Cardiovascular Fitness, Insulin Resistance and Metabolic Syndrome in Severely Obese Prepubertal Italian Children

Baratto, Claudia; Grossi, Armando; Fintini, Danilo; Fiori, Rossana; Ubertini, Graziamaria; Colabianchi, Diego; Ciampalini, Paolo; Tozzi, Alberto Eugenio; Barbetti, Fabrizio; Cappa, Marco

doi:10.1159/000161865

Cited by 9 publications

(17 citation statements)

References 75 publications

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“…The difference in perceived exertion, especially in children/adolescents, has already been demonstrated in other studies . Our data, in accordance with other studies , suggest that a physically active lifestyle has beneficial effects on glucose homeostasis and insulin sensitivity.…”

Section: Discussionsupporting

confidence: 92%

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Energy expenditure and insulin sensitivity evaluation in obese children affected by hepatosteatosis

et al. 2012

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Section: Discussionsupporting

confidence: 92%

“…Very recently, NAFLD has been proposed as a component of the MetS and seems to lead to a premature atherosclerosis . It has been shown that young obese patients, with or without NAFLD, display a reduced capacity to perform physical exercise .…”

Section: Discussionmentioning

confidence: 99%

Energy expenditure and insulin sensitivity evaluation in obese children affected by hepatosteatosis

et al. 2012

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“…When comparing changes in metabolic parameters between the three groups with stable or reduced BMI z-score and the group with increased BMI z-score adjustment was made for improvement in aerobic fitness where the data was available, since cardiovascular fitness and CVD risk factors might be independently related in obese children [49]. A previously published study found that low cardiovascular fitness was strongly associated with the clustering of CVD risk factors in children independent of country, age and sex [50].…”

Section: Discussionmentioning

confidence: 99%

“…Only 102 subjects (44%) had data on aerobic fitness, and when repeating the analyzes in the 102 subject only adjusting for gender, baseline BMI z-score and waist circumference we got the same results as when aerobic fitness were included in the model. Former research has demonstrated divergent results regarding the relationship between insulin resistance and physical fitness in obese children and adolescents, and the effect of fitness on insulin may be mediated through a direct pathway and indirectly through changes in body composition [49,51]. A newly published study among 6 th grade youths concluded that both fatness and fitness are associated with cardiometabolic risk factors, but that fatness has a stronger association than fitness [52].…”

Section: Discussionmentioning

confidence: 99%

Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study - a hospital/public health nurse combined treatment

et al. 2011

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BackgroundWeight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results.MethodsFrom 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1-< 0.23, Group 3: decrease in/stable BMI z-score≥0.0-< 0.1, Group 4: increase in BMI z-score (>0.00-0.55).Results230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio.ConclusionsEven a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.

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“…It is worth noting that a total of ten studies adjusted for both fat and lean masses in their analyses [9,18,48,56,61,72,82,[93][94][95], with eight out of the ten studies still finding at least one independent association of SI with PA, CRF or strength, suggesting that additional pathways may exist independent of the amount of lean mass as well as fat mass.…”

Section: Controlling For Lean Mass As Well As Fatmentioning

confidence: 99%

Physical activity is related to insulin sensitivity in children and adolescents, independent of adiposity: a review of the literature

Berman

Weigensberg

Spruijt‐Metz

2012

Diabetes Metabolism Res

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In adults, there is evidence that physical activity effectively improves insulin sensitivity regardless of adiposity. Whether this is also the case in children and adolescents has been less clear. Whether this is also the case in children and adolescents is less clear. Clarifying this matter may help to identify the best outcomes to target in exercise programs for these age groups, where changes in adiposity may not always be desirable or realistic. A review of the literature was conducted on studies that examined the relationships of physical activity, cardiorespiratory fitness and strength with insulin sensitivity independent of adiposity in children and adolescents. Experimental (intervention) and correlational (longitudinal and cross-sectional) studies on participants ages 18 and younger were identified. A total of 42 studies were included in this review. Sample sizes in the studies ranged from 14 to 4,955 participants, with individual ages ranging from 5 to 19 years. A significant relationship with SI existed in 78% of studies on physical activity, 69% of studies on cardiorespiratory fitness and 66% of studies on strength. In studies that examined both physical activity and cardiorespiratory fitness concurrently, evidence suggests that they are both correlated with insulin sensitivity independent of adiposity, especially when physical activity is at higher intensities. However the strength of this relationship might be influenced by study design, measurement techniques and participant characteristics. This is the first review of its type to take research design into account, and to examine study outcomes according to participant ethnicity, gender, age, pubertal status and weight status.

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Cardiovascular Fitness, Insulin Resistance and Metabolic Syndrome in Severely Obese Prepubertal Italian Children

Cited by 9 publications

References 75 publications

Energy expenditure and insulin sensitivity evaluation in obese children affected by hepatosteatosis

Energy expenditure and insulin sensitivity evaluation in obese children affected by hepatosteatosis

Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study - a hospital/public health nurse combined treatment

Physical activity is related to insulin sensitivity in children and adolescents, independent of adiposity: a review of the literature

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