Interdisciplinary Therapy Improves the Mediators of Inflammation and Cardiovascular Risk in Adolescents with Obesity.

Obesity is associated with inflammation and an increased risk of cardiovascular disease and premature mortality, as well as a range of other conditions. Obesity is a growing global problem, not only in adults, but also in children and adolescents. Therefore, the present study aimed to assess the effects of a one-year interdisciplinary intervention on the cardiometabolic and inflammatory profiles of adolescents with obesity. Twenty-two adolescents completed the intervention, which included clinical, nutritional, psychological and physical exercise counselling. Body composition, and metabolic, inflammatory, and cardiovascular risk biomarkers were analyzed before and after one year of intervention. Visceral and subcutaneous fat were determined ultrasonographically. The homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) equation were used to estimate insulin resistance and insulin sensitivity, respectively. A reduction in body mass, adiposity, glucose, and insulin and an improved lipid profile were observed after the therapy. Hyperleptinemia was reduced from 77.3% to 36.4%. Plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule 1 (ICAM-1), leptin, the leptin/adiponectin ratio, and the adiponectin/leptin ratio were also significantly improved. Metabolic changes were associated with a reduction in visceral fat and waist circumference, and adiponectin and the leptin/adiponectin ratio were associated with HOMA-IR. The interdisciplinary therapy promoted improvements in hyperleptinemia and metabolic, inflammatory, and cardiovascular biomarkers.

Tri-ponderal mass index as a tool for insulin resistance prediction in overweight adolescents: A cross-sectional study.

OBJECTIVE: The aims of this study were to assess the capacity of tri-ponderal mass index (TMI) to screen and predict insulin resistance (IR) in overweight Brazilian adolescents, comparing it with body mass index (BMI) predictive capacity; and to verify the IR predictive capacity of other assessment tools such as waist circumference (WC), and waist-to-height ratio (WHR). METHODS: A cross-sectional study was carried out with 217 overweight adolescents, from both sexes, between 12 and 18 y of age. The participants were classified as having IR according to a previous established cutoff point of ≤3.16. IR was determined by the homeostasis model assessment of insulin resistance. The other assessment tools were measured with standard protocols. RESULTS: There was no difference between TMI and BMI to explain the presence of IR. In girls, BMI presented a slightly better predictive capacity to explain IR than TMI. Moreover, WC was reported to be the most effective IR screening methods for girls. Receiver operating characteristic curves showed that TMI and BMI presented similar values of sensibility and specificity for boys. Nevertheless, BMI had a better sensibility and TMI had a better specificity for girls. Interestingly, WC demonstrated a strong sensibility for both sexes. CONCLUSIONS: TMI did not present a superior predictive accuracy for IR screening in overweight Brazilian adolescents when compared with BMI. TMI and BMI presented similar values of sensitivity and specificity for boys and WC a slightly superior IR predictive capacity for girls.

Effects of 2 Types of Resistance Training Models on Obese Adolescents' Body Composition, Cardiometabolic Risk, and Physical Fitness.

Magnani Branco, BH, Carvalho, IZ, Garcia de Oliveira, H, Fanhani, AP, Machado dos Santos, MC, Pestillo de Oliveira, L, Macente, SB, and Nelson, NJ. Effects of 2 types of resistance training models on obese adolescents' body composition, cardiometabolic risk, and physical fitness. J Strength Cond Res 34(9): 2672-2682, 2020-The main objective of this study was to investigate the effects of 2 types of resistance training (RT) models in conjunction with interdisciplinary interventions by other health professionals to reduce the body fat and cardiometabolic risk of obese adolescents while improving their general health-related physical fitness. The 12-week analyses involved 18 male adolescents who were split into 2 groups (weight lifting: n = 9 and functional: n = 9), with equalization according to the primary muscle group (whenever possible), the effort:pause ratio, and intensity. The results showed reductions in fat mass and body fat, as well as in waist and hip circumferences (p < 0.05) after the intervention period. However, no significant differences were observed in terms of the body mass, body mass index, neck circumference, systolic and diastolic blood pressures, and for lean mass (p > 0.05) after the respective period. Maximal isometric strength, abdominal strength resistance, flexibility, and maximal oxygen consumption all produced significant increases after the interventions (p < 0.05). There were reductions in low-density lipoproteins and triglyceride levels after the intervention period (p < 0.05). For fasting glycemia, high-density lipoproteins, and alanine aminotransferase, no differences were observed (p > 0.05). In addition, no differences were observed in rating of perceived recovery, internal training load, or caloric intake (p > 0.05). With the results presented, it is concluded that both RT methods were effective at reducing both fat mass and body fat, thus improving health-related physical fitness components and decreasing cardiometabolic risk.

