Effects of a Family-Based Lifestyle Intervention Plus Supervised Exercise Training on Abdominal Fat Depots in Children With Overweight or Obesity. A Secondary Analysis of a Nonrandomized Clinical Trial
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American Medical Association
Fecha
2022-11-28Referencia bibliográfica
Cadenas-Sanchez C... [et al.]. Effects of a Family-Based Lifestyle Intervention Plus Supervised Exercise Training on Abdominal Fat Depots in Children With Overweight or Obesity: A Secondary Analysis of a Nonrandomized Clinical Trial. JAMA Netw Open. 2022;5(11):e2243864. doi:[10.1001/jamanetworkopen.2022.43864]
Patrocinador
Spanish Ministry of Health's Fondos de Investigacion Sanitaria del Instituto de Salud Carlos III PI13/01335 Spanish Government DEP2016-78377; European Commission 0011-1365-2019-000085; Regional Government of Navarra's Department of Economic Development - ERDF Government of Navarra's Department of Health 47/2021; Ministry of Science and Innovation, Spain (MICINN) Spanish Government FJC2018-037925-I; Marie Sklodowska Curie 101028929 European Commission; Education Department of the Government of the Basque Country BES-2017-080770 PRE_2016_1_0057 PRE_2017_2_0224 PRE_2018_2_0057 PRE_2019_2_0004; Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades, ERDF SOMM17/6107/UGRResumen
IMPORTANCE Excess 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.
OBJECTIVES To 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 PARTICIPANTS This 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.
INTERVENTIONS The 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 MEASURES The 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.
RESULTS The 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 reductionswere 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 RELEVANCE These 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.