Depressive Symptoms Associated With Musculoskeletal Pain in Inactive Adults During COVID-19 Quarantine.

BACKGROUND: Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level. AIM: To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels. DESIGN: Cross-sectional study. METHODS: This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants' level of physical activity. RESULTS: Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain. CONCLUSION: During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.

Cardiovascular Effects of Aerobic Exercise With Self-Selected or Predetermined Intensity in Adolescents With Obesity.

This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid-femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = -9 mm Hg; PEI, Δ = -4 mm Hg; P < .01), central systolic BP (SEI, Δ = -4 mm Hg; PEI, Δ = -4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = -4 mm Hg; PEI, Δ = -3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid-femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.

Effects of photobiomodulation on muscle strength in post-menopausal women submitted to a resistance training program.

The aim of this study was to compare the effects of resistance training of low volume and high intensity with or without photobiomodulation (PBM) on muscle strength and functional performance in post-menopausal women. Thirty-four post-menopausal women were randomized into resistance training (RTG, n = 17) or resistance training plus PBM (PBMG, n = 17). Individuals from both groups received the same RT protocol consisting of leg-press 45°, front lat pulldown, leg curl, chest press, and squat performed in two sets of 10 repetitions with a workload of 75% of one repetition maximum (1RM), twice per week, during 8 weeks. PBMG individuals also received, prior to the exercise session, PBM through a cluster containing 7 visible diodes (630 nm) and 7 infrared diodes (850 nm) with power of 100 mW each and energy of 4 J per diode, applied to the quadriceps femoris muscle; individuals from RTG received placebo PBM prior to the sessions, applied with the same device switched off. Muscle strength (1RM; isometric dynamometer), functional performance (Time Up and Go; Berg Balance Scale; 6-min walk test), and quality of life (World Health Organization Quality of Life-Bref) were performed before and after 8 weeks. Both groups increased muscle strength (p < 0.001) for all exercises, without group differences (p = 0.651). Quality of life (p = 0.015) and balance (p = 0.006) increased only in the RTG. The results suggest that PBM were not able for inducing additional benefits to RT to improve muscle strength in post-menopausal women.

Effect of Low- Versus High-Intensity Exercise Training on Biomarkers of Inflammation and Endothelial Dysfunction in Adolescents With Obesity: A 6-Month Randomized Exercise Intervention Study.

PURPOSE: To investigate the effects of a low- versus high-intensity aerobic training on biomarkers of inflammation and endothelial dysfunction in adolescents with obesity. METHODS: Sixty-two adolescents with obesity [age = 15 (14) y, body mass index = 34.87 (4.22) kg·m-2] were randomized to receive either a high-intensity training (HIT, n = 31) or a low-intensity training (LIT, n = 31) for 24 weeks. All participants also received nutritional, psychological, and clinical counseling. Leptin, total and subtype leukocyte counts, tumor necrosis factor-alpha, interleukin-6, myeloperoxidase, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1 were obtained at baseline and after 24 weeks. RESULTS: HIT reduced neutrophils [from 4.4 (1.9) to 3.6 (1.3) µL-1 × 103; P = .01] and monocytes [from 7.2 (2.5) to 5.2 (1.8) µL-1 × 102; P < .01], but LIT increased neutrophils [from 4.5 (1.7) to 5.2 (3.3) µL-1 × 103; P = .01]. Although tumor necrosis factor-alpha increased in LIT [from 13.3 (7.5) to 17.7 (10.8) pg·mL-1; P = .01], it decreased in HIT [from 12.4 (7.5) to 11.3 (6.2) pg·mL-1; P = .01]. No changes in leukocyte counts, soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, and homeostasis assessment model for insulin resistance were observed. CONCLUSIONS: Both HIT and LIT improved the inflammatory profile. The study, however, indicated that the number of biomarkers and the magnitude of changes were higher in the HIT compared with LIT.

Aerobic training performed at ventilatory threshold improves liver enzymes and lipid profile related to non-alcoholic fatty liver disease in adolescents with obesity.

