Asociación entre variantes genéticas relacionadas con el metabolismo lipídico y energético y la pérdida de peso tras una intervención en adolescentes con sobrepeso u obesidad

Background: Some SNPs related to lipid and energy metabolism may be implicated not only in the development of obesity and associated comorbidities, but also in the weight loss response after a nutritional intervention. Objective: In this context, the present study analyzed four SNPs located within four genes known to be associated with obesity and other obesity-related complications, and their putative role in a weight-loss intervention in overweight/obese adolescents. Methods: The study population consisted of 199 overweight/obese adolescents (13-16 yr old) undergoing 10 weeks of a weight loss multidisciplinary intervention: the EVASYON programme (www.estudioevasyon.org). Adolescents were genotyped for 4 SNPs, and anthropometric measurements and biochemical markers were analyzed at the beginning and after the intervention. Results: Interestingly, APOA5(rs662799) was associated with the baseline anthropometric and biochemical outcomes, whereas FTO (rs9939609) seemed to be related with the change of these values after the 10-week intervention. The other two SNPs, located in the CETP (rs1800777) and the APOA1 (rs670) genes, showed important relationships with adiposity markers. Specifically, a combined model including both SNPs turned up to explain up to 24% of BMI-SDS change after 10 weeks of the multidisciplinary intervention, which may contribute to under - stand the weight loss response. Conclusion: Common variants in genes related to lipid and energy metabolism may influence not only biochemical outcomes but also weight loss response after a multidisciplinary intervention carried out in obese/overweight adolescents..Antecedentes: Algunas variantes genéticas relacionadas con el metabolismo lipídico y energético pueden estar implicadas en la respuesta a una intervención nutricional además de estar asociadas con el desarrollo de obesidad y comorbilidades asociadas. Objetivo: En este sentido, este artículo analiza cuatro polimorfismos situados en cuatro genes que han sido previamente asociados con la obesidad u otras complicaciones asociadas a la misma, así como su posible papel en la respuesta a una intervención para la pérdida de peso en adolescentes con sobrepeso u obesidad. Métodos: La población en estudio está formada por 199 adolescentes con sobrepeso u obesidad (13-16 años) llevando a cabo una intervención multidisciplinar de 10 semanas para la pérdida de peso: programa EVASYON (www.estudioevasyon.org). Los adolescentes fueron genotipados para los 4 SNPs y tanto al comienzo como al final de la intervención se analizaron marcadores bioquímicos y se tomaron medidas antropométricas. Resultados: Rs662799 del gen APOA5 se asoció al inicio con parámetros antropométricos y bioquímicos, mientras que el rs9939609 del gen FTO parecía estar asociado con el cambio de estas variables tras 10 semanas de intervención. Las variantes rs1800777 del gen CETP y rs670 del gen APOA1 mostraron una importante asociación con marcadores de adiposidad. Concretamente, un modelo combinado incluyendo los dos polimorfismos logró explicar hasta un 24% del cambio en el IMC-SDS tras 10 semanas de intervención. Conclusión: Variantes genéticas previamente relacionadas con el metabolismo lipídico y energético, pueden repercutir no solamente en valores bioquímicos sino también en la respuesta a una intervención multidisciplinar para la pérdida de peso en adolescentes con sobrepeso u obesidad.Research relating to this abstract was funded by grants from the Health Research Fund from the Carlos III Health Institute from Ministry of Health and Consumption, FIS (PI051579, PI051080) for the EVASYON project, Línea Especial, Nutrición y Obesidad (University of Navarra), CIBERobn and RETICS (Gob Navarra). The scholarships to A. Moleres from the Navarra Government is fully acknowledged

Design and evaluation of a treatment programme for Spanish adolescents with overweight and obesity. The EVASYON Study

