Long-term effects of aerobic plus resistance training on the metabolic syndrome and adiponectinemia in obese adolescents.

The metabolic syndrome is an emerging clinical problem and different kinds of interventions have emphasized that healthy eating and exercise are crucial to its control. The aim of this study was to identify whether aerobic training plus resistance training (AT+RT) is more effective than AT on improving features of the metabolic syndrome and adiponectinemia in obese adolescents. A total of 30 adolescents (aged 15-19 years, body mass index ≥95 percentile) were enrolled in the program. All patients were diagnosed with the metabolic syndrome and submitted to 1 year of interdisciplinary intervention. They were divided into two groups: AT (n=15) and AT+RT (n=15). Blood samples were collected to analyze glycemia and lipid profiles. Adiponectin was measured by enzyme-linked immunosorbent assay, and insulin resistance was measured by homeostasis model assessment of insulin resistance index. After short- and long-term intervention, both groups presented a significant reduction in body mass, body mass index, fat mass, and visceral fat. Indeed, the AT+RT group had significantly higher changes throughout the intervention in body composition, total cholesterol, waist circumference, glucose, and adiponectin. Although important clinical parameters were ameliorated with AT, the AT+RT group showed more effective improvements in metabolic profiles and adiponectinemia. These findings suggest a clinical role of AT+RT in the control of metabolic syndrome in pediatric populations.

Long-term effects of metformin and lifestyle modification on nonalcoholic Fatty liver disease obese adolescents.

Objective. To assess the long-term effects of metformin in combination with lifestyle intervention and its association between insulin levels and the degree of steatosis at ultrasonography (US) in obese adolescents. Methods. Thirty-five postpubertal obese boys were randomized into two groups: one receiving metformin in combination with a multidisciplinary lifestyle intervention versus a placebo group, which also received the same intervention. The visceral, subcutaneous fat and degree of steatosis were measured by ultrasonography. Fasting blood samples were collected to analyze glucose, insulin, insulin resistance, and aminotransferases. Repeated ANOVA measures were used to compare changes over time and between groups, and Spearman's correlations were used to identify an association between insulin and the degree of steatosis at US. Results. There was a positive correlation between the degree of steatosis at US with insulin concentrations and HOMA-IR. Long-term therapy plus metformin significantly reduced body weight, body mass index, insulin, HOMA-IR, and visceral fat. Conclusions. Metformin was more effective than the placebo in improving clinical parameters associated with obesity and steatosis.

Negative correlation between neuropeptide Y/agouti-related protein concentration and adiponectinemia in nonalcoholic fatty liver disease obese adolescents submitted to a long-term interdisciplinary therapy.

The complexity pathogenesis in the nonalcoholic fatty liver disease (NAFLD) involves an interplay between adipokines and neuroendocrine regulation of energy balance, including the role of neuropeptide Y (NPY)/agouti-related protein (AgRP) system. The first aim of this study was to assess the effect of long-term interdisciplinary intervention on NAFLD in obese adolescents, and the second objective was to establish the relationship between NPY/AgRP ratio and adiponectinemia. Fifty-five postpuberty obese adolescents were submitted to interdisciplinary intervention. The group was divided between subjects with and without NAFLD (n = 19 and 36, respectively). Blood samples were collected to measure glycemia, hepatic transaminases, lipid profile, insulin resistance, and sensitivity. Adiponectin, NPY, and AgRP concentrations were measured by enzyme-linked immunosorbent assay. Food intake was measured using 3-day diet records. It was observed at baseline that important clinical parameters including body weight, body mass index, visceral fat, homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index, triglycerides, very low-density lipoprotein cholesterol, and hepatic transaminases were more altered in NAFLD patients. After the intervention, these parameters, total energy, and macronutrient intake were reduced significantly in both groups. The most important finding was the positive correlation between AgRP and visceral fat in all patients and the negative correlation between NPY/AgRP and adiponectinemia only in NAFLD obese adolescents. The NAFLD patients presented more altered clinical parameters than the non-NAFLD subjects, including the negative correlation between adiponectinemia and NPY/AgRP. These results suggested that NAFLD obese adolescents presented an inflammatory profile that can influence the neuroendocrine regulation of energy balance, suggesting an additional impairment in the weight loss therapy.