The role of multicomponent therapy in the metabolic syndrome, inflammation and cardiovascular risk in obese adolescents

Abstract

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.

Effectiveness of Multidisciplinary Intervention in Obese Women with Binge Eating Disorder

“…The prevalence of physical inactivity and hypertension was also similar between the groups, as well as the severity of obesity [28,29]. After 24 weeks of BT and CBT intervention, our results indicated a 4% reduction in body weight as well as a significant improvement in almost all variables analyzed regardless of the presence of binge eating disorder.…”

Long-term effects of vitamin D supplementation in vitamin D deficient obese children participating in an integrated weight-loss programme (a double-blind placebo-controlled study) – rationale for the study design

“…Also involvement of family members, friends and acquaintances is considered to be an important determinant of a successful weight-loss intervention [1–3]. …”

“…High risk of complications associated with childhood obesity justifies early implementation of intervention programmes. Many previous studies demonstrated that the most effective form of intervention are integrated multidisciplinary weight-loss programmes, involving not only children but also their family members [1–3]. Reduction of fat mass is associated with normalization of metabolic parameters, such as inflammatory markers, lipid profile, insulin resistance and arterial blood pressure [3–6].…”

The Long-Term Impact of High Levels of Alpha-Melanocyte-Stimulating Hormone in Energy Balance Among Obese Adolescents

“…Our study, in which long-term multidisciplinary weight loss therapy was able to reduce weight and BMI, and increase the free fat mass [9, 28], brings a new perspective of how anorexigenic neuropeptide levels detection before treatment can be positive to clinical practice. This study presents some limitations: The leptin levels were not found to correlate with α-MSH levels, the small sample size post treatment, and lack of a lean control group.…”