BACKGROUND: Despite the positive effects of high-intensity training on weight management and health-related outcomes, it is postulated that high-intensity training may also induce oxidative stress, increasing hepatic damage. AIM: The aim of this study was to compare the effects of low versus high-intensity training on biomarkers related to non-alcoholic fatty liver disease (NAFLD) in adolescents with obesity. METHODS: For this study 107 adolescents (15 ± 1 years) with obesity (BMI = 34.7 ± 4.1 kg/m2) were randomized into High-Intensity Training (HIT, n = 31), Low-Intensity Training (LIT, n = 31) or Control Group (CG, n = 45). Adolescents from HIT and LIT received nutritional, psychological and clinical counseling. Blood lipids, Castelli risk index, glucose, insulin and hepatic enzymes were measured at baseline and after 12 weeks. RESULTS: Castelli risk index 1 was reduced in all groups ( p < 0.001) with moderate effect size ( d) for HIT ( d = 0.62) and LIT ( d = 0.66). Castelli risk index 2 also decreased ( p < 0.001 for all groups; HIT d = 0.65; LIT d = 0.79). High-density lipoprotein increased in all groups ( d = 0.25 and d = 0.18 in HIT and LIT), while alanine aminotransferase tended to reduce ( p = 0.062) in HIT ( d = 0.34) and LIT ( d = 0.73) and aspartate aminotransferase decreased ( p = 0.024) in both HIT ( d = 0.24) and LIT ( d = 0.45). There were no changes in glucose, insulin and insulin resistance. CONCLUSION: Both high and low-intensity training improved biomarkers related to NAFLD. Thus, high-intensity training can be a safe and effective alternative to prevent and treat NAFLD in adolescents with obesity.

Rating of Perceived Exertion During Circuit Weight Training: A Concurrent Validation Study.

The aim of this study was to determine whether rating of perceived exertion (RPE) is a valid method to control the effort during the circuit weight training (CWT) in trained men. Ten men (21.3 ± 3.3 years) with previous experience in resistance training (13.1 ± 6.3 months) performed 3 sessions: 1 orientation session and 2 experimental sessions. The subjects were randomly counterbalanced to 2 experimental sessions: CWT or multiple-set resistance training (control). In both sessions, 8 exercises (bench press, leg press 45°, seated row, leg curl, triceps pulley, leg extension, biceps curl, and adductor chair) were performed with the same work: 60% of 1 repetition maximum, 24 stations (3 circuits) or 24 sets (3 sets/exercise), 10 repetitions, 1 second in the concentric and eccentric phases, and rest intervals between sets and exercise of 60 seconds. Active muscle RPEs were measured after each 3 station/sets using the OMNI-Resistance Exercise Scale (OMNI-RES). In this same time, blood lactate was collected. Compared with baseline, both levels of blood lactate and RPE increased during whole workout in both sessions, the RPE at third, 23rd, and 27th minute and the blood lactate at third, seventh, 11th, 15th, 27th, and 31st minute were higher in multiple set compared with CWT. Positive correlation between blood lactate and RPE was observed in both experimental sessions. The results indicated that the RPE is a valid method to control the effort during the CWT in trained men and can be used to manipulate the intensity without the need to perform invasive assessments.

Effect of aerobic exercise on hunger feelings and satiety regulating hormones in obese teenage girls.

Exercise is implicated in modifying subsequent energy intake (EI) through alterations in hunger and/or satiety hormones. Our aim was to examine the effects of aerobic exercise on hunger, satiety regulatory peptides, and EI in obese adolescents. Nine obese girls (age: 13-18 years old, BMI: 33.74 ± 4.04 kg/m2) participated in this randomized controlled crossover study. Each participant randomly underwent 2 experimental protocols: control (seated for 150 min) and exercise (exercised for 30 min on a treadmill performed at ventilatory threshold [VT] intensity and then remained seated for 120 min). Leptin, peptide YY(3-36) (PYY(3-36)), and subjective hunger were measured at baseline as well as 30 min and 150 min, followed by 24-hr EI measurement. Exercise session resulted in an acute increase in PYY(3-36) (p < .01) without changes in leptin and/or hunger scores. The control session increased hunger scores (p < .01) and decreased circulating leptin levels (p = .03). There was a strong effect size for carbohydrate intake (d = 2.14) and a modest effect size for protein intake (d = 0.61) after the exercise compared with the control session. Exercise performed at VT intensity in this study appears to provoke a state of transient anorexia in obese girls. These changes may be linked to an increase in circulating PYY3-36 and maintenance of leptin levels.

