Lifestyle Modification Improves Insulin Resistance and Carotid Intima‐Media Thickness in a Metabolically Healthy Obese Prepubescent Population

Abstract

Objectives: The aim of this study was to analyze effects of a 12-month lifestyle modification that involved a Mediterranean diet (MedDiet) and physical activity (PA) program in a population of metabolically healthy obese children (MHOCh). Methods: We included a population of MHOCh with ≤1 of the following criteria: waist circumference and blood pressure ≥90 percentile, triglycerides >150 mg/dL, high-density lipoprotein-cholesterol (HDL-c) <40 mg/dL, or impaired fasting glucose. After 12 months of intensive lifestyle modification, anthropometric measurements, glycemic and lipid profiles, adherence to the MedDiet, energy intake, PA, body composition, and carotid intima-media thickness (cIMT) were analyzed. Results: One hundred thirty-one MHOCh (70 boys and 61 girls; P = 0.65, age: 7.9 ± 1.3 years, body mass index [BMI]: 24.7 ± 3.5 kg/m2) were included. After 12 months of intervention, a significant decrease in standard deviation (SD) units of body weight (−0.5 ± 0.1; P < 0.001) and BMI (−0.5 ± 0.1; P < 0.001) were observed in the total population. A significant improvement in adherence to the MedDiet (+2 points) and a significant reduction in protein, fatty acids, total fat, and cholesterol intake in the entire population were observed. All participants did more moderate-vigorous PA, which led to a significant increase in lean and total mass and decrease in total fat. Significant improvements in the glycemic profile (insulin levels [−6.6 μIU/mL, P < 0.001] and HOMA index [−1.2, P < 0.001]) were observed. Participants with pathological cIMT values reduced this cardiovascular predictor to normal values. Conclusions: A 12-month lifestyle modification intervention involving weight loss with MedDiet and PA in MHOCh yielded improvements in MedDiet adherence, lipid intake, moderate-vigorous PA, body composition, insulin resistance, and cIMT.

Long-term metabolic fate and mortality in obesity without metabolic syndrome

“…However, converting metabolic status from unhealthy to healthy whether the subject had obesity or not, reduced CVD risk considerably [ 35 ]. Thus, one of the main conclusions from this study, namely that MetS, not body weight, is the decisive risk factor for CVD events, is in line with these earlier findings, even though improvements in the subclinical signs of atherosclerosis are reported in MHO subjects after lifestyle modification and weight loss [ 36 , 37 ]. Finally, MetS rather than obesity is related to myocardial dysfunction [ 38 ], which may party explain the higher CVD morbidity among the individuals with MetS than those without MetS.…”

Promoting Health in Pediatric Obesity: A Decade\'s Research of Physical Activity\'s Influence on Cardiometabolic Parameters

“…Preventing obesity and forming healthy habits at a young age is crucial for establishing long-term healthy behaviors. The acquisition of habits of a healthy lifestyle in childhood depends both on the individual and his or her socio-psychological environment [ 41 ].…”

“…Children with overweight or obesity are more likely to develop cardiovascular problems in the form of type 2 diabetes, hypertension, myocardial infarction, coronary heart disease, dyslipidemia, and stroke [ 35 , 36 , 46 ]. Increased overweight and obesity is associated with hepatic steatosis, a high level of cholesterol, glucose intolerance, insulin resistance, interference with the menstrual cycle, and balance disorders [ 23 , 41 , 47 ]. Children with obesity are exposed to harmful short- and long-term health effects, thus showing metabolic syndrome components, such as changes in the lipid profile of the plasma [ 17 ], hypertension, insulin resistance, and impaired glucose metabolism [ 11 , 12 , 17 , 21 ].…”

“…Children with obesity are exposed to harmful short- and long-term health effects, thus showing metabolic syndrome components, such as changes in the lipid profile of the plasma [ 17 ], hypertension, insulin resistance, and impaired glucose metabolism [ 11 , 12 , 17 , 21 ]. Furthermore, their vascular structures deteriorate, which contributes to an adverse reconstruction of the heart, resulting in an abnormal cardiovascular response [ 41 ]. Damage to the endothelium, which leads to atherosclerosis, can develop during puberty [ 45 ].…”

The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review

“…Gallardo-Escribano and colleagues investigated the role of a lifestyle program, which also included a MedDiet intervention, in a group of metabolically healthy prepubertal children with obesity. After 12 months, the population showed statistically significant improvements in the glycemic profile, since reductions in insulin levels and HOMA-IR were observed compared to baseline [ 122 ]. Blancas-Sánchez analyzed the efficacy of a nutritional intervention based on the MedDiet in comparison with a healthy standardized diet in school-aged children with obesity or overweight presenting altered HbA1c levels.…”