Geometric and Mechanical Bone Response to a Multidisciplinary Weight Loss Intervention in Adolescents With Obesity: The ADIBOX Study.

The effectiveness of structured multidisciplinary weight loss (WL) programs combining nutrition and physical activity on bone geometry and strength remains uncertain in adolescents with obesity. The study investigated the impact of a structured WL intervention on bone geometry and strength in adolescents with obesity. Thirty-one adolescents with obesity (mean [standard deviation] 13.61 [1.27] yr, body mass index Z-score 2.26 [0.30]) experienced an 8-mo WL program. A group of 23 maturation-matched controls (mean [standard deviation] 15.90 [0.43] yr, body mass index Z-score -0.12 [0.48]) were recruited for calculating Z-scores. Body composition, bone density, geometry, and mechanical properties were assessed using dual-energy X-ray absorptiometry and dual-energy X-ray absorptiometry-derived hip structural analysis. Plasma concentration of leptin, estradiol, collagen type 1 cross-linked C-telopeptide (CTx), and procollagen type 1 N-terminal propeptide were measured. Longitudinal analysis showed that adolescents with obesity reduced body weight and fat mass (total [g, %; p < 0.007]). After 8 mo, body mineral density at total body less head (Δ 3.22 [3.58] % p < 0.001) and lumbar spine (Δ 3.67 [4.04] % p < 0.001) increased. At the narrow neck (NN) of the femur, lower body mineral density (Δ -7.19 [8.79] % p < 0.001) and higher endocortical diameter and width were observed (NN endocortical diameter Δ 2.85 [0.26] %, NN width Δ 5.48 [10.84] %, respectively). An increased buckling ratio (Δ 8.24 [2.00] % p = 0.005) was also evident. Similar concentration of procollagen type 1 N-terminal propeptide and CTx was seen from baseline to 8 mo. However, at 4 mo, lower CTx levels were observed. The 8-mo WL program was associated with some positive adaptations among bone density parameters for the whole body and spine. However, bone geometry and strength estimates appeared to weaken at the NN. Clinically, the buckling ratio score at the NN was close to the fracture threshold. An "androgynous-like" adaptation was observed with bone geometry changes demonstrating periosteal expansion and endocortical resorption.

Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis.

Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship are needed. This systematic review and meta-analysis investigated the effect of obesity on bone health and assessed the effect of structured intervention in children and adolescents with obesity. Medline complete, OVID, CINAHL, EMBASE and PubMed databases were searched for studies on obesity and bone health variables up to September 2016, then an update occurred in March 2016. Search items included obesity, childhood, dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Twenty-three studies (14 cross-sectional and nine longitudinal) matched the inclusion criteria. Results from the meta-analysis (cross-sectional studies) confirmed that children and adolescents with obesity have higher bone content and density than their normal weight peers. Results from longitudinal studies remain inconclusive as only 50% of the included studies reported a positive effect of a structured intervention program on bone health. As such, the meta-analysis reported that structured intervention did not influence bone markers despite having beneficial effects on general health in youth with obesity.

Bone-adiposity cross-talk: implications for pediatric obesity. A narrative review of literature.

The rising prevalence of overweight and obesity among pediatric populations has become a major global concern. The objective of this review is to demonstrate potential interactions between the products released by fat tissue and the hormonal production of bone tissue in obese children and adolescents. Advancing the understanding of the complex interactions between adipocyte and osteocyte activities may contribute to the mechanistic understanding of the body's responses to weight loss during adolescence. This knowledge could also reveal any side effects encountered with these interventions. Currently, the concept of bone-adiposity crosstalk has not been fully elucidated, and the mechanisms remain controversial. Understanding the local interactions between the released products by fat tissue and hormones produced in bone tissue requires further investigations.

Smartphone Interventions for Weight Treatment and Behavioral Change in Pediatric Obesity: A Systematic Review.

BACKGROUND: Traditional approaches for treating or managing children and adolescents with overweight or obesity have limited effectiveness. Current advances in smartphone technology may improve the attractiveness and accessibility of weight management support for children and adolescents with overweight or obesity. This systematic review aimed to provide a comparative evaluation of the effectiveness of using smartphones in the multidisciplinary treatment of child and adolescent overweight or obesity, with a specific interest in behavior change. MATERIALS AND METHODS: The databases of Medline complete, OVID, CINAHL, EMBASE, and PubMed were searched for randomized controlled trial (RCT) studies addressing behavioral change using smartphone technology, plus nutrition and/or physical activity, to treat or manage child and adolescent obesity. RESULTS: Only two RCTs have described the effectiveness of smartphone devices in pediatric overweight or obesity treatment. Within the limitation of the two studies, electronic contact (e-contact) appeared unsuccessful in achieving weight loss. However, smartphone usage was linked to improved engagement and reduced dropout rates during important sustainability phases of these long-term interventions. CONCLUSIONS: Smartphone technologies allow users to accomplish tasks anywhere and anytime and, as such, provide researchers with additional and generationally appropriate capacities to deliver health promotion. E-contact should be used for its significant capacity to prolong engagement and decrease withdrawal during sustainability phases that follow intensive intervention for weight management in young populations. Despite increasing popularity in published protocols of weight management trials, the effectiveness of the impact of smartphone technology in pediatric programs remains equivocal.

Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal.

BACKGROUND: Peripheral quantitative computed tomography (pQCT) is an established technology that allows for the measurement of the material properties of bone. Alterations to bone architecture are associated with an increased risk of fracture. Further pQCT research is necessary to identify regions of interest that are prone to fracture risk in people with chronic diseases. The second metatarsal is a common site for the development of insufficiency fractures, and as such the aim of this study was to assess the reproducibility of a novel scanning protocol of the second metatarsal using pQCT. METHODS: Eleven embalmed cadaveric leg specimens were scanned six times; three times with and without repositioning. Each foot was positioned on a custom-designed acrylic foot plate to permit unimpeded scans of the region of interest. Sixty-six scans were obtained at 15% (distal) and 50% (mid shaft) of the second metatarsal. Voxel size and scan speed were reduced to 0.40 mm and 25 mm.sec(-1). The reference line was positioned at the most distal portion of the 2(nd) metatarsal. Repeated measurements of six key variables related to bone properties were subject to reproducibility testing. Data were log transformed and reproducibility of scans were assessed using intraclass correlation coefficients (ICC) and coefficients of variation (CV%). RESULTS: Reproducibility of the measurements without repositioning were estimated as: trabecular area (ICC 0.95; CV% 2.4), trabecular density (ICC 0.98; CV% 3.0), Strength Strain Index (SSI) - distal (ICC 0.99; CV% 5.6), cortical area (ICC 1.0; CV% 1.5), cortical density (ICC 0.99; CV% 0.1), SSI - mid shaft (ICC 1.0; CV% 2.4). Reproducibility of the measurements after repositioning were estimated as: trabecular area (ICC 0.96; CV% 2.4), trabecular density (ICC 0.98; CV% 2.8), SSI - distal (ICC 1.0; CV% 3.5), cortical area (ICC 0.99; CV%2.4), cortical density (ICC 0.98; CV% 0.8), SSI - mid shaft (ICC 0.99; CV% 3.2). CONCLUSIONS: The scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2(nd) metatarsal. This protocol extends the capabilities of pQCT to evaluate bone quality in people who may be at an increased risk of metatarsal insufficiency fractures.

Dietary Fibres and the Management of Obesity and Metabolic Syndrome: The RESOLVE Study.

OBJECTIVES: This study was performed to evaluate the long-term maintenance of nutritional changes promoted during an intensive initial intervention to induce body weight loss. The ability of these changes to predict long-term health outcomes was also examined. METHODS: Nutritional variables, body composition, and metabolic markers collected in the RESOLVE project were analyzed before and after a 3-week intensive diet-exercise intervention (Phase 1), and during a subsequent supervision under free living conditions, of 12 months (Phase 2). RESULTS: As expected, the macronutrient composition of the diet was modified to promote a negative energy balance during Phase 1. The decrease in carbohydrates imposed during this phase was maintained during Phase 2 whereas the increase in protein intake returned to baseline values at the end of the program. Dietary fiber intake was almost doubled during Phase 1 and remained significantly greater than baseline values throughout Phase 2. Moreover, fiber intake was the only nutritional variable that systematically and significantly predicted variations of health outcomes in the study. CONCLUSION: The adequacy of dietary fiber intake should be a matter of primary consideration in diet-based weight reduction programs.

Stress management in obesity during a thermal spa residential programme (ObesiStress): protocol for a randomised controlled trial study.

INTRODUCTION: Stress and obesity are two public health issues. The relationship between obesity and stress is biological through the actions of stress on the major hormones that regulate appetite (leptin and ghrelin). Many spa resorts in France specialise in the treatment of obesity, but no thermal spa currently proposes a specific programme to manage stress in obesity. The ObesiStress protocol has been designed to offer a new residential stress management programme. This thermal spa treatment of obesity implements stress management strategies as suggested by international recommendations. METHODS AND ANALYSIS: 140 overweight or obese participants with a Body Mass Index of >25 kg/m2 and aged over 18 years will be recruited. Participants will be randomised into two groups: a control group of usual practice (restrictive diet, physical activity and thermal spa treatment) and an intervention group with stress management in addition to the usual practice. In the present protocol, parameters will be measured on five occasions (at inclusion, at the beginning of the spa (day 0), at the end of the spa (day 21), and at 6 and 12 months). The study will assess the participants' heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometric profile, body composition, psychology and quality of life via the use of questionnaires and bone parameters. ETHICS AND DISSEMINATION: The ObesiStress protocol complies with the ethics guidelines for Clinical Research and has been approved by the ethics committee (CPP Sud-Est VI, Clermont-Ferrand - ANSM: 2016-A01774-47). This study aimed to highlight the efficacy of a 21-day thermal spa residential programme of stress management in obesity through objective measurements of well-being and cardiovascular morbidity. Results will be disseminated during several research conferences and articles published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03578757.

