Division of Psychology, Nemours Children's Specialty Care, Jacksonville, Florida, USA.
Nemours Biostatistics Core, Alfred I duPont Hospital for Children, Wilmington, Delaware, USA.
Metab Syndr Relat Disord. 2021 Jun;19(5):264-271. doi: 10.1089/met.2020.0097. Epub 2021 Mar 1.
The sustainability of health benefits in response to lifestyle-based interventions remains unclear in children with overweight and obesity, and cardiometabolic disease (CMD). We determined the changes in novel biomarkers of CMD in a 1-year family-based intervention (FBI) program, during 6-month active monitoring phase and at 12-month follow-up. Children with an age-adjusted body mass index (BMI) percentile ≥85 ( = 130; age 8-11 years) were recruited for a 1-year (6-month monitored and 6-month unmonitored) randomized controlled FBI program. Anthropometry and selected biomarkers of CMD were measured in 87 participants, randomly allocated to intervention (INT) and education-only (EDU) groups, at baseline, immediately after a 6-month active intervention or control period, and at 12-month unmonitored follow-up. Samples from 87 participants (age 10.00 ± 0.11 years and Tanner stage ≤3) with obesity (BMI%ile = 97.45 ± 0.15) were available. Overall intervention effect (between groups), was observed for total (T) and high molecular weight (HMW) adiponectin, ratio of total to HMW adiponectin, fibrinogen, and interleukin (IL)-6 ( < 0.05 for all). However, between-group beneficial changes after adjusting for baseline levels were limited to BMI percentile, T and HMW adiponectin and their ratio, IL-6, and fibrinogen ( < 0.05 for all) mainly during the 6-month period of monitored intervention. Changes in traditional risk factors such as lipids and triglycerides were inconsistent. During the 6-month follow-up period, the changes in biomarkers leveled-off, except for T and HMW adiponectin, IL-6, and fibrinogen that continued to show benefits ( < 0.05) from the 6- to 12-month follow-up. The FBI program beneficially altered novel biomarkers of CMD during the monitored intervention phase in school-age children with obesity, but they mostly moved back toward baseline during the unmonitored follow-up phase. The changes in novel biomarkers of CMD appear to be more sensitive compared to the traditional risk factors. The study implies the need for refinements in lifestyle-based approaches in the preservation of cardiovascular health and calls for robust biomarkers to monitor the changes. The study was registered at ClinicalTrials.gov (NCT01146314).
在超重和肥胖以及心血管代谢疾病 (CMD) 的儿童中，生活方式干预对健康益处的可持续性仍不清楚。我们在一项为期 1 年的家庭为基础的干预（FBI）计划中确定了 6 个月的主动监测阶段和 12 个月的随访期间新型 CMD 生物标志物的变化。年龄调整后的体重指数（BMI）百分位≥85（=130；年龄 8-11 岁）的儿童被招募参加为期 1 年（6 个月监测和 6 个月不监测）的随机对照 FBI 计划。在基线、6 个月主动干预或对照期结束后以及 12 个月未监测随访时，对 87 名参与者（年龄 10.00±0.11 岁，Tanner 分期≤3）进行了人体测量和选定的 CMD 生物标志物测量，这些参与者被随机分配到干预（INT）和教育仅（EDU）组。87 名参与者（年龄 10.00±0.11 岁，Tanner 分期≤3，肥胖（BMI%ile=97.45±0.15））的样本可用。总体干预效果（组间）观察到总（T）和高分子量（HMW）脂联素、总与 HMW 脂联素的比值、纤维蛋白原和白细胞介素（IL）-6（均<0.05）。然而，在调整基线水平后，仅观察到 BMI 百分位、T 和 HMW 脂联素及其比值、IL-6 和纤维蛋白原的组间有益变化（均<0.05），主要发生在 6 个月的监测干预期间。传统危险因素（如脂质和甘油三酯）的变化不一致。在 6 个月的随访期间，生物标志物水平趋于稳定，除 T 和 HMW 脂联素、IL-6 和纤维蛋白原外，这些生物标志物在从 6 个月到 12 个月的随访中继续表现出获益（均<0.05）。FBI 计划在肥胖学龄儿童的监测干预阶段有益地改变了 CMD 的新型生物标志物，但在未监测的随访阶段，它们大多又回到了基线。CMD 新型生物标志物的变化似乎比传统危险因素更敏感。该研究表明，需要改进基于生活方式的方法来保持心血管健康，并呼吁使用强大的生物标志物来监测变化。该研究在 ClinicalTrials.gov（NCT01146314）注册。