Prevalence of metabolically healthy obese phenotype and associated factors in South American overweight adolescents: A cross-sectional study.

OBJECTIVE: The aim of this study was to verify the prevalence of metabolically healthy obese (MHO) phenotype and associated factors in South American adolescents who are overweight. METHODS: A cross-sectional study was carried out with 340 overweight adolescent boys and girls between 10 and 18 y of age. The participants were classified as MHO according to two definitions: absence of any metabolic syndrome component and absence of insulin resistance (IR). The MHO phenotype-associated factors analyzed were age, sex, nutritional status, waist circumference (WC), body composition, metabolic profile, and cardiorespiratory fitness. Multivariable logistic regression was used to determine predictors of MHO using odds ratios with 95% confidence intervals. RESULTS: The prevalence of MHO in South American overweight adolescents was 49.4% and 55.9% according to MS and IR criteria, respectively. Sex and WC were predictors of the MHO phenotype, considering MS classification criterion. For the IR criterion, age, WC, and triacylglycerol levels were independent predictors of MHO in adolescents. Cardiorespiratory fitness did not predict MHO phenotype in any of the criteria used. CONCLUSIONS: The prevalence of MHO in South American overweight adolescents was high and varied according to the definition used. Age, sex, WC, and triacylglycerolslevel were independent predictors of the MHO phenotype in this population.

Results From Brazil's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Very few studies have comprehensively analyzed the physical activity of children and adolescents in Brazil. The purpose of this article is to show the methodology and summarize findings from the first Brazilian Report Card on Physical Activity for Children and Youth. METHODS: Three Brazilian research institutions coordinated the activities to develop the Brazilian 2016 Report Card. The data available were collected independently and then synthesized by the Research Work Group using the grade system developed for the First Global Matrix released in 2014, which included 9 indicators of physical activity. Where possible, grades were assigned based on the percentage of children and youth meeting each indicator: A is 81% to 100%; B is 61% to 80%; C is 41% to 60%; D is 21% to 40%; F is 0% to 20%; INC is incomplete data. RESULTS: Among the 9 indicators, only 5 had sufficient data for grading. Overall Physical Activity received a C- grade, Active Transportation received a C+ grade, Sedentary Behavior received a D+ grade, and Government Strategies and Investments received a D grade. CONCLUSIONS: The low grades observed highlight the need for continued efforts aimed at improving physical activity in Brazilian children.

Effect of water- versus land-based exercise training as a component of a multidisciplinary intervention program for overweight and obese adolescents.