Cardiovascular risk of adipokines: a review.

Over the last two decades, the understanding of adipose tissue has undergone radical change. The perception has evolved from an inert energy storage tissue to that of an active endocrine organ. Adipose tissue releases a cluster of active molecules named adipokines. The severity of obesity-related diseases does not necessarily correlate with the extent of body fat accumulation but is closely related to body fat distribution, particularly to visceral localization. There is a distinction between the metabolic function of central obesity (visceral abdominal) and peripheral obesity (subcutaneous) in the production of adipokines. Visceral fat accumulation, linked with levels of some adipokines, induces chronic inflammation and metabolic disorders, including glucose intolerance, hyperlipidaemia, and arterial hypertension. Together, these conditions contribute to a diagnosis of metabolic syndrome, directly associated with the onset of cardiovascular disease. If it is well known that adipokines contribute to the inflammatory profile and appetite regulation, this review is novel in synthesising the current state of knowledge of the role of visceral adipose tissue and its secretion of adipokines in cardiovascular risk.

Bioelectrical impedance is an accurate method to assess body composition in obese but not severely obese adolescents.

The aim of this study was to compare total and segmental body composition results between bioimpedance analysis (BIA) and dual x-ray absorptiometry (DXA) scan and to test the reproducibility of BIA in obese adolescents. We hypothesized that BIA offers an accurate and reproducible method to assess body composition in adolescents with obesity. Whole-body and segmental body compositions were assessed by BIA (Tanita MC-780) and DXA (Hologic) among 138 (110 girls and 28 boys) obese adolescents (Tanner stage 3-5) aged 14±1.5years. The BIA analysis was replicated on 3 identical occasions in 32 participants to test the reproducibility of the methods. Whole-body fat mass percentage was significantly higher using the BIA method compared with DXA (40.6±7.8 vs 38.8±4.9%, P<.001), which represents a 4.8% overestimation of the BIA technique compared with DXA. Similarly, fat mass expressed in kilograms is overestimated by 2.8% using BIA (35.8±11.7kg) compared with the DXA measure (34.3±8.7kg) (P<.001), and fat-free mass is underestimated by -6.1% using BIA (P<.001). Except for the right arm and leg percentage of fat mass, all the segmental measures of body composition are significantly different between the 2 methods. Intraclass correlation coefficient and Lin coefficient showed great agreement and concordance between both methods in assessing whole-body composition. Intraclass correlation coefficient between the 3 BIA measures ranged from 0.99 to 1 for body weight, body fat, and fat-free mass. Bioimpedance analysis offers an acceptable and reproducible alternative to assess body composition in obese adolescents, with however a loss of correlation between BIA and DXA with increasing body fat; its validity remains uncertain for segmental analysis among obese youth.

Cross-sectional and longitudinal study protocols of the 'ADIposity and BOne metabolism: effects of eXercise-induced weight loss in obese adolescents' (ADIBOX) project.

INTRODUCTION: A need exists for sustainable and clinically effective weight management interventions, suitable for preventing well-linked chronic disease such as diabetes and cardiovascular disease and some less investigated secondary conditions such as bone alteration. The ADIposity and BOne metabolism: effects of eXercise-induced weight loss in obese adolescents (ADIBOX) protocol was designed to provide a better understanding of the interaction between adipokines and bone hormones in adolescents with obesity and how a 10-month physical activity programme may affect these interactions. METHODS AND ANALYSIS: The ADIBOX protocol combines 2 studies. The first study involves a total of 68 adolescents aged 12-16 years. This cross-sectional study will include both males and females (1:1 ratio), either living with obesity/overweight (n=34; body mass index (BMI) ≤97th centile and ≥85th centile) or normal weight (n=34; BMI<85th centile). The second study is a longitudinal study that will include 50 obese adolescent girls and track them over a period of 42 weeks. Weight loss programme will consist of a combination of physical activity and a normocaloric diet. Bone and adiposity-related measurements will be performed every 14 weeks. Both studies will assess participants' anthropometric profile, nutrition and physical activity, body composition, bone densitometry and blood markers of bone, growth and adiposity. ETHICS AND DISSEMINATION: The ADIBOX protocol complies with the ethics guidelines for clinical research and has been approved by their respective ethics committee (Australian Catholic University Committee Ethic, Australia and Hospital Sud Est 1 committee, France). Findings from this protocol are expected to clarify the possible interactions between adiposity and bone in childhood obesity and will be disseminated at several research conferences and published articles in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02626273; Pre-results.