<p>Abstract</p> <p>Background</p> <p>The prevalence of overweight and obesity (OW/OB) among adolescents worldwide has increased since the 60 s. Spain has reached one of the highest OW/OB prevalence rates among adolescents from European countries. The aim of this methodological paper is to describe the design and evaluation in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for adolescents with OW/OB: integral education on nutrition and physical activity).</p> <p>Methods/Design</p> <p>The EVASYON was planned by a multidisciplinary team to treat OW/OB in Spanish adolescents. The EVASYON is a multi-centre study conducted in 5 hospitals in 5 Spanish cities (Granada, Madrid, Pamplona, Santander and Zaragoza) and two hundred and four OW/OB Spanish adolescents were recruited for this intervention. The treatment was implemented for approximately one-year follow-up. The adolescents were treated in groups of a maximum of 10 subjects; each group had 20 visits during the treatment period in two phases: intensive during the first 2 months (1^stto 9^thvisits), and extensive during the last 11 months (10^thto 20^thvisits). In order to assess the efficacy of the treatment, 8 dimensions were measured: diet; physical activity and fitness; eating behaviour; body composition; haematological profile; metabolic profile; minerals and vitamins; immuno-inflammatory markers. Moreover, genetic polymorphisms were also determined.</p> <p>Discussion</p> <p>The treatment programme developed in the EVASYON study was designed as a national pilot study to be implemented as an effective treatment for adolescents with OW/OB into the Spanish Health Care Service.</p

Design and evaluation of a treatment programme for Spanish adolescents with overweight and obesity. The EVASYON Study

Background The prevalence of overweight and obesity (OW/OB) among adolescents worldwide has increased since the 60 s. Spain has reached one of the highest OW/OB prevalence rates among adolescents from European countries. The aim of this methodological paper is to describe the design and evaluation in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for adolescents with OW/OB: integral education on nutrition and physical activity). Methods/Design The EVASYON was planned by a multidisciplinary team to treat OW/OB in Spanish adolescents. The EVASYON is a multi-centre study conducted in 5 hospitals in 5 Spanish cities (Granada, Madrid, Pamplona, Santander and Zaragoza) and two hundred and four OW/OB Spanish adolescents were recruited for this intervention. The treatment was implemented for approximately one-year follow-up. The adolescents were treated in groups of a maximum of 10 subjects; each group had 20 visits during the treatment period in two phases: intensive during the first 2 months (1st to 9th visits), and extensive during the last 11 months (10th to 20th visits). In order to assess the efficacy of the treatment, 8 dimensions were measured: diet; physical activity and fitness; eating behaviour; body composition; haematological profile; metabolic profile; minerals and vitamins; immuno-inflammatory markers. Moreover, genetic polymorphisms were also determined. Discussion The treatment programme developed in the EVASYON study was designed as a national pilot study to be implemented as an effective treatment for adolescents with OW/OB into the Spanish Health Care Service

Changes in plasma fatty acid composition are associated with improvements in obesity and related metabolic disorders: A therapeutic approach to overweight adolescents

“This is an original manuscript published by Churchill Livingstone in Clinical Nutrition on February 2018, available at: doi: 10.1016/j.clnu.2016.11.006.”Background & aims: In recent years, obesity has reached alarming levels among children and adolescents. The study of plasma fatty acid (FA) composition, as a reflection of diet, and its associations with other parameters, that are closely linked to obesity and the cardiometabolic profile, may be useful for setting nutritional goals for obesity treatment and prevention. This study explored the role of plasma FA levels as modulators of body fat and cardiometabolic risk markers, in overweight adolescents. Methods: A multidisciplinary weight loss program was followed by 127 overweight and obese adolescents aged 12-17 years old. Plasma FA composition, anthropometric indicators of adiposity and biochemical parameters were analyzed at baseline, two months (the end of the intensive intervention phase) and six months (the end of the extensive phase). Results: While saturated fatty acid (SFA) and n-6 polyunsaturated fatty acid (PUFA) levels decreased significantly during the intervention, monounsaturated fatty acid (MUFA) and n-3 PUFA showed the opposite trend. The decrease in SFA C14:0 was associated with a reduction in total and LDL cholesterol, apolipoprotein B and insulin. The increase in MUFAs, especially C18:1n-9, was related to a reduction in weight, fat mass, fat mass index and glucose. Regarding PUFAs, changes in the n-3 series were not associated with any of the parameters studied, whereas the reduction in n-6 PUFAs was directly related to weight, fat mass, total and HDL cholesterol, apolipoprotein A1, glucose and insulin, and inversely associated with diastolic blood pressure. The adolescents with greater weight loss presented significant changes in MUFAs, n-6 PUFAs and C14:0. Conclusions: Modifications in plasma FA composition could help modulate adiposity and the cardiometabolic profile in anti-obesity programs aimed at adolescents. The changes observed in FA composition were related to the success of the treatment, since the individuals most affected by these variations were those who presented the greatest weight loss.This work is part of the EVASYON study funded by the Spanish 326 Ministry of Health and Consumption (Carlos III Institute of Health. FIS. Grant PI 051579). The EVASYON study has received the award from AESAN (Spanish Agency for Food Security and Nutrition) from the Spanish Ministry of Health and Consumption to the best applied research project in 2009