Screen time is negatively associated with sleep quality and duration only in insufficiently active adolescents: A Brazilian cross-sectional school-based study.

Background: Time spent on screen devices affects sleep quality and duration leading to several health impairments in youth. Although physical activity (PA) benefits sleep patterns and decreases screen time in adolescents, it is unclear whether the relationship between sleep quality/duration and screen time could be influenced by PA levels. Objective: To analyze the association between sleep quality and duration with screen time in Brazilian adolescents according PA levels. Methods: The sample included 1010 adolescents aged 13.2 ± 2.4 years (n = 556 females - 55 % of the sample). Sleep quality and sleep duration, and PA were assessed by Mini Sleep and Baecke questionnaires, respectively. Participants in the highest quartile were classified as physically active. Screen time was analyzed by the self-reported number of hours spent on different screen devices (i.e., television, computer, videogame, and cellphone/tablet). Participants in the highest tertile were classified as having high screen time. Sex, age, and body mass index were considered covariates in binary logistic regression models. Results: Poor sleep quality was observed in 52.3 % of the sample, whereas 46.6 % reported sleeping less than eight hours/day. High screen time was associated with poor sleep quality (OR = 1.45; 95 %CI = 1.01-2.12) and insufficient sleep duration (OR = 1.52; 95 %CI = 1.01-2.03) in adolescents insufficiently active. There were no associations between screen time and sleep parameters in active adolescents. Conclusion: High screen time was associated with poor sleep quality and insufficient sleep duration only in insufficiently active adolescents. These results suggest that high PA levels may contribute to improving sleep patterns in pediatric population.

Development of an Extended-Reality (XR)-Based Intervention to Treat Adolescent Obesity.

Public health policies aimed at obesity reduction are more often directed toward adults than children. This is alarming given that rates of childhood obesity have been steadily increasing, and, if not treated early, adolescents with obesity may develop comorbidities into adulthood. Lifestyle-based interventions are the cornerstone of childhood obesity treatment. Recently, extended-reality (XR)-based interventions have been incorporated into the treatment of obesity, and parents and adolescents perceive virtual reality (VR) interventions as a promising approach to increasing physical activity levels and improving eating habits. VR is a tool that fits perfectly with contemporary adolescent culture, which is radically different from that of just two generations ago. It is plausible that an XR-based intervention for treating adolescents with obesity could have a profound influence on obesity management over the long-term. An understanding of adolescents' preferences, wants, and needs must be considered in the development of new interventions. We suggest that VR interventions can provide a new approach to weight management for children and adolescents and provide recommendations to assess adolescents', caregivers', and primary care providers' needs. These needs could then be used for the development of an XR-based intervention aimed at inducing sustained lifestyle changes in adolescents with obesity.

Impact of COVID-19 pandemic on physical activity level and screen time is associated with decreased mental health in Brazillian adults: A cross-sectional epidemiological study.

The objective was to verify whether the impact of COVID-19 on physical activity and screen time was associated with the impact on quality of life and symptoms of anxiety and depression in a sample of Brazilian adults. The invitation was made through social networks and the collection was carried out through electronic research. There was a decrease in quality of life and physical activity, and an increase in symptoms of anxiety and depression and screen time. These findings are important for new strategies that promote physically active habits during the pandemic .

Anxiety is more related to inadequate eating habits in inactive than in physically active adults during COVID-19 quarantine.

