The Adibox Study: Adiposity and Bone Metabolism: Effects of Exercise-induced Weight Loss in Adolescents with Obesity

Introduction: This program of research targeted the impact of an 8-month weight loss intervention induced by physical activity and nutrition on bone health in adolescents with obesity. The overall aim of this thesis was to examine the impact of a lifestyle weight loss intervention on the bone parameters in adolescents with obesity. Method: Sixty-five adolescents were recruited: 31 (6 males) adolescents with obesity in the weight loss intervention (age: 13.61 (1.27)), 23 normal weight (NW) adolescents (age: 15.90 (0.43)) and 11 (4 males) adolescents with obesity in another control group (14.02 (1.39)). Primary outcomes targeted bone densitometry (whole body, spine, hip DXA). Secondary outcomes included body composition, bone geometry and strength (hip structural analysis) and bone biomarkers (procollagen type 1 N-terminal propeptide (P1NP), C telopeptide (CTx) estradiol, leptin). Data were collected at baseline, 4 months and 8 months. Data were adjusted for body weight, fat mass and lean mass changes. Results: Compared with the NW controls, adolescents with obesity displayed lower unadjusted and adjusted bone density. Following successful weight loss (~ -11%) adolescents with obesity increased whole body (%Ob Δ 3.22 (3.58) pp<0.001) and lumbar spine (%Ob Δ 6.27 (12.45) p=0.014) BMD. However, values remain lower than their NW peers after adjustment to body weight changes. After the weight loss intervention, compromised estimates of fracture risk remained especially at the narrow neck (buckling ratio (BR) 8.25 (2.00) p=0.005), despite positive adaptations of some geometric properties (i.e. NN CSA, NN Z). Also, bone accretion changes in adolescents with obesity followed an androgen-like adaptation demonstrated by periosteal expansion (% NW Δ 0.69 (3.71); Ob Δ 1.67 (9.11)) and endocortical resorption (% NW Δ -2.11 (11.79); Ob Δ 4.42 (10.56)). Among the intervention group, differences in bone markers favoured formation during the first 4 months and favoured resorption in the remaining months. Conclusion: Bone fragility in adolescents with obesity was demonstrated by (1) baseline and post intervention lower whole body and regional BMD than NW controls, (2) post-intervention higher fracture risk index at the narrow neck, (3) bone biomarkers showing reduced z-scores, uncoupling indices and qualitative representations of the distribution of bone remodeling. Future investigations of links between bone and obesity during adolescence can be well informed by the results of this thesis

Effects of a short residential thermal spa program to prevent work-related stress/burnout on stress biomarkers: The thermstress proof of concept study

Objective Work-related stress is a public health issue. Stress has multiple physical and psychological consequences, the most serious of which are increased mortality and cardiovascular morbidity. The ThermStress protocol was designed to offer a short residential thermal spa program for work-related stress prevention that is compatible with a professional context. Methods Participants will be 56 male and female workers aged 18 years or above. All participants will undergo a 6-day residential spa program comprising psychological intervention, physical activity, thermal spa treatment, health education, eating disorder therapy and a follow-up. On six occasions, participants’ heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometry and body composition, psychology and quality of life will be measured using questionnaires and bone parameters. Results This study protocol reports the planned and ongoing research for this intervention. Discussion The ThermStress protocol has been approved by an institutional ethics committee (ANSM: 2016 A02082 49). It is expected that this proof of concept study will highlight the effect of a short-term specific residential thermal spa program on the prevention of occupational burnout and work-related stress. The findings will be disseminated at several research conferences and in published articles in peer-reviewed journals. Trial Registration: ClinicalTrials.gov (NCT 03536624, 24/05/2018

Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Background: Peripheral quantitative computed tomography (pQCT) is an established technology that allows for the measurement of the material properties of bone. Alterations to bone architecture are associated with an increased risk of fracture. Further pQCT research is necessary to identify regions of interest that are prone to fracture risk in people with chronic diseases. The second metatarsal is a common site for the development of insufficiency fractures, and as such the aim of this study was to assess the reproducibility of a novel scanning protocol of the second metatarsal using pQCT. Methods. Eleven embalmed cadaveric leg specimens were scanned six times; three times with and without repositioning. Each foot was positioned on a custom-designed acrylic foot plate to permit unimpeded scans of the region of interest. Sixty-six scans were obtained at 15% (distal) and 50% (mid shaft) of the second metatarsal. Voxel size and scan speed were reduced to 0.40 mm and 25 mm.sec-1. The reference line was positioned at the most distal portion of the 2nd metatarsal. Repeated measurements of six key variables related to bone properties were subject to reproducibility testing. Data were log transformed and reproducibility of scans were assessed using intraclass correlation coefficients (ICC) and coefficients of variation (CV%). Results: Reproducibility of the measurements without repositioning were estimated as: trabecular area (ICC 0.95; CV% 2.4), trabecular density (ICC 0.98; CV% 3.0), Strength Strain Index (SSI) - distal (ICC 0.99; CV% 5.6), cortical area (ICC 1.0; CV% 1.5), cortical density (ICC 0.99; CV% 0.1), SSI - mid shaft (ICC 1.0; CV% 2.4). Reproducibility of the measurements after repositioning were estimated as: trabecular area (ICC 0.96; CV% 2.4), trabecular density (ICC 0.98; CV% 2.8), SSI - distal (ICC 1.0; CV% 3.5), cortical area (ICC 0.99; CV%2.4), cortical density (ICC 0.98; CV% 0.8), SSI - mid shaft (ICC 0.99; CV% 3.2). Conclusions: The scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2 nd metatarsal. This protocol extends the capabilities of pQCT to evaluate bone quality in people who may be at an increased risk of metatarsal insufficiency fractures

Etude ADIBOX : adiposité et métabolisme osseux : effets de la perte de poids induite par l'exercice chez les adolescents obèses