Body composition changes during a multidisciplinary treatment programme in overweight adolescents: EVASYON Study

Resumen Introducción: el principal objetivo de las intervenciones de pérdida de peso es disminuir la masa grasa manteniendo la masa libre de grasa. Objetivo: evaluar la efectividad de una intervención multidisciplinar en la composición corporal de adolescentes con sobrepeso, evaluados mediante diferentes métodos de composición corporal. Material y métodos: la intervención fue multidisciplinar sobre el estilo de vida, aplicada durante 13 meses. Los participantes eran adolescentes entre 13 y 16 años con sobrepeso y obesidad. Los adolescentes (n = 156; 54,8% mujeres) fueron evaluados mediante antropometría, absorciometría dual de rayos X y pletismografía por desplazamiento de aire. Todas las mediciones se realizaron al inicio, a los 2 y a los 13 meses. Se aplicaron análisis de la covarianza de medidas repetidas y la corrección de Bonferroni. Se realizó la imputación de las medidas antropométricas. Resultados: se logró una alta disminución significativa en el índice de masa grasa en los hombres después de 2 y 13 meses de intervención, según antropometría (1,16 y 1,56 kg/m2, respectivamente), absorciometría de rayos X (1,51 y 1,91 kg/m2) y pletismografía (2,13 y 2,44 kg/m2). Por otra parte, el mantenimiento a corto y largo plazo de la grasa y libre de grasa en el índice de masa fue observado por absorciometría de rayos X en las mujeres (0,94 y 0,68 kg/m2).Abstract Introduction: the main objectives of weight-loss interventions are to decrease fat mass while maintaining fatfree mass. Objective: our aim was to address effectiveness body composition changes in overweight adolescents assessed by different body composition methods following an obesity intervention programme. Material and methods: the life-style intervention was multi-disciplinary, with 13 months follow-up. Participants were 13-to-16 year-old overweight, or obese, Spanish adolescents. The adolescents (n = 156; 54.8% females) had body composition measured with anthropometry, dual-energy X-ray absorptiometry and air-displacement plethysmography. All measurements were made at baseline, and after 2- and 13-months. Repeated measures analysis of covariance to compare mean anthropometric changes over time and the Bonferroni correction were applied. Imputation of anthropometric measures was performed. Results: a high significant decrease in fat mass index was achieved in males after 2-and 13-months of intervention as measured by anthropometry (1.16 and 1.56 kg / m2, respectively), X-ray absorptiometry (1.51 and 1.91 kg / m2) and plethysmography (2.13 and 2.44 kg/m2). Moreover, a short and long-term maintenance of fat-and fat-free mass index was observed by X-ray absorptiometry in females (0.94 and 0.68 kg/m2)

Anthropometric indices to assess body-fat changes during a multidisciplinary obesity treatment in adolescents: EVASYON Study

