Effects of a Family-Based Lifestyle Intervention Plus Supervised Exercise Training on Abdominal Fat Depots in Children With Overweight or Obesity

Abstract

ImportanceExcess abdominal fat is a major determinant in the development of insulin resistance and other metabolic disorders. Increased visceral adipose tissue (VAT) seems to precede the development of insulin resistance and is therefore a prime target of childhood lifestyle interventions aimed at preventing diabetes.ObjectivesTo examine the effect of added exercise to a family-based lifestyle intervention program designed to reduce VAT plus subcutaneous (ASAT), intermuscular (IMAAT), and pancreatic (PAT) adipose tissue in children with overweight or obesity and to explore the effect of changes in VAT on insulin resistance.Design, Setting, and ParticipantsThis 2-group, parallel-design clinical trial was conducted in Vitoria-Gasteiz, Spain. A total of 116 children with overweight or obesity participated and were assigned to a 22-week family-based lifestyle program (control group [n = 57]) or the same program plus an exercise intervention (exercise group [n = 59]). Data were collected between September 1, 2014, and June 30, 2017, and imaging processing for fat depot assessments and data analysis were performed between May 1, 2019, and February 12, 2021.InterventionsThe compared interventions consisted of a family-based lifestyle and psychoeducation program (two 90-minute sessions per month) and the same program plus supervised exercise (three 90-minute sessions per week).Main Outcomes and MeasuresThe primary outcome of this study was the change in VAT between baseline and 22 weeks as estimated by magnetic resonance imaging. The secondary outcomes were changes in ASAT, IMAAT, and PAT. The effect of changes in VAT area on insulin resistance was also recorded.ResultsThe 116 participants included in the analysis (62 girls [53.4%]) had a mean (SD) age of 10.6 (1.1) years, and 67 (57.8%) presented with obesity. Significantly greater reductions were recorded for the exercise group in terms of reduction in VAT (−18.1% vs −8.5% for the control group; P = .004), ASAT (−9.9% vs −3.0%; P = .001), and IMAAT (−6.0% vs −2.6%; P = .02) fat fractions compared with the control group. Changes in VAT explained 87.6% of the improvement seen in insulin resistance (β = −0.102 [95% CI, −0.230 to −0.002]).Conclusions and RelevanceThese findings suggest that the addition of exercise to a lifestyle intervention program substantially enhanced the positive effects on abdominal fat depots in children with overweight or obesity. In addition, the reduction in VAT seemed to largely mediate the improvement of insulin sensitivity. These results highlight the importance of including exercise as part of lifestyle therapies aimed at treating childhood obesity and preventing the development of type 2 diabetes.Trial RegistrationClinicalTrials.gov Identifier: NCT02258126

Medical imaging in the assessment of cardiovascular disease risk

“…Recent studies show that several ectopic adipose tissue depots are sensitive to lifestyle interventions focused on dietary habits and/or exercise. Moreover, the reduction of selective adipose tissue depositions may mediate the improvement of cardiometabolic disturbances regardless of body mass loss [11 ▪ ,12]. These findings show the importance of accurately measuring adipose tissue distribution.…”

“…Moreover, because of its high accuracy and reliability, MRI can be used to measure the relatively small changes that may occur during longitudinal and interventional studies (e.g. lifestyle or pharmacological interventions) [11 ▪ ,12,19].…”

“…It is well known that VAT, assessed either by CT or MRI, is a representative marker of CVD and all-cause mortality [1 ▪▪ ]. Moreover, previous studies have shown that abdominal cavity ectopic depots are largely heterogeneous and are associated in a different manner with CVD and cardiometabolic risk factors [11 ▪ ,12]. Previous literature has suggested that elevated accumulation of VAT is associated with CVD and metabolic disorders regardless the amount of SAT and/or whole-body adipose tissue accumulation [1 ▪▪ ,2].…”

Differences in specific abdominal fat depots between metabolically healthy and unhealthy children with overweight/obesity: The role of cardiorespiratory fitness

“…The mean value obtained of each adiposity measure was calculated and used for analyses. An extended information can be found elsewhere 10,29,30 …”

Ginsenoside Rb1 Interfered with Macrophage Activation by Activating PPARγ to Inhibit Insulin Resistance in Obesity

“…Obesity is a pathological phenomenon in which lipids accumulate in the body and is also the main factor inducing IR. Adipose tissue (AT) is generally regarded as a lipid storage organ, and visceral adipose tissue plays a more important role in endocrine regulation [ 4 ]. Adipose tissue regions usually contain mature adipocytes, stem cells, other stromal cells, and reactive immune cells, such as macrophages [ 5 ].…”