of insulin resistance index. After short-and long-term intervention, both groups presented a significant reduction in body mass, body mass index, fat mass, and visceral fat. Indeed, the AT+RT group had significantly higher changes throughout the intervention in body composition, total cholesterol, waist circumference, glucose, and adiponectin. Although important clinical parameters were ameliorated with AT, the AT+RT group showed more effective improvements in metabolic profiles and adiponectinemia. These findings suggest a clinical role of AT+RT in the control of metabolic syndrome in pediatric populations. J Clin Hypertens (Greenwich). 2011;13:343-350. Ó2010 Wiley Periodicals, Inc.Physical inactivity in adolescence strongly and independently predicts obesity and favors the development of a self-perpetuating vicious cycle of obesity and a sedentary lifestyle. Not surprisingly, physical activity should be a major target of obesity prevention in the young. 1Childhood obesity has continued to escalate despite considerable efforts to reverse the current trends. Childhood obesity represents a public health concern because overweight-obese youth experience comorbidities such as type 2 diabetes mellitus, nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, and cardiovascular disease, which are conditions that were once considered to be limited to adults. 2-4Although mounting evidence in adults has demonstrated the benefits of regular physical activity as a treatment strategy for abdominal obesity and cardiovascular risk, the specific role of aerobics combined with resistance training (RT) is unclear in adolescents with the metabolic syndrome. 2,5Several randomized controlled studies have suggested that aerobic training (AT) is a better therapeutic coadjuvant to treat youth obesity and metabolic syndrome than RT alone.6-8 However, evidence regarding the effects of AT+RT on the control of metabolic syndrome is lacking and demands further investigation.Recently, studies have demonstrated that the metabolic syndrome represented a constellation of metabolically altered parameters that could lead to a chronic inflammatory process during adolescence and adulthood.4,9...

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and it is associated with other medical conditions such as diabetes mellitus, metabolic syndrome, and obesity. The mechanisms of the underlying disease development and progression are not completely established and there is no consensus concerning the pharmacological treatment. In the gold standard treatment for NAFLD weight loss, dietary therapy, and physical activity are included. However, little scientific evidence is available on diet and/or physical activity and NAFLD specifically. Many dietary approaches such as Mediterranean and DASH diet are used for treatment of other cardiometabolic risk factors such as insulin resistance and type-2 diabetes mellitus (T2DM), but on the basis of its components their role in NAFLD has been discussed. In this review, the implications of current dietary and exercise approaches, including Brazilian and other guidelines, are discussed, with a focus on determining the optimal nonpharmacological treatment to prescribe for NAFLD.