BACKGROUND & AIMS: Anxiety can be related to reduced diet quality during pandemics such as COVID-19. However, it is not clear whether these relationships would be similar in inactive and physically active participants. The aim of this study was to analyze associations between anxiety and eating habits in physically active and inactive individuals during the COVID-19 pandemic. METHODS: The sample consisted of 1826 adults (58.5% women) who were invited through social media to answer an online questionnaire. The instrument included questions related to physical activity, eating habits, health behavior, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Anxiety, food habits (high food habits consumption ≥5 times per week) and physical activity (≥150 min per week) were assessed during the COVID-19 pandemic. The relationship between anxiety and eating habits according to levels of physical activity (inactive vs. active) was assessed using binary logistic regression adjusted for sex, age, education level, social isolation, and body mass index. RESULTS: Among the inactive participants, anxiety was related with high consumption of sweets (OR = 1.43; 95% CI = 1.11-1.83) and fast foods (OR = 2.23; 95% CI = 1.05-4.74) while quarantining during the COVID-19 pandemic. No relationship was observed between anxiety and food consumption among physically active participants in the final model. CONCLUSION: Anxiety was associated with less desirable eating habits among physically inactive adults during the COVID-19 pandemic.

Recreational Physical Activity Improves Adherence and Dropout in a Non-Intensive Behavioral Intervention for Adolescents With Obesity.

Purpose: The aim of this study was to compare adherence and dropout rates in adolescents with obesity participating in a behavioral-counseling intervention with or without recreational physical activity (PA). Material and methods: Seventy-four adolescents (13 to 18y, 40 girls and 34 boys) with obesity (body mass index [BMI] z-score ≥ 2.0) were randomized into a counseling group (CG; n = 37) and a counseling + recreational physical activity group (CPAG; n = 37). Adolescents from both groups received behavioral counseling once a week for 12 weeks and monthly for an additional 12 weeks. CPAG adolescents participated in supervised recreational physical activity sessions twice a week for 12 weeks. Body composition, body image dissatisfaction, symptoms of depression, binge eating, bulimia, anorexia and quality of life were assessed at baseline and after 24-weeks. Result: The dropout rate was 2.73 times higher in adolescents from CG compared to CPAG (χ2 = 4.48; p = .034; R2McF = 0.044). Girls were 2.56 times more likely to withdraw when compared to boys (χ2 = 3.86; p = .049; R2McF = 0.038). Binomial logistic regression which incorporated sex, intervention group, BMI z-score and BSQ score at baseline (R2McF = 0.177) explained 75% of the dropout rate. Both interventions were effective in reducing waist circumference (p < .01) and improving quality of life, symptoms of depression, bulimia and binge eating (p < .01). Conclusion: Incorporating a recreational physical activity component to a non-intensive behavioral intervention may be a feasible strategy to reduce dropout rates in adolescents with obesity seeking treatment.

Obesity does not modulate men's eating behavior after a high intensity interval exercise session: an exercise trial.

BACKGROUND: We investigated the impact of obesity on responses to high intensity interval exercise (HIIE) on hunger and energy intake (EI) in young men. METHODS: Ten men with obesity (OB) (Body Mass Index [BMI]: 34.6±4.4 kg/m2) and 10 with normal weight (CG) (BMI: 23.1±3.9 kg/m2) participated in a HIIE session. The session consisted of 6 rounds performed at 100% of maximum aerobic velocity (MAV) for 30 seconds, followed by 30 seconds of active recovery at 50% MAV and concluded with 4 minutes of passive recovery. This was repeated three times. EI was estimated at baseline and 24 h-post-HIIE. Hunger was measured at baseline, 2 h- and 24 h-post HIIE. RESULTS: Carbohydrate (CHO) intake increased in both groups (P<0.01). Hunger feelings (19.5 [0-50] mm at baseline to 50 [9-73] mm post-2 h and 60 [8-92] mm in post-24 h [group: P=0.71, time: P<0.01, group × time: P=0.06]) and a desire to eat (34 [1-89] ±36.0 mm at baseline to 63 [11-86] mm post-2 h and 51 [7-84] mm post-24 h [group: P=0.65, time: P<0.01, group × time: P=0.29]) increased in both groups. CONCLUSIONS: Weight status does not modulate hunger and EI post-HIIE. However, the compensatory increase in CHO intake and hunger feelings is particularly noteworthy for health professionals.

