Jacobson M S, Copperman N, Haas T, Shenker I R
Division of Adolescent Medicine, Albert Einstein College of Medicine, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11042.
Ann N Y Acad Sci. 1993 Oct 29;699:220-9. doi: 10.1111/j.1749-6632.1993.tb18852.x.
Ten obese adolescents, referred because of elevated cardiovascular disease risk, were treated in a pediatric atherosclerosis prevention center. The focus of treatment was an increase in exercise tolerance and aerobic capacity and a decrease in the percentage of fat in the diet. Weight loss was not a goal of treatment, but continued growth with a slowing of the rate of weight gain was emphasized. All patients were at elevated cardiovascular risk at the entry to the study, and nine of the ten had significant improvements in one or more of their cardiovascular risk parameters. Furthermore, with regard to body composition, eight of the ten patients were able to improve their body mass index. On average, triceps skinfold thicknesses declined 25 percent. Total cholesterol declined 14%, triglycerides declined 33%, LDL cholesterol declined 13%, and HDL cholesterol did not change with this form of treatment. As for systolic and diastolic blood pressure, four of the ten patients who had elevated blood pressures at the initiation of treatment were able to decrease their blood pressure, in absolute terms and on the basis of their percentiles for age and sex. We conclude that, in obese adolescents, improved diet and body composition, a slowed rate of weight gain, and a reduction of cardiovascular risk shown through lipid profiles and blood pressures can be achieved from a multidisciplinary treatment program focused on achievable goals. These goals include (1) increased habitual exercise and increased aerobic exercise and (2) a decrease in the percentage of energy intake from fat and saturated fat, with a concomitant decrease in the balance of energy intake to energy output. It is important to remember that we did not focus on weight loss per se and that the treatment was individualized to the developmental stage of the adolescent.
十名因心血管疾病风险升高而前来就诊的肥胖青少年，在一家儿科动脉粥样硬化预防中心接受治疗。治疗的重点是提高运动耐量和有氧能力，以及降低饮食中的脂肪比例。体重减轻不是治疗目标，但强调在持续生长的同时减缓体重增加速度。所有患者在进入研究时心血管风险均升高，十名患者中有九名在一个或多个心血管风险参数方面有显著改善。此外，在身体组成方面，十名患者中有八名能够改善其体重指数。平均而言，肱三头肌皮褶厚度下降了25%。总胆固醇下降了14%，甘油三酯下降了33%，低密度脂蛋白胆固醇下降了13%，而高密度脂蛋白胆固醇在这种治疗方式下没有变化。至于收缩压和舒张压，治疗开始时血压升高的十名患者中有四名能够降低血压，无论是绝对值还是根据其年龄和性别的百分位数来看。我们得出结论，在肥胖青少年中，通过一个以可实现目标为重点的多学科治疗方案，可以实现改善饮食和身体组成、减缓体重增加速度以及通过血脂水平和血压显示的心血管风险降低。这些目标包括：（1）增加习惯性运动和有氧运动；（2）减少脂肪和饱和脂肪的能量摄入比例，同时减少能量摄入与能量输出的平衡。重要的是要记住，我们本身并没有专注于体重减轻，而且治疗是根据青少年的发育阶段进行个体化的。
