Responsiveness on metabolic syndrome criteria and hepatic parameters after 12 weeks and 24 weeks of multidisciplinary intervention in overweight adolescents.

PURPOSE: This study aimed to evaluate the effect and individual responsiveness after 12 (12wk) and 24 weeks (24wk) of physical exercise (PE) and nutritional guidance (NG) on metabolic syndrome (MetS) criteria and hepatic parameters in overweight adolescents. METHODS: The study comprised 94 overweight adolescents, aged between 10 and 16 years old, from both sexes, allocated into groups: PE and NG (PENGG, n = 64) and control with NG (NGCG, n = 30). Variables were collected at baseline, 12wk, and 24wk. Weight, height, abdominal circumference (AC), blood pressure, and peak oxygen consumption (VO2peak), as well as insulin, triglycerides (TAG), high-density lipoprotein (HDL-c), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were evaluated. HOMA-IR and QUICKI were calculated. PE session consisted of 45 min of indoor cycling, 45 min of walking, and 20 min of stretching, three times a week. The NG consisted of three collective sessions in the first 12wk. Anova, effect size, and prevalence of responders were used for statistical analysis. RESULTS: The PENGG12wk reduced anthropometric and metabolic measurements, while increased VO2peak and HDL-c. The PEG24wk promoted anthropometric, blood pressure, metabolic, and VO2peak improvements, but participants without PE returned to pre-exercise status and presented worsening AST and ALT concentrations. Frequencies of respondents in PENGG12wk versus (vs) NGCG12wk were, respectively, AC (69.1% vs 17.6%, p < 0.01), HDL-c (87.2% vs 23.5%, p < 0.01), TAG (67.3% vs 41.7%, p = 0.05) and ALT (45.5% vs 5,9%; p = 0.003). CONCLUSION: Interventions with PE were effective to reduce MetS components in 12wk and maintenance in 24wk, showing anthropometric, metabolic, and VO2peak improvements. Higher individual responses were observed in 12wk and in 24wk, important changes in overweight adolescent's therapy. LEVEL OF EVIDENCE: Level I, evidence obtained from well-designed controlled trials randomization. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: Brazilian Registry of Clinical Trials (RBR-4v6h7b) and date of registration April 4th, 2020.

Calcium metabolism, vitamin D and bone mineral density after bariatric surgery.

SUMMARY: Lower bone mineral density, vitamin D deficiency, lower lean body mass, greater loss of excess weight, and increased bone turnover are complications found after bariatric surgery correlated in the literature with increased risk of fractures. The prevention and treatment of such complications should begin immediately after surgery. INTRODUCTION: The aims of the study were to evaluate bone mass in patients undergoing bariatric surgery by the Wittgrove technique after 1 year of the procedure and correlate it with body composition, weight loss, 25OH vitamin D levels, and markers of bone metabolism. METHODS: The operated group (OG) participated in a clinical consultation; a blood sample taken and a body composition; and bone mineral density assessment by dual energy X-ray absorptiometry (DXA). The results were compared with a control group (CG). RESULTS: Fifty-six subjects in the OG and 27 in the CG were included. The bone mineral density (BMD), after the surgery, at the lumbar spine (LS) was lower in the OG than in the CG. There was a positive correlation between total body (TB) BMD with 25OHD, body mass index (BMI), and lean mass and an inverse correlation with percentage of excess weight loss (%EWL). Vitamin D deficiency was seen in 60.41% (OG) and in 16.6% (CG). PTH was higher in the OG, with secondary hyperparathyroidism in 41.7%. In 26.5% and 14.2% of the OG, ALP and OC levels were above the reference values. In <50 years, elevated values of carboxy-terminal telopeptide (CTX) were found in 66.7% of patients. A difference was observed in the variation of CTX between 12 and 18 months when compared to over 24 months. CONCLUSIONS: Lower BMD was observed, correlated with lower lean body mass and greater loss of excess weight. Vitamin D deficiency with high prevalence of secondary hyperparathyroidism and high bone turnover was detected. The prevention of bone loss should be initiated in the first months after surgery, which is a period associated with severe muscle loss and increased bone turnover.

Exercise-induced bronchospasm in obese adolescents.

BACKGROUND: Assess the frequency and severity of exercise-induced bronchospasm (EIB) in obese adolescents. METHODS: A cross-sectional descriptive study involving 80 adolescents of both genders, aged 10-16 years-old, divided into four groups according to clinical history of asthma and/or allergic rhinitis and body mass index as follows: asthmatic obese (n = 18); asthmatic non-obese (n = 21); obese non-asthmatic (n = 26); and healthy individuals (n = 15). An exercise bronchoprovocation test was used for EIB diagnosis, considered positive when the forced expiratory volume in one second (FEV(1)) decreased > or = 15% in relation to pre-exercise FEV(1). Maximum percent fall in FEV(1) (MF%FEV(1)) and area above the curve (AAC(0-30)) were calculated to evaluate EIB severity and recovery. RESULTS: No significant difference was found in EIB frequency between asthmatic obese (50.0%) and asthmatic non-obese (38.0%) individuals or between obese non-asthmatics (11.5%) and healthy individuals (6.7%). However, the MF%FEV(1) and AAC(0-30) were significantly greater in the asthmatic obese group compared to the asthmatic non-obese (37.7% and 455 vs 24.5% and 214, p<0.03). CONCLUSIONS: Obesity did not contribute to increased EIB frequency in asthmatics and non-asthmatics. However, obesity did contribute to increased EIB severity and recovery among asthmatics.