Branched-chain Amino Acids and Relationship With Inflammation in Youth With Obesity: A Randomized Controlled Intervention Study.

CONTEXT: Elevated concentrations of branched-chain amino acids (BCAA) are strong predictors of type 2 diabetes mellitus (T2DM). Their association with cardiovascular disease (CVD) remains uncertain, particularly in youth. OBJECTIVE: We investigated the role of BCAA and aromatic amino acids (AAA) in obesity, their relationships with novel biomarkers of CVD, and response to a physical activity-based lifestyle intervention (PAL-I) in a randomized controlled study in youth with normal weight (NW) and obesity (OB). METHODS: Age (14-18 years) and Tanner stage (≥IV) matched youth (OB, n = 15 and NW, n = 6) were studied; the 15 participants with OB underwent a 3-month randomized controlled PAL-I. Circulating amino acid profile, glucose, insulin, lipids, adiponectin, retinol binding protein-4, fibrinogen, high-sensitivity C-reactive protein, interleukin-6, and 25-hydroxy vitamin-D, along with body composition, were measured at baseline and after PAL-I. Independent t tests, analysis of covariance, and mixed-effect models were used for analysis of the data. RESULTS: Compared with NW, the concentration of various amino acids, including BCAA and AAA, were altered in OB (P < 0.05). BCAA and AAA showed baseline correlations with body composition and novel biomarkers of CVD, particularly inflammatory factors (all P < 0.05). The PAL-I produced only negligible effects (P > 0.05) on BCAA and AAA. Glutamine, glycine, and aspartic acid decreased with PAL-I (all P < 0.05). CONCLUSION: The novel finding of the BCAA-inflammation relationship, along with strong correlations with nontraditional biomarkers of CVD, may raise the prospect of BCAA as a biomarker of CVD and evoke a potential link between obesity, T2DM, and CVD.

Physical Activity Is Associated With Improved Eating Habits During the COVID-19 Pandemic.

The aim of this study was to analyze the association between physical activity and eating habits during the COVID-19 pandemic among Brazilian adults. A sample of 1,929 participants answered an online survey, however 1,874 were included in the analysis. The impact of the COVID-19 pandemic on eating habits was assessed inquiring about participants' intake of fruits, vegetables, fried foods, and sweets during the pandemic. Physical activity was assessed by asking participants about their weekly frequency, intensity and number of minutes/hours engaging in structured physical activities per week. Participants were then stratified into categories based on moderate-to-vigorous intensity (0-30; 31-90; 91-150; 151-300; and >300 min/week) and into active (≥150 min) or inactive (<150 min). Increased sweets consumption was the most commonly reported change to eating habits (42.5%), followed by an increase in the consumption of vegetables (26.6%), fruits (25.9%), and fried foods (17.9%). Physical activity practice was related to lower consumption of fried foods (OR = 0.60; p < 0.001) and sweets (OR = 0.53; p < 0.001). A cluster analysis revealed subjects with higher the level of physical activity was more likely to follow a healthy diet (p < 0.001). Thus, physical activity was positively associated with healthier eating habits. Health authorities must recommend regular physical as a strategy to improve overall health during the COVID-19 pandemic. Future studies should address the physical activity interventions to improve health status during a pandemic.

Reduction of Physical Activity Levels During the COVID-19 Pandemic Might Negatively Disturb Sleep Pattern.

