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

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 reductions were 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.This study was supported by grant PI13/01335 from the Spanish Ministry of Health’s Fondos de Investigación Sanitaria del Instituto de Salud Carlos III; by grant DEP2016-78377 from the Spanish Ministry of the Economy Industry and Competitiveness; by European Regional Development Funds (ERDF) Una Manera de Hacer Europa; by grant 0011-1365-2019-000085 from the Regional Government of Navarra’s Department of Economic Development (cofunded by ERDF 2014-2020 for Navarra); by grant 47/2021 from the Government of Navarra’s Department of Health; by grant FJC2018-037925-I from the Spanish Ministry of Science and Innovation (Dr Cadenas-Sanchez); by Marie Sklodowska Curie grant agreement 101028929 from the European Union’s Horizon 2020 Research and Innovation Programme (Dr Cadenas-Sanchez); by grant BES-2017-080770 from the Spanish Ministry of the Economy Industry and Competitiveness (Dr Osés); by grants PRE_2016_1_0057, PRE_2017_2_0224, PRE_2018_2_0057, and PRE_2019_2_0004 from the Education Department of the Government of the Basque Country (Dr Arenaza); and by grant SOMM17/6107/UGR from the University of Granada Plan Propio de Investigación 2021 Excellence actions: Unit of Excellence on Exercise, Nutrition and Health and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, ERDF

Independent and joined association between socioeconomic indicators and pediatric obesity in Spain: the PASOS study

Childhood obesity is a public health problem worldwide. An important determinant of child and adolescent obesity is socioeconomic status (SES). However, the magnitude of the impact of different SES indicators on pediatric obesity on the Spanish population scale is unclear. The aim of this study was to assess the association between three SES indicators and obesity in a nationwide, representative sample of Spanish children and adolescents. A total of 2791 boys and girls aged 8 to 16 years old were included. Their weight, height, and waist circumference were measured. SES was assessed using two parent/legal guardian self-reported indicators (educational level -University/non-University- and labor market status -Employed/Unemployed-). As a third SES indicator, the annual mean income per person was obtained from the census section where the participating schools were located (≥12.731€/<12.731€). The prevalence of obesity, severe obesity, and abdominal obesity was 11.5%, 1.4%, and 22.3%, respectively. Logistic regression models showed an inverse association of both education and labor market status with obesity, severe obesity, and abdominal obesity (all p < 0.001). Income was also inversely associated with obesity (p < 0.01) and abdominal obesity (p < 0.001). Finally, the highest composite SES category (University/Employed/≥12.731€ n = 517) showed a robust and inverse association with obesity (OR = 0.28; 95% CI: 0.16–0.48), severe obesity (OR = 0.20; 95% CI: 0.05–0.81), and abdominal obesity (OR = 0.36; 95% CI: 0.23–0.54) in comparison with the lowest composite SES category (Less than University/Unemployed/<12.731€; n = 164). No significant interaction between composite SES categories and age and gender was found. SES is strongly associated with pediatric obesity in Spain.The PASOS study was funded by Fundación PROBITAS (2019) and the Gasol Foundation (2019-2020). Additional funds were received from the Barça Foundation (2019-2020), Banco Santander (2019), IFA (2019-2020), Vienna (2019), and the Fundación Deporte Joven (2019) (no references are applicable). J.A.T., M.G.-G. and C.B. are funding by Instituto de Salud Carlos III through the CIBEROBN CB12/03/30038, which are co-funded by the European Regional Development Fund