P2304Effects of weight management intervention on cardiometabolic risk factors in children and adolescents with obesity

Abstract

Aim: To evaluate the hypothesis that a 1-year long weight management program could influence cardiometabolic risk factors in children and adolescents with obesity. Methods: The prospective clinical intervention study included 123 children and adolescents with obesity (body mass index (BMI) ≥2 standard deviations above the WHO Growth Reference median). The median of initial age - 13,2 years old, girls - 61%. Anthropometric and body composition (bioelectrical impedance analysis), clinical, laboratory, instrumental measurements were performed. Resting metabolic rate was measured by indirect calorimetry. We examined changes in body mass index (BMI), waist circumference, percentage body fat and fat free mass, systolic and diastolic blood pressure, lipids, glucose, HOMA-IR and Matsuda index, aspartate transaminase (AST), alanine transaminase (ALT), OGTT, features of dyslipidemia (DLP), hypertension, metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD) between baseline and 1-year follow-up. Weight management intervention: The 1st stage - 2-weeks in a specialized inpatient nutrition department (1600-1700 kcal) and individual aerobic exercisetraining program, the 2nd stage - regular visits to outpatient department, dietary, lifestyle and behavioral counseling for adolescents and their parents, targeting a isocaloric diet and increased daily physical activity. Weight stabilization was diagnosed when dynamic of body weight from initial was less than 0,05 BMI standard deviation score (SDS) (1st group, n=19), reduction/increase of weight were diagnosed when there were a decrease/increase of weight more than 0,05 SDS BMI (2nd (n=57) and 3rd groups 3 (n=47)). Results: In one year, 46% of pts had weight reduction, 38% had weight gain and 16% had body weight stabilization. There was a reduction of percentage of fat mass; AST, ALT, HOMA-IR, Matsuda index, postprandial glucose and increase of high-density lipoprotein in total group (p<0.01). With repeated testing we found that some pts had changes in blood pressure, MS and DLP classifications. There was a reduction of features of DLP (from 69 to 45%), impaired glucose tolerance (25 to 14%), NAFLD (64 to 48%), pre- and hypertension (43 to 30%), and MS (IDF, 2007) (25 to 14%) in total group (p<0.05). There was a reduction of rate of NAFLD with reduction of liver density (transient elastography) in all three groups, and reduction of features of MS and hypertension only in weight reduction group (p<0.01). Conclusion: In children and adolescents, long-term weight reduction interventions that include a diet component, exercises, behavior changes and parental support could be effective in reduction of cardiometabolic risk factors. Weight loss was the best predictor for improvement of cardiometabolic profile, but beneficial effects were also observed in total group and body weight stabilization group.