BACKGROUND: The outbreak of novel coronavirus disease 2019 (COVID-19) has caused a global panic and public concern due to its mortality ratio and lack of treatments/vaccines. Reduced levels of physical activity have been reported during the outbreak, affecting the normal daily pattern. OBJECTIVE: To investigate (i) the relationship of physical activity level with sleep quality and (ii) the effects of reduction physical activity levels on sleep quality. METHODS: A Google form was used to address personal information, COVID-19 personal care, physical activity, and mental health of 1,907 adult volunteers. Binary logistic regression was used to verify the association of physical activity parameters and sleep quality. RESULTS: Insufficient physical activity levels were a risk factor to have disturbed sleep pattern [OR: 1.28, 95% CI (1.01-1.62)]; however, when the BMI was added to the analysis, there was no more statistical difference [OR: 1.23, 95% CI (0.96-1.57)]. On the other hand, we found that the reduction of physical activity levels was associated with negative changes in sleep quality [OR: 1.73, 95% CI (1.37-2.18)], regardless all the confounders [OR: 1.30, 95% CI (1.01-1.68)], unless when feeling of depression was added in Model 6 [OR: 1.28, 95% CI (0.99-1.66)]. CONCLUSION: Disruption in daily physical activity routine, rather than physical activity level, negatively influences sleep quality during the COVID-19 quarantine.

Aerobic Training Performed at Ventilatory Threshold Improves Psychological Outcomes in Adolescents With Obesity.

BACKGROUND: Physical activity may be as effective as some drugs for improving psychological outcomes; however, vigorous exercise may be needed for improving these outcomes in adolescents with obesity. The aim of this study is to examine the effects of low- and high-intensity training on self-esteem and symptoms of depression and anxiety in adolescents with obesity. METHODS: A total of 62 pubertal adolescents with obesity (age 15 [1.5] y, body mass index 34.87 [4.22] kg/m2) were randomized into high-intensity group (HIG, n = 31) or low-intensity group (LIG, n = 31) for 24 weeks. All participants also received nutritional, psychological, and clinical counseling. Body composition and measures of depressive symptoms, anxiety, and self-esteem were assessed at baseline and after 24 weeks. RESULTS: Depressive symptoms decreased significantly in both HIG (d = 1.16) and LIG (d = 0.45) (P ≤ .01). Trait anxiety decreased after 24 weeks for HIG (d = 0.81, P = .002) and LIG (d = 0.31, P = .002). No changes were observed in state anxiety or self-esteem. CONCLUSIONS: Results from the present study demonstrate that 24 weeks of multidisciplinary intervention improves depression and anxiety symptoms in adolescents with obesity; however, the magnitude of changes is higher in HIG compared with LIG.

Hormonal alteration in obese adolescents with eating disorder: effects of multidisciplinary therapy.

BACKGROUND/AIMS: Ghrelin and leptin play important roles in the physiopathology of eating disorders, starting generally in infancy and adolescence. The aim of this study was to evaluate the effects of multidisciplinary short-term therapy on ghrelin and leptin concentrations, bulimia nervosa symptoms, binge eating disorder symptoms, body composition, and visceral and subcutaneous fat in obese adolescents. METHODS: Twenty obese adolescents with simple obesity (BMI >95th percentile, 36.93 +/- 4.14, CDC) were submitted to multidisciplinary (nutrition, psychology, exercise and clinical) therapy. Plasma ghrelin and leptin concentrations were measured by radioimmunoassay. Bulimic and binge eating behaviors were measured by the Bulimic Investigation Test Edinburgh and the Binge Eating Scale, respectively. Visceral and subcutaneous fat were measured by ultrasonography and body composition by plethysmography. RESULTS: Significant reductions were observed in body weight (101.04 +/- 11.18 to 94.79 +/- 10.94 kg), BMI (36.93 +/- 4.14 to 34.27 +/- 4.78), fat% (41.96 +/- 6.28 to 39.14 +/- 7.62%), visceral fat (4.34 +/- 1.53 to 3.41 +/- 1.12 cm), leptin concentration (20.12 +/- 6.47 to 16.68 +/- 8.08 ng/ml), prevalence of bulimia nervosa (100 to 67%) and binge eating disorder symptoms (40 to 17%). CONCLUSION: Short-term multidisciplinary therapy was effective in improving body composition, visceral fat, leptinemia and eating disorders in obese adolescents.

