Triglyceride/glucose index is a reliable alternative marker for insulin resistance in South American overweight and obese children and adolescents.

Background The aim of the present study was to investigate the correlation between the triglyceride/glucose index (TyG index) and homeostasis model assessment of insulin resistance (HOMA-IR). Additionally, we compared the ability of the TyG index and triglycerides/high-density lipoprotein cholesterol (TG/HDL-c) index and the combination of these two indices (TyG index plus TG/HDL-c) to predict insulin resistance (IR) in South American overweight and obese children and adolescents. Methods A cross-sectional study was carried out in 345 overweight adolescents aged 10-18 years, from both the sexes. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL])/2, while the TG/HDL-c index was calculated by the division of TG (mg/dL) by HDL-c (mg/dL). HOMA-IR was calculated with the formula: fasting insulin (FI) (U/mL) × fasting glucose (mmol/L)/22.5. The cut-off point used to determine the presence of IR was HOMA-IR ≥ 3.16. Results The TyG index showed a positive correlation with HOMA-IR. The area under the receiver operating characteristic (ROC) curve of the TyG index was 0.74, indicating good sensitivity (75.7%) and specificity (67.4%). Furthermore, the TyG index cut-off point of >4.44 was established for IR prediction in this population. Conclusions The TyG index is a simple and cost-effective surrogate marker of IR in South American overweight children and adolescents. Moreover, due to its good accessibility, it can be used in large epidemiological studies.

Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits.

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive. CONCLUSIONS: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.

Intervenção multiprofissional melhora a aptidão física relacionada à saúde de adolescentes com maior efeito sobre as meninas em comparação aos meninos / Multiprofessional intervention improves health-related physical fitness in adolescents with greater effect on girls compared to boys

Resumo Este estudo teve como objetivo verificar as diferenças entre as respostas de meninos e meninas a um programa multiprofissional de tratamento da obesidade sobre a aptidão física relacionada à saúde. Fizeram parte do estudo 163 adolescentes com excesso de massa corporal e idade entre 10 e 18 anos. Foram avaliados parâmetros antropométricos, composição corporal, flexibilidade, força e resistência abdominal e aptidão cardiorrespiratória antes e após 16 semanas de intervenção multiprofissional. A intervenção multiprofissional contou com a participação de profissionais de educação física, nutrição, psicologia e pediatria e teve como foco principal o incentivo a mudanças nos hábitos alimentares e de atividade física que pudessem promover alterações positivas nos parâmetros analisados. A intervenção teve frequência semanal de três sessões, sendo uma hora de intervenções teóricas com os profissionais de educação física, nutrição e psicologia e a outra hora destinada à prática regular de exercícios físicos, com predominância de exercícios físicos resistidos, aeróbios e prática de basquetebol. Após a intervenção tanto as meninas quanto os meninos apresentaram melhoras significativas nas variáveis IMC, circunferência de cintura e quadril, massa gorda relativa e absoluta, massa magra, flexibilidade, força/resistência abdominal e aptidão cardiorrespiratória, porém com resultados mais expressivos para as meninas sobre a circunferência de cintura, gordura corporal (kg), VO2max e força/resistência abdominal.(AU)

Abstract This study aimed to verify the differences between both boys and girls responses to a multidisciplinary program of obesity treatment on health-related physical fitness. One hundred and sixty three adolescents with excess body weight and aged 10 to 18 years took part in the present study. It was assessed anthropometric parameters, body composition, flexibility, abdominal strength/resistance and cardiorespiratory fitness before and after 16 weeks of a multiprofessional intervention. The multiprofessional intervention was developed by physical educators, nutritionist, psychologist, pediatrician and was focused on motivate eating and exercise changes which could promote positive changes on the parameters analyzed. The intervention was conducted three times per week in which theoretical intervention lasted one hour with physical educators, nutritionist and psychologist and another hour designated to practical interventions of the physical educators in which predominated resistance and aerobic exercise as well as basketball practice. After the intervention, both girls and boys presented significant improvements in BMI, waist and hip circumference, relative and absolute body fat, lean mass, flexibility, strength and resistance in abdominal and cardiorespiratory fitness; however the results were more expressive for girls on waist circumference, body fat (kg), VO2max and abdominal strength/resistance.(AU)

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.

Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents.

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention.

[Physical, clinical, and psychosocial parameters of adolescents with different degrees of excess weight]. / Parâmetros físicos, clínicos e psicossociais de adolescentes com diferentes graus de excesso de peso.

OBJECTIVE: To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity. METHODS: 220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study. This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05. RESULTS: There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weight increased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately. CONCLUSION: Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed.

Physical, clinical, and psychosocial parameters of adolescents with different degrees of excess weight / Parâmetros físicos, clínicos e psicossociais de adolescentes com diferentes graus de excesso de peso

OBJECTIVE: To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity. METHODS: 220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study . This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05. RESULTS: There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weightincreased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately. CONCLUSION: Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed...

OBJETIVO: Comparar composição corporal, parâmetros hemodinâmicos, aptidão física relacionada à saúde e qualidade de vida relacionada à saúde em adolescentes com o diagnóstico antropométrico de sobrepeso, obesidade e obesidade grave. MÉTODOS: Foram selecionados 220 adolescentes com excesso de peso, ingressantes em um programa de intervenção segundo os critérios de inclusão neste programa, baseados na idade, disponibilidade, presença de excesso de peso, local de residência e concordância na participação do estudo. Foram coletadas variáveis antropométricas, hemodinâmicas, aptidão física relacionada à saúde e qualidade de vida relacionada à saúde dos adolescentes. Para a análise de comparação entre os três grupos, foram utilizados testes paramétricos e não paramétricos quando apropriado. A significância foi pré-estabelecido em p<0,05. RESULTADOS: Não houve diferença significativa para a frequência cardíaca de repouso, aptidão física relacionada à saúde, gordura relativa, massa magra (relativa e absoluta) e qualidade de vida relacionada à saúde entre adolescentes com sobrepeso, obesos e obesos graves (p>0,05). O peso, índice de massa corporal, circunferência de cintura e de quadril e pressão arterial sistólica aumentaram conforme aumentou o grau de excesso de peso (p<0,05). A pressão arterial diastólica do grupo com obesidade grave foi maior que a dos demais grupos (p<0,05). Observou-se associação entre o aumento grau de excesso de peso e a prevalência de pressão arterial alterada (sobrepeso: 12,1%; obesidade: 28,1%; obesidade grave: 45,5%; p<0,001). Os resultados foram semelhantes quando os sexos foram analisados separadamente...

Parasympathetic cardiac activity is associated with cardiorespiratory fitness in overweight and obese adolescents.

The aim of this study was to investigate the association between cardiac parasympathetic activity and cardiorespiratory fitness, insulin, and hemodynamic profile in overweight and obese adolescent girls and boys (aged 12-16 years). Data were taken from the Multidisciplinary Obesity Treatment Program. Only post-intervention measurements are presented herein. Body composition, cardiorespiratory fitness, blood pressure, and metabolic profile (insulin and glucose profile) of adolescents were assessed. Cardiac parasympathetic activity was determined by resting heart rate variability, which was analyzed using a heart rate monitor. Greater parasympathetic cardiac activity was associated with higher levels of cardiorespiratory fitness in both girls and boys (0.375 ≤ r ≤ 0.900), while the sympathetic-vagal balance was negatively related to maximal oxygen uptake (VO2max) in girls (r = 0.478). An association between lower parasympathetic activity and insulin resistance was noted in girls (mean of R-R intervals [RRmean] and homeostasis model assessment insulin-resistance index [HOMA-IR]: r = -0.678), while greater systolic blood pressure (SBP) and lower parasympathetic activity were associated in both sexes (RRmean and SBP: r = -0.526; high frequency [HF (nu)] and SBP: r = -0.754). In conclusion, autonomic nervous system activity was associated with cardiorespiratory fitness, insulin resistance, and SBP in overweight and obese adolescents. The identification of these potential relationships assists with the establishment of future long-term exercise interventions that evaluate the improvements in parasympathetic nervous system activity, in addition to metabolic profile and cardiorespiratory fitness in overweight and obese adolescents.