Background & aims: The main objectives of weight loss interventions in children and adolescents are to decrease fat mass while maintaining fat-free mass. Several methods are available to assess childhood and adolescence obesity, such as weight and height, bioelectrical impedance, skin-fold thickness measurements and other laboratory methods. The aim was to assess simple anthropometric indices as predictors of body-fat changes, using dual-energy X-ray absorptiometry measurements as reference method. Methods: Multi-intervention approach (diet, physical activity and psychological support in a family group- based treatment) was implemented with a one-year follow-up in 13- to-16-year-old overweight or obese Spanish adolescents. A total of 83 adolescents were recruited from Granada and Zaragoza, males (n=43) (31.6 kg/m2) and females (n=40) (32.0 kg/m2). We measured body composition with anthropometry and dual-energy X-ray absorptiometry. All measurements were made at baseline, and after 2 and 13 months. Random coefficient regression model was used to calculate the proportion of body composition changes during follow-up that would be explained by simple body composition indices based on anthropometric measures. Results: After controlling for age and Tanner stage, body mass index explained 76.5% of body composition changes in males and 90.1% in females, while fat mass index (assessed by skin-folds) explained 78.9% of body composition changes in males and 84.0% of body composition changes in females. Conclusions: In conclusion, we found that BMI was a good indicator of body fat composition changes in children and adolescents, although FMI assessed by anthropometry was also a good indicator.the Ministry of Health, Social Services and Equality; the Spanish Government (Carlos III Institute of Health. FIS. Grant PI051080, PI051579); European Regional Development Fund (MICINN-FEDER).Peer Reviewe

Insulin resistance and impaired glucose tolerance in obese children and adolescents

In developed countries, obesity prevalence has strongly increased in the last decades. This has also been observed in children and adolescents. Until recently, type 2 diabetes mellitus was considered very rare among children and adolescents; however, in the last decades, some cases have been observed mainly in obese adolescents of some minority populations. The aim of our study was to assess the prevalence of type 2 diabetes, impaired glucose tolerance (IGT) and insulin resistance, and it's main metabolic features, in obese children and adolescents. We have studied 95 obese children and adolescents, 53 males and 42 females, aged 4-16 years. The prevalence of IGT in the obese children and adolescents studied was 7.4%; there was not any child with type 2 diabetes. Fasting glucose and insulin serum concentrations do not showed significant differences between obese children with or without IGT; however, 120 minutes after an oral glucose tolerance test, glucose and insulin serum concentrations showed significant differences between both groups. Insulin resistance was defined as a HOMA index higher than 4. The prevalence of insulin resistance in the obese children studied was 35.8%. Trygliceride serum concentrations were higher and HDL-C serum concentrations were lower in obese children with IGT than in those without IGT, but differences were not statistically significant. IGT and insulin resistance are frequent in obese children and adolescents; early institution of treatment in obese children and adolescents with IGT, has the best chance of reversing progression to b-cell failure and to prevent type 2 diabetes.La prevalencia de obesidad en los países desarrollados ha aumentado de manera alarmante en las últimas décadas. Esto se ha observado también en niños y adolescentes. Clásicamente, la diabetes tipo 2 se consideraba muy rara en niños y adolescentes; sin embargo, en las últimas décadas, se han observado algunos casos, especialmente en adolescentes obesos de algunas poblaciones minoritarias. El objetivo de nuestro estudio consiste en valorar la prevalencia de diabetes tipo 2, intolerancia a la glucosa (IG) y resistencia a la insulina, y sus principales manifestaciones, en niños y adolescentes obesos. Se estudiaron 95 niños y adolescentes obesos, 53 varones y 42 mujeres, de 4 a 16 años. La prevalencia de IG en los niños y adolescentes obesos estudiados fue de 7.4%; no se detectó ningún niño con diabetes tipo 2. Las concentraciones séricas en ayunas de glucosa e insulina no mostraron diferencias significativas entre los niños obesos con y sin IG; sin embargo, 120 minutos después de la sobrecarga oral con glucosa, las concentraciones séricas de glucosa e insulina mostraron diferencias significativas entre ambos grupos. La resistencia a la insulina se definió cuando el índice HOMA fue mayor que 4. La prevalencia de resistencia a la insulina en los niños obesos estudiados fue 35.8%. Las concentraciones séricas de triglicéridos fueron mayores y las de HDL-C menores en los niños obesos con IG que en aquellos que no la presentaban, pero las diferencias no fueron estadísticamente significativas. La IG y la resistencia a la insulina son frecuentes en niños y adolescentes obesos; el inicio de un tratamiento precoz en los niños y adolescentes obesos con IG puede evitar el deterioro de la función de las células b y contribuir a prevenir la aparición de diabetes tipo 2 en el futuro

