Effect of lifestyle change on the management of metabolic syndrome and nonalcoholic fatty liver in adolescents: a systematic review / Efeito da mudança no estilo de vida no tratamento da síndrome metabólica e do fígado gorduroso não alcoólico em adolescentes: uma revisão sistemática

Objective: To evaluate the impact of interventions related to lifestyle change in the management of metabolic syndrome and nonalcoholic fatty liver disease in adolescents. Methods: Systematic review covering randomized clinical trials in adolescents aged 12 to 18 years with a diagnosis of metabolic syndrome and/or nonalcoholic fatty liver disease, with a minimum intervention period of three months. We included the Pubmed, Embase, and Cochrane databases. We included studies published in English, Spanish, Portuguese, Italian, French, German, and Swedish. Results and conclusion: A total of 1.676 articles were found and, after adequate evaluation, five articles considered relevant to the objective of this systematic review. Dietary interventions have been shown to be effective in weight reduction, BMI, lipid profile, and intrahepatic fat. In the form of aerobic training associated with resistance training, interventions in physical activity were effective in reducing the prevalence of nonalcoholic fatty liver disease. The high and low-intensity training resulted in the improvement of biomarkers related to the disease. In patients with risk factors for metabolic syndrome, dietary, psychological, and physical activity intervention reduced fat mass, lipid profile, and C-reactive protein. It is important to highlight the multidisciplinary role of interventions, demonstrating the importance of integrated care to adolescent health

Nutrition and Lifestyle Modifications in the Prevention and Treatment of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a burgeoning health problem worldwide. NAFLD is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol Different methods are employed in the diagnosis of NAFLD. Certain drugs, genetics, lifestyle factors have been implicated in the development of NAFLD. NAFLD symptoms are asymptomatic but indicated when there is unexplained persistent elevation of liver enzyme levels. Nutrition and lifestyle modifications are widely prescribed as helpful in the prevention and treatment of Non-Alcoholic Fatty Liver disease (NAFLD). Dietary and lifestyle modifications are apparent measures considering the disease association with obesity, diabetes, and cardiovascular disease which many reviews have linked to the condition. Reduction in body weight, involvement in both aerobic and anaerobic exercises, conscious intake in the types of fat and carbohydrates are helpful in the management of NAFLD. This chapter highlights the various theories and principles underlying nutrition and lifestyle modifications in the prevention and treatment of NAFLDs

Childhood obesity: An overview of laboratory medicine, exercise and microbiome

In the last few years, a significant increase of childhood obesity incidence unequally distributed within countries and population groups has been observed, thus representing an important public health problem associated with several health and social consequences. Obese children have more than a 50% probability of becoming obese adults, and to develop pathologies typical of obese adults, that include type 2-diabetes, dyslipidemia and hypertension. Also environmental factors, such as reduced physical activity and increased sedentary activities, may also result in increased caloric intake and/or decreased caloric expenditure. In the present review, we aimed to identify and describe a specific panel of parameters in order to evaluate and characterize the childhood obesity status useful in setting up a preventive diagnostic approach directed at improving health-related behaviors and identifying predisposing risk factors. An early identification of risk factors for childhood obesity could definitely help in setting up adequate and specific clinical treatments

QUAL A MELHOR CONDUTA TERAPÊUTICA NÃO-MEDICAMENTOSA PARA PACIENTES COM DOENÇA HEPÁTICA GORDUROSA NÃO-ALCOÓLICA?

Estudos mostram um crescente aumento no número de pessoas com excesso de peso no Brasil. Dentre outros fatores prejudiciais pelo excesso de peso, a Doença Hepática Gordurosa Não-Alcoólica (DHGNA) pode ser seriamente prejudicial à saúde. Esta revisão sistemática tem por objetivo verificar qual a melhor conduta não-medicamentosa para pacientes com DHGNA. Foi realizada uma busca nas bases de dados BIREME, MEDLINE, PEDro, PubMed e SciELO, e o período de publicação dos estudos foi de 2008 à 2013. Dentre os artigos encontrados, foi realizada uma análise nos títulos e resumos, visando confirmar se os artigos se encontravam nos critérios de seleção estabelecidos; os estudos deveriam ser originais; não deveriam ser revisões sistemáticas. Os achados mostraram que a utilização de uma dieta adequada e exercícios físicos são eficazes em pacientes com DHGNA, mas novos estudos são necessários para padronizar a conduta para estes pacientes

The "Adipo-Cerebral" Dialogue in Childhood Obesity: Focus on Growth and Puberty. Physiopathological and Nutritional Aspects

Overweight and obesity in children and adolescents are overwhelming problems in western countries. Adipocytes, far from being only fat deposits, are capable of endocrine functions, and the endocrine activity of adipose tissue, resumable in adipokines production, seems to be a key modulator of central nervous system function, suggesting the existence of an “adipo-cerebral axis.” This connection exerts a key role in children growth and puberty development, and it is exemplified by the leptin–kisspeptin interaction. The aim of this review was to describe recent advances in the knowledge of adipose tissue endocrine functions and their relations with nutrition and growth. The peculiarities of major adipokines are briefly summarized in the first paragraph; leptin and its interaction with kisspeptin are focused on in the second paragraph; the third paragraph deals with the regulation of the GH-IGF axis, with a special focus on the model represented by growth hormone deficiency (GHD); finally, old and new nutritional aspects are described in the last paragraph