Introduction: This program of research targeted the impact of an 8-month weight loss intervention induced by physical activity and nutrition on bone health in adolescents with obesity. The overall aim of this thesis was to examine the impact of a lifestyle weight loss intervention on the bone parameters in adolescents with obesity. Method: Sixty-five adolescents were recruited: 31 (6 males) adolescents with obesity in the weight loss intervention (age: 13.61 (1.27)), 23 normal weight (NW) adolescents (age: 15.90 (0.43)) and 11 (4 males) adolescents with obesity in another control group (14.02 (1.39)). Primary outcomes targeted bone densitometry (whole body, spine, hip DXA). Secondary outcomes included body composition, bone geometry and strength (hip structural analysis) and bone biomarkers (procollagen type 1 N-terminal propeptide (P1NP), C telopeptide (CTx) estradiol, leptin). Data were collected at baseline, 4 months and 8 months. Data were adjusted for body weight, fat mass and lean mass changes.Results: Compared with the NW controls, adolescents with obesity displayed lower unadjusted and adjusted bone density. Following successful weight loss (~ -11%) adolescents with obesity increased whole body (%Ob ∆ 3.22 (3.58) p<0.001) and lumbar spine (%Ob ∆ 6.27 (12.45) p=0.014) BMD. However, values remain lower than their NW peers after adjustment to body weight changes. After the weight loss intervention, compromised estimates of fracture risk remained especially at the narrow neck (buckling ratio (BR) 8.25 (2.00) p=0.005), despite positive adaptations of some geometric properties (i.e. NN CSA, NN Z). Also, bone accretion changes in adolescents with obesity followed an androgen-like adaptation demonstrated by periosteal expansion (% NW ∆ 0.69 (3.71); Ob ∆ 1.67 (9.11)) and endocortical resorption (% NW ∆ -2.11 (11.79); Ob ∆ 4.42 (10.56)). Among the intervention group, differences in bone markers favoured formation during the first 4 months and favoured resorption in the remaining months.Conclusion: Bone fragility in adolescents with obesity was demonstrated by (1) baseline and post intervention lower whole body and regional BMD than NW controls, (2) post-intervention higher fracture risk index at the narrow neck, (3) bone biomarkers showing reduced z-scores, uncoupling indices and qualitative representations of the distribution of bone remodeling. Future investigations of links between bone and obesity during adolescence can be well informed by the results of this thesis.Introduction : Ce programme de recherche visait à étudier l'impact d'une intervention de 8 mois entrainant une perte de poids induite par l'activité physique et la nutrition sur la santé osseuse chez des adolescents obèses. L'objectif global de cette thèse était d'examiner l'impact d'une intervention de perte de poids sur les paramètres osseux chez les adolescents obèses.Méthode : Soixante-cinq adolescents ont été recrutés : 31 (6 garçons) obèses pour le groupe intervention (âge : 13,61 (1,27)), 23 adolescents de poids normal (NW) (âge : 15,90 (0,43)) et 11 (4 hommes) adolescents obèses pour le groupe témoin (14.02 (1.39)). Le critère d’évaluation principal concernait la densitométrie osseuse par DXA (corps entier, colonne vertébrale, hanche). Les critères d'évaluation secondaires comprenaient la composition corporelle (DXA), la géométrie et la résistance des os (analyse structurelle de la hanche) et des biomarqueurs osseux (propeptide N-terminal (P1NP) procollagène de type 1, estradiol C-télopeptide (CTx), leptine). Les données ont été collectées au départ à 4 mois et à 8 mois. Les données ont été ajustées en fonction des changements de poids corporel, de masse grasse et de masse maigre.Résultats : Comparés au groupe contrôle de poids normal, les adolescents obèses présentaient une densité osseuse non ajustée et ajustée inférieure. Suite à la perte de poids (~ -11%), les adolescents obèses ont augmentés leur densité osseuse au corps entier (% Ob 3,22 (3,58) p <0,001) et à la colonne lombaire (% Ob 6,27 (12,45) p = 0,014). Cependant, ces valeurs restent inférieures à celles de leurs homologues contrôle de poids normal après ajustement aux variations de poids corporel. Après l’intervention entrainant une perte de poids, les estimations du risque de fracture sont restées élevée, en particulier au niveau du col étroit (buckling ratio (BR) 8,25 (2,00) p = 0,005) et ce malgré des adaptations positives de certaines propriétés géométriques (i.e. NN CSA, NN Z). De plus, les modifications de l'accrétion osseuse chez les adolescents obèses suivent une adaptation de type androgènes, cela est démontrée par une expansion périostée (% NW ∆ 0,69 (3,71); Ob ∆ 1,67 (9,11)) et une résorption endocorticale (% NW ∆ -2,11 (11,79); Ob ∆ 4,42 (10,56)). Dans le groupe intervention, les différences au regard des marqueurs osseux favorisent la formation osseuse au cours des 4 premiers mois alors que par la suite la résorption osseuse est favorisée.Conclusion : La fragilité osseuse chez les adolescents obèses a été démontrée par (1) une densité minérale osseuse inférieure corps entier et régionale pré et post-intervention par rapport aux contrôles normo-pondérés, (2) un indice de risque de fracture élevé après intervention au niveau du cou étroit, (3) des biomarqueurs osseux démontrant des z-scores, indices de découplage (uncoupling indices) et représentations qualitatives de la distribution du remodelage osseux inférieures. Les résultats de cette thèse contribuent aux recherches futures sur les liens entre os et obésité à l’adolescence

Smartphone interventions for weight treatment and behavioral change in pediatric obesity : A systematic review

Background: Traditional approaches for treating or managing children and adolescents with overweight or obesity have limited effectiveness. Current advances in smartphone technology may improve the attractiveness and accessibility of weight management support for children and adolescents with overweight or obesity. This systematic review aimed to provide a comparative evaluation of the effectiveness of using smartphones in the multidisciplinary treatment of child and adolescent overweight or obesity, with a specific interest in behavior change. Materials and Methods: The databases of Medline complete, OVID, CINAHL, EMBASE, and PubMed were searched for randomized controlled trial (RCT) studies addressing behavioral change using smartphone technology, plus nutrition and/or physical activity, to treat or manage child and adolescent obesity. Results: Only two RCTs have described the effectiveness of smartphone devices in pediatric overweight or obesity treatment. Within the limitation of the two studies, electronic contact (e-contact) appeared unsuccessful in achieving weight loss. However, smartphone usage was linked to improved engagement and reduced dropout rates during important sustainability phases of these long-term interventions. Conclusions: Smartphone technologies allow users to accomplish tasks anywhere and anytime and, as such, provide researchers with additional and generationally appropriate capacities to deliver health promotion. E-contact should be used for its significant capacity to prolong engagement and decrease withdrawal during sustainability phases that follow intensive intervention for weight management in young populations. Despite increasing popularity in published protocols of weight management trials, the effectiveness of the impact of smartphone technology in pediatric programs remains equivocal