Short- and long-term beneficial effects of a multidisciplinary therapy for the control of metabolic syndrome in obese adolescents.

Visceral fat is highly correlated with metabolic syndrome in obese adolescents. The aims of this study were to determine the prevalence of metabolic syndrome and to assess the effect of a long-term (1 year) intervention with multidisciplinary therapy in predicting metabolic syndrome among obese adolescents, as well as to compare short- with long-term therapy. Eighty-three postpuberty obese adolescents were recruited, including 37 boys (body mass index [BMI], 36.19 +/- 3.85 kg/m(2)) and 46 girls (BMI, 35.73 +/- 4.42 kg/m(2)). Body composition was measured by plethysmography using the BOD POD body composition system (version 1.69, Life Measurement Instruments, Concord, CA), and visceral fat was analyzed by ultrasound. Metabolic syndrome was determined according to the World Health Organization criteria. Patients were assigned to a weight loss multidisciplinary intervention consisting of nutritional, exercise, psychological, and clinical therapy. At the beginning of therapy, we found that 27.16% of the obese adolescents presented metabolic syndrome, whereas only 8.3% did so after intervention. Indeed, in boys, BMI (36.19 +/- 3.85 to 32.06 +/- 5.85 kg/m(2)), visceral fat (4.88 +/- 1.35 to 3.63 +/- 1.71 cm), homeostasis model assessment of insulin resistance (4.77 +/- 3.41 to 3.18 +/- 2.33), and percentage of body fat (38.24% +/- 6.54% to 30.02% +/- 13.43%) presented a statistically significant reduction; and their fat-free mass percentage increased (62.14% +/- 5.78% to 69.17% +/- 12.37%). In girls, after long-term therapy, BMI (35.73 +/- 4.42 to 33.62 +/- 3.78 kg/m(2)), visceral fat (3.70 +/- 1.40 to 2.75 +/- 1.01 cm), and percentage of body fat (46.10% +/- 5.66% to 39.91% +/- 5.59%) showed a statistically significant reduction; and their fat-free mass increased (53.61% +/- 5.65% to 59.82% +/- 5.78%). In conclusion, long-term multidisciplinary therapy was effective in promoting beneficial changes in some predictors and decreasing the prevalence of metabolic syndrome in obese adolescents.

Metabolic and nutritional profile of obese adolescents with nonalcoholic fatty liver disease.

BACKGROUND: The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing due to its prevalence in obesity, diabetes, and insulin-resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention can improve and prevent it. The aim of the present study was to evaluate the dietary and metabolic profiles of obese adolescents with NAFLD who participated in a multidisciplinary program. PATIENTS AND METHODS: We studied 43 adolescents ages 15 to 19 years (17.18 +/- 1.66 years) with a body mass index (BMI) > or = 30, consisting of 30 patients without NAFLD (BMI = 35.80 +/- 3.44 kg/m2) and 13 with NAFLD (BMI = 33.47 +/- 2.34 kg/m2). The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic aminotransferase levels, and lipid profiles. Insulin resistance was measured by homeostasis model assessment insulin-resistance index (HOMA-IR). The analyses of baseline and postintervention food intake were made by a 3-day inquiry. RESULTS: At baseline conditions, the patients with NAFLD showed significant differences in body mass, BMI, and visceral and subcutaneous fat. Glucose and visceral and subcutaneous fat presented a significant reduction after treatment in patients with NAFLD. Analyzing the food intake, at baseline we observed a positive correlation between the visceral obesity and lipid consumption only in patients with NAFLD. We also observed significant decrease in energy and cholesterol consumption in patients with NAFLD after the multidisciplinary therapy. CONCLUSIONS: The intervention promoted a decrease in the prevalence of NAFLD, a significant decrease in visceral obesity, and improved HOMA-IR, glycemia, and serum lipid levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.