Efeito do Tratamento Multiprofissional no Perfil Inflamatório de Adolescentes Obesos

Objective: The aim of this study was to analize the effect of multiprofessional treatment in the concentrations of inflammatory markers in obese adolescents. Methods: A total of thirteen obese adolescents (aged 16 ± 1.55 years) received multiprofessional treatment during a period of 6 months. The treatment consisted of 4 weekly sessions of physical exercise (2 sessions of aerobic exercise and 2 sessions of resistance exercise) and nutricional and psicological counseling. Body mass, BMI, waist circumference and cardiorespiratory fitness of the adolescents were evaluated. To determine the concentrations of PCR, TNF-, IL-6, PAI-1, IL-10, adiponectin, leptin and resistin, specific kits and Enzyme Linked Immunosorbant Assay (ELISA) were used. Results: There was a significant decrease in body mass (p= 0,007) and waist circumference (p=0,001) and an increase in cardiorespiratory fitness (p = 0,001). In the inflammatory markers there was a decrease in the plasma concentration of CRP (p = 0,04), TNF- (p = 0,04), PAI-1 (p = 0,04), leptin (p <0,0001) and resistin (p = 0,03). The other inflammatory variables did not present a significant difference. Conclusion: The physical training associated with nutritional and psychological monitoring was able to improve the inflammatory profile and the quality and life expectancy in obese adolescentsTrabalho de Conclusão de Curso (Graduação)Objetivo: Analisar o efeito do tratamento multiprofissional nas concentrações de marcadores inflamatórios de adolescentes obesos. Métodos: Participaram do estudo 13 adolescentes obesos pós-púberes de ambos os sexos com média de idade de 16±1,55 anos. Os adolescentes passaram por um tratamento multiprofissional durante 6 meses onde realizaram 4 sessões semanais de exercício físico (2 sessões de exercício aeróbio e 2 sessões de exercício resistido), uma sessão semanal de reeducação alimentar e uma sessão semanal de terapia comportamento em grupo. Foram avaliados a massa corporal, IMC, circunferência abdominal e aptidão cardiorrespiratória dos adolescentes. Para determinar as concentrações de PCR, TNF-, IL-6, PAI-1, IL-10, adiponectina, leptina e resistina utilizou-se kits específicos e o teste enzimático ELISA (Enzime Linked Immunosorbant Assay). Resultados: Os adolescentes obesos apresetaram diminuição significativa na massa corporal (p= 0,007), no IMC (p=0,005), circunferencia abdominal (p= 0,001) e aumento na aptidão cardiorrespiratória (p= 0,001). Nos marcadores inflamatórios houve diminuição na concentração plasmática de PCR (p= 0,04), TNF- (p= 0,04), PAI-1 (p= 0,04), leptina (p<0,0001) e resistina (p= 0,03). As demais variáveis inflamatórias não apresentaram diferença significativa. Conclusão: O treinamento físico associado ao acompanhamento nutricional e psicologógico foi capaz de melhorar o perfil inflamatório refletindo na vida de adolescentes obesos

Impact of exercise training on the sarcopenia criteria in non-alcoholic fatty liver disease: A systematic review and meta-analysis

Indexación ScopusSarcopenia is a highly prevalent complication of non-alcoholic fatty liver disease (NAFLD). We aimed to conduct a systematic review and meta-analyses to elucidate the exercise training (ET)'s efficacy on NAFLD adult patients' sarcopenia criteria. We identified relevant randomized controlled trials (RCT) in electronic databases PubMed, CINAHL, and Scopus. We selected seven RCT from 66 screened studies. The ET programs included endurance or combined (endurance and resistance) training. No study performed resistance training alone. The physical function improved with endurance or combined training (mean differences [MD] 8.26 mL/Kg*min [95% CI 5.27 to 11.24 mL/Kg*min], p < 0.0001); Muscle mass showed no evidence of the beneficial effects of endurance or combined training (MD 1.01 Kg [95% CI -1.78 to 3.80 Kg], p = 0.48). None of the selected studies evaluated muscle strength. Endurance and combined training increase physical function criteria but do not improve muscle mass criteria on sarcopenia in NAFLD patients. These results must be interpreted with caution for the small number of patients included in the RCTs analyzed, the different characteristics of the ET carried out, the non-use of resistance training, which prevents assess its effect on sarcopenia despite the evidence that recommends it and does not assessment muscle strength criteria in RCT include. Future research should include muscle strength assessments and resistance training to evaluate the effects in this condition. Exercise training is beneficial for sarcopenia in NAFLD but is necessary more experimental evidence to define the best type of training that positively affects the three criteria of sarcopenia. PROSPERO reference number CRD42020191471. © 2021 PAGEPress Publications. All rights reserved.https://www.pagepressjournals.org/index.php/bam/article/view/963