Bioelectrical impedance is an accurate method to assess body composition in obese but not severely obese adolescents

The aim of this study was to compare total and segmental body composition results between bioimpedance analysis (BIA) and dual x-ray absorptiometry (DXA) scan and to test the reproducibility of BIA in obese adolescents. We hypothesized that BIA offers an accurate and reproducible method to assess body composition in adolescents with obesity. Whole-body and segmental body compositions were assessed by BIA (Tanita MC-780) and DXA (Hologic) among 138 (110 girls and 28 boys) obese adolescents (Tanner stage 3-5) aged 14 ± 1.5 years. The BIA analysis was replicated on 3 identical occasions in 32 participants to test the reproducibility of the methods. Whole-body fat mass percentage was significantly higher using the BIA method compared with DXA (40.6 ± 7.8 vs 38.8 ± 4.9%, P < .001), which represents a 4.8% overestimation of the BIA technique compared with DXA. Similarly, fat mass expressed in kilograms is overestimated by 2.8% using BIA (35.8 ± 11.7 kg) compared with the DXA measure (34.3 ± 8.7 kg) (P < .001), and fat-free mass is underestimated by − 6.1% using BIA (P < .001). Except for the right arm and leg percentage of fat mass, all the segmental measures of body composition are significantly different between the 2 methods. Intraclass correlation coefficient and Lin coefficient showed great agreement and concordance between both methods in assessing whole-body composition. Intraclass correlation coefficient between the 3 BIA measures ranged from 0.99 to 1 for body weight, body fat, and fat-free mass. Bioimpedance analysis offers an acceptable and reproducible alternative to assess body composition in obese adolescents, with however a loss of correlation between BIA and DXA with increasing body fat, its validity remains uncertain for segmental analysis among obese youth

Neural response to food cues and energy intake following exercise in adolescents: effect of weight status

International audienc

Bone-adiposity cross-talk: implications for pediatric obesity

The rising prevalence of overweight and obesity among pediatric populations has become a major global concern. The objective of this review is to demonstrate potential interactions between the products released by fat tissue and the hormonal production of bone tissue in obese children and adolescents. Advancing the understanding of the complex interactions between adipocyte and osteocyte activities may contribute to the mechanistic understanding of the body’s responses to weight loss during adolescence. This knowledge could also reveal any side effects encountered with these interventions. Currently, the concept of bone-adiposity crosstalk has not been fully elucidated, and the mechanisms remain controversial. Understanding the local interactions between the released products by fat tissue and hormones produced in bone tissue requires further investigations

Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis

International audienc

Cross-sectional and longitudinal study protocols of the 'ADIposity and BOne metabolism: Effects of eXercise-induced weight loss in obese adolescents' (ADIBOX) project

Introduction: A need exists for sustainable and clinically effective weight management interventions, suitable for preventing well-linked chronic disease such as diabetes and cardiovascular disease and some less investigated secondary conditions such as bone alteration. The ADIposity and BOne metabolism: effects of eXercise-induced weight loss in obese adolescents (ADIBOX) protocol was designed to provide a better understanding of the interaction between adipokines and bone hormones in adolescents with obesity and how a 10-month physical activity programme may affect these interactions. Methods and analysis: The ADIBOX protocol combines 2 studies. The first study involves a total of 68 adolescents aged 12–16 years. This cross-sectional study will include both males and females (1:1 ratio), either living with obesity/overweight (n=34; body mass index (BMI) ≤97th centile and ≥85th centile) or normal weight (n=34; BMI < 85th centile). The second study is a longitudinal study that will include 50 obese adolescent girls and track them over a period of 42 weeks. Weight loss programme will consist of a combination of physical activity and a normocaloric diet. Bone and adiposity-related measurements will be performed every 14 weeks. Both studies will assess participants' anthropometric profile, nutrition and physical activity, body composition, bone densitometry and blood markers of bone, growth and adiposity. Ethics and dissemination: The ADIBOX protocol complies with the ethics guidelines for clinical research and has been approved by their respective ethics committee (Australian Catholic University Committee Ethic, Australia and Hospital Sud Est 1 committee, France). Findings from this protocol are expected to clarify the possible interactions between adiposity and bone in childhood obesity and will be disseminated at several research conferences and published articles in peer-reviewed journals