Psyllium fibre and the metabolic control of obese and adolescents

Insulin resistance and impaired glucose tolerance are frequently observed in obese children and adolescents. In children and adolescents from developed countries, obesity prevalence has strongly increased in the last decades. Some dietary components like low glycemic index foods and dietary fibre could be used in order to improve glucose homeostasis in these children. Psyllium or ispaghula husk (the husk of the seeds of Plantago ovata) is a mixture of neutral and acid polysaccharides with a rest of galacturonic acid with ratio of soluble / insoluble fibre of 70 / 30; some foods could potentially be enriched with psyllium, like breads, breakfast cereals, pasta and snacks. The aim of this review was to assess the usefulness of psyllium in the management of obese children and adolescents with abnormalities of carbohydrate and lipid metabolism. After psyllium supplementation, the percentage change in postprandial glucose in type 2 diabetes patients, ranged from -12.2 to -20.2%. In hypercholesterolemic children, the effect of psyllium in LDL-cholesterol serum concentrations ranged from 2.78 to -22.8%; the effect in HDL-cholesterol from -4.16 to 3.05%; and the effect on triglycerides from 8.49 to -19.54%. The reviewed evidence seems to show that psyllium improves glucose homeostasis and the lipid and lipoprotein profile; however, more well controlled trials and basic studies are needed to clarify it's effects and the basic mechanisms involved in it's effect.La resistencia a la insulina y la intolerancia a la glucosa se observan con frecuencia en niños y adolescentes obesos. La prevalencia de la obesidad ha aumentado de manera considerable en las últimas décadas en los niños y adolescentes de los países desarrollados. Algunos componentes de la dieta, como los alimentos con un índice glucémico bajo o la fibra dietética se podrían usar para mejorar la homeostasis de la glucosa en estos niños. El psyllium es la piel de las semillas de Plantago ovata, que constituyen una mezcla de ácidos polisacáridos neutros con un resto de ácido galacturónico y una relación fibra soluble / insoluble de 70 / 30. Algunos alimentos pueden ser enriquecidos potencialmente con psyllium, como el pan, los cereales de desayuno, la pasta y los snacks. En esta revisión se valora la utilidad del psyllium para el tratamiento de los niños y adolescentes con anomalías del metabolismo de los hidratos de carbono y los lípidos. En pacientes con diabetes tipo 2, tras la suplementación con psyllium, el porcentaje de cambio en la glucosa postprandial oscilaba entre -12.2 y -20.2%. En niños con hipercolesterolemia, el efecto del psyllium en las concentraciones séricas de LDL-colesterol oscilaba entre 2.78 y -22.8%, el efecto en HDL-colesterol entre -4.16 y 3.05%; y el efecto en los triglicéridos entre 8.49 y -19.54%. Los estudios revisados parecen mostrar que el psyllium mejora la homeostasis de la glucosa y el metabolismo de los lípidos y lipoproteinas; sin embargo, se necesitan más estudios controlados e investigación básica con el fin de aclarar sus efectos y los mecanismos básicos involucrados en ellos

Interplay between weight loss and gut microbiota composition in overweight adolescents

10 pages.-- PMID: 19390523 [PubMed].-- Printed version published Oct 2009.-- EVASYON Study Group.The aim of this study was to determine the influence of an obesity treatment program on the gut microbiota and body weight of overweight adolescents. Thirty-six adolescents (13–15 years), classified as overweight according to the International Obesity Task Force BMI criteria, were submitted to a calorie-restricted diet (10–40%) and increased physical activity (15–23 kcal/kg body weight/week) program over 10 weeks. Gut bacterial groups were analyzed by quantitative real-time PCR before and after the intervention. A group of subjects (n = 23) experienced >4.0 kg weight loss and showed significant BMI (P = 0.030) and BMI z-score (P = 0.035) reductions after the intervention, while the other group (n = 13) showed <2.0 kg weight loss. No significant differences in dietary intake were found between both groups. In the whole adolescent population, the intervention led to increased Bacteroides fragilis group (P = 0.001) and Lactobacillus group (P = 0.030) counts, and to decreased Clostridium coccoides group (P = 0.028), Bifidobacterium longum (P = 0.031), and Bifidobacterium adolescentis (P = 0.044) counts. In the high weight–loss group, B. fragilis group and Lactobacillus group counts also increased (P = 0.001 and P = 0.007, respectively), whereas C. coccoides group and B. longum counts decreased (P = 0.001 and P = 0.044, respectively) after the intervention. Total bacteria, B. fragilis group and Clostridium leptum group, and Bifidobacterium catenulatum group counts were significantly higher (P < 0.001–0.036) while levels of C. coccoides group, Lactobacillus group, Bifidobacterium, Bifidobacterium breve, and Bifidobacterium bifidum were significantly lower (P < 0.001–0.008) in the high weight–loss group than in the low weight–loss group before and after the intervention. These findings indicate that calorie restriction and physical activity have an impact on gut microbiota composition related to body weight loss, which also seem to be influenced by the individual's microbiota.Peer reviewe

Shifts in clostridia, bacteroides and immunoglobulin-coating fecal bacteria associated with weight loss in obese adolescents

10 pages, 4 tables, 3 figures.-- Online version published 9 December 2008[Objective]: To evaluate the effects of a multidisciplinary obesity treatment programme on fecal microbiota composition and immunoglobulin-coating bacteria in overweight and obese adolescents and their relationship to weight loss.[Design]: Longitudinal intervention study based on both a calorie-restricted diet (calorie reduction=10–40%) and increased physical activity (calorie expenditure=15–23 kcal/kg body weight per week) for 10 weeks.[Participants]: Thirty-nine overweight and obese adolescents (BMI mean 33.1 range 23.7–50.4; age mean 14.8 range, 13.0–16.0).[Measurements]: BMI, BMI z-scores and plasma biochemical parameters were measured before and after the intervention. Fecal microbiota was analyzed by fluorescent in situ hybridization. Immunoglobulin-coating bacteria were detected using fluorescent-labelled F(ab')2 antihuman IgA, IgG and IgM.[Results]: Reductions in Clostridium histolyticum and E. rectale-C. coccoides proportions significantly correlated with weight and BMI z-score reductions in the whole adolescent population. Proportions of C. histolyticum, C. lituseburense and E. rectale-C. coccoides dropped significantly whereas those of the Bacteroides-Prevotella group increased after the intervention in those adolescents who lost more than 4 kg. Total fecal energy was almost significantly reduced in the same group of adolescents but not in the group that lost less than 2.5 kg. IgA-coating bacterial proportions also decreased significantly in participants who lost more than 6 kg after the intervention, paralleled to reductions in C. histolyticum and E. rectale-C. coccoides populations. E. rectale-C. coccoides proportions also correlated with weight loss and BMI z-score reduction in participants whose weight loss exceeded 4 kg.[Conclusions]: Specific gut bacteria and an associated IgA response were related to body weight changes in adolescents under lifestyle intervention. These results suggest interactions between diet, gut microbiota and host metabolism and immunity in obesity.This work was supported by grants AGL2005- 05788