Exercise-induced bronchospasm in obese adolescents

Background Assess the frequency and severity of exercise-induced bronchospasm (EIB) in obese adolescents. Methods A cross-sectional descriptive study involving 80 adolescents of both genders, aged 10-16 years-old, divided into four groups according to clinical history of asthma and/or allergic rhinitis and body mass index as follows: asthmatic obese (n=18); asthmatic non-obese (n=21); obese non-asthmatic (n=26); and healthy individuals (n=15). An exercise bronchoprovocation test was used for EIB diagnosis, considered positive when the forced expiratory volume in one second (FEV1) decreased ≥15% in relation to pre-exercise FEV1. Maximum percent fall in FEV1 (MF%FEV1) and area above the curve (AAC0_30) were calculated to evaluate EIB severity and recovery. Results No significant difference was found in EIB frequency between asthmatic obese (50.0%) and asthmatic non-obese (38.0%) individuals or between obese non-asthmatics (11.5%) and healthy individuals (6.7%). However, the MF%FEV1 and AAC0_30 were significantly greater in the asthmatic obese group compared to the asthmatic non-obese (37.7% and 455 vs 24.5% and 214, p<0.03). Conclusions Obesity did not contribute to increased EIB frequency in asthmatics and non-asthmatics. However, obesity did contribute to increased EIB severity and recovery among asthmatics (AU)

Effects of physical exercise and nutritional guidance on metabolic syndrome in obese adolescents / Efeito do exercício físico e da orientação nutricional na síndrome metabólica em adolescentes obesos

OBJECTIVES: To analyze the effects of physical exercise and nutritional guidance on body composition, physical fitness, lipid profile and insulin resistance among obese adolescents with and without metabolic syndrome. METHODS: Sixty-four obese adolescents (26 boys), 10-16 years of age, were divided into two groups: with metabolic syndrome (n=29) and without metabolic syndrome (n=35). They were classified as having metabolic syndrome if they met three or more criteria for age and sex according to the Adult Treatment Panel III (ATP III). Blood pressure, waist circumference, maximum oxygen uptake (VO2peak), blood glucose, blood insulin, homeostatic model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and lipid profile were assessed at baseline and after 12 weeks of intervention. Both groups participated in 12 weeks of physical education and two nutritional guidance sessions. Each physical education session consisted of 50 min indoor cycling, 50 min of walking/running and 20 min of stretching, three times a week. RESULTS: Fifty-five participants (with metabolic syndrome=25; without metabolic syndrome=30) completed the treatment. After 12 weeks, both groups showed reductions in body weight, BMI z-score, waist circumference, fat mass and triglycerides; and increases in height, HDL-C and VO2peak (p<0.05). In addition, the group with metabolic syndrome presented reduced systolic blood pressure and increased insulin sensitivity (p<0.05). The risk factors for metabolic syndrome decreased by 72 percent. CONCLUSION: Following the multidisciplinary intervention, the risk factors decreased, with improvements in physical fitness and metabolic profile. The multidisciplinary intervention was effective in reducing metabolic syndrome.

OBJETIVOS: Analisar os efeitos de exercícios físicos (EF) e orientação nutricional (ON) sobre a composição corporal, aptidão física, perfil lipídico e resistência insulínica em adolescentes obesos com e sem síndrome metabólica (SM). MÉTODOS: 64 obesos (26 meninos), com idade entre 10 a 16 anos, divididos em dois grupos: com SM (n=29) e sem SM (n=35). Utilizou-se como critério de classificação de SM a presença de três ou mais critérios para idade e sexo de acordo com Adult Treatment Panel III (ATP III). Mensuraram-se antes e após 12 semanas de intervenção: pressão arterial, circunferência abdominal, consumo máximo de oxigênio (VO2pico), glicemia, insulinemia, Homeostatic Metabolic Assessments (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) e perfil lipídico. Os dois grupos participaram de 12 semanas de EF e duas sessões de ON. Cada sessão de EF consistiu em 50 minutos de ciclismo indoor, 50 minutos de caminhada e 20 minutos de alongamento, três vezes por semana. RESULTADOS: 55 sujeitos (com SM=25; sem SM=30) completaram o tratamento. Após 12 semanas, houve diminuição na massa corporal, IMC escore-z, circunferência abdominal, massa gorda, TG e aumento na estatura, HDL-C e VO2pico, em ambos os grupos. Além disso, houve uma redução na pressão arterial sistólica, aumento na sensibilidade à insulina (p<0,05) no grupo com SM. Os fatores de risco para SM diminuíram em 72 por cento. CONCLUSÃO: Após a intervenção multidisciplinar, houve uma redução nos fatores de risco, melhorando a aptidão física e perfil metabólico. A intervenção multidisciplinar foi efetiva para redução da SM.