To compare water- versus land-based exercise programs, as part of a multidisciplinary intervention, on physical fitness and health-related quality of life in overweight and obese adolescents. A total of 151 overweight and obese adolescents (age: 13.2±1.8years) were divided into: 1) a water-based intervention (WB; n=28); 2) a land-based intervention (LB; n=57); and 3) a control group (CG; n=66). Anthropometric measures, body composition, flexibility, abdominal strength/endurance, cardiorespiratory fitness and health-related quality of life were assessed prior and by the end of a 16-week intervention. Both the water- and land-based interventions were part of a multidisciplinary program focusing on behavioral changes. Fat Mass (%) was significantly reduced in both intervention groups and a higher progression was observed in the WB group (-9.8±7.2% versus -6.1±6.2%; p<0.05 for pre-to-post changes within-groups). However, LB increased more abdominal strength than WB (69.6±165.8% versus 53.4±83.4%; p<0.05) and significantly increased social (19.7±88.8%), psychosocial (5.1±15.1%) and total score (6.3±14.8%), which was observed in neither WB nor CG. The intervention groups did not change body weight (WB: -1.7±5.3%; LB: 0.1±3.4%; p>0.05 for both groups) and increased (p<0.05) fat-free mass (WB: 4.6±4.0%; LB: 4.4±4.1%), VO2max (WB: 9.3±7.8%; LB: 11.0±13.4%), and physical dimension of quality of life (WB: 9.2±17.2%; LB: 8.9±18.0%) differently of what was observed in CG. The physical dimension improvement observed in the land-based and water-based samples was associated with decreased percentage fat mass (r=0.282 and 0.229; p<0.05). We suggest water- and land-based physical exercises within a multidisciplinary program promote similar improvements in body composition, physical fitness and health-related quality of life in overweight and obese adolescents.

Parent-proxy perception of overweight adolescents' health-related quality of life is different according to adolescent gender and age and parent gender.

UNLABELLED: This study assessed health-related quality of life (HRQoL) reported by overweight adolescents and compared to their parent-proxy perception of HRQoL, according to adolescent gender, adolescent age, and parent gender. Patients and a total of 179 adolescents aged 10 to 18 years with excess weight were evaluated for perceived HRQoL prior to beginning a weight-loss intervention, using the Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaire, estimating quality of life in the physical, emotional, social, and school domains, as well as index measures of psychosocial and overall quality of life. Parents completed the same questionnaire estimating his or her child's HRQoL. Compared to their child's self-report, parents underestimated all the domains of HRQoL except the school domain. Parents underestimated all the domains of HRQoL among boys; however, they only underestimated the physical domain among girls. Comparisons between parent-proxy perception and self-report of the adolescent according to adolescent's age revealed that parents underestimated their children's HRQoL in the younger adolescents (10 to 13 years) for all except for the school domain and underestimated only the physical domain in older adolescents (14 to 18 years). The same comparison between parent-proxy perception and their child's self-report of HRQoL according to parent gender showed that mothers underestimated HRQoL in all domains except for the school domain, while fathers only underestimated the school domain. CONCLUSION: The differences between self-report of overweight adolescent and perceptions of their parents about the HRQoL of their children are influenced by adolescent gender and age and parent gender.

Multidisciplinary therapy reduces risk factors for metabolic syndrome in obese adolescents.

This study aims to assess the effects of a 16-week multidisciplinary program of obesity treatment on the control of metabolic syndrome (MS) and dyslipidemia in obese adolescents. Eighty-six adolescents aged 10-18 years were allocated in either the intervention group (IG; n = 44) or control group (CG; n = 42). IG was submitted to a multidisciplinary intervention based on cognitive behavioral therapy that aimed to modify eating habits and exercise behavior. We analyzed, before and after the intervention period, anthropometric parameters, body composition, bone mineral density, cardiorespiratory fitness, blood pressure, glucose, insulin, and lipid profile of the subjects. MS was classified according to International Diabetes Federation (2007) and the presence of dyslipidemia according to Back et al. (Arq Bras Cardiol 85:4-36, 2005). In the beginning of the intervention, the median number (range) of risk factors for MS present was 2.0 (0.0-5.0) in the IG and 2.0 (0.0-4.0) in the CG. After the intervention, this parameter reduced significantly in the IG (1.0 (0.0-5.0); p = 0.004) while no change was observed in the CG (2.0 (0.0-4.0); p = 0.349). In addition, we observed improvements in body mass index, waist circumference, hip circumference, maximal oxygen uptake, absolute and relative body fat, systolic blood pressure, diastolic blood pressure, and total cholesterol in the IG which was not identified in the CG. Conclusio n: We suggest that a 16-week multidisciplinary intervention based on cognitive behavioral therapy was adequate to reduce risk factors for MS in obese adolescents.