BackgroundWeight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results.MethodsFrom 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1-< 0.23, Group 3: decrease in/stable BMI z-score≥0.0-< 0.1, Group 4: increase in BMI z-score (>0.00-0.55).Results230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio.ConclusionsEven a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.

This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Berntsen, S., Mowinckel, P., Carlsen, K.-H., Carlsen, C. L., Kolsgaard, M. L. P., Joner, G., Anderssen, S. A. (2010 There is no competing or conflicts of interests.Berntsen -Active play in obese children 2 Abstract AIM: To determine whether five months of guided active play in overweight or obese children and adolescents under multi-disciplinary management for weight reduction leads to increased physical activity levels in leisure time, as well as changes in aerobic fitness and body composition. METHODS:Sixty overweight or obese children and adolescents were randomly assigned to an intervention or control group. All participants received dietary advice and were encouraged to increase physical activity level. The intervention group additionally participated in 60 minute guided active play/physical activity twice a week for 5 months. Physical activity was recorded; aerobic fitness and body composition were measured at inclusion and after cessation of intervention. RESULTS:Physical activity level during weekend days was significantly higher for the intervention group compared to the controls after five months intervention (p=0.04). The mean reduction in percentage of body fat was 1.8 (95%CI; 0.6, 3.1) % in the intervention group (p=0.04) and not significant among the controls (0.9 (-0.9, 2.7)). There was no change in aerobic fitness. CONCLUSION:Five months of guided active play was associated with increased physical activity levels during weekend days and reduced body fat, although weakly, in overweight and obese children and adolescents participating in multi-disciplinary weight reduction programmes.

The elevation of visfatin observed in children and adolescents with MetS was proportionate to number of components of MetS but was not associated with insulin resistance. The increase in visfatin may contribute to low-grade systemic inflammation associated with MetS.

MC4R mutations are not a common cause of obesity in Norway and screening of obese patients does not appear to be warranted. The results are consistent with results from previous studies.

Metabolic syndrome was found more frequently among children and adolescents with Middle Eastern and South Asian origins than Norwegians. Differences were found even after adjustment for age, sex and degree of obesity. This suggests that ethnic minorities may have an increased sensitivity to adiposity and need more aggressive prevention and treatment than their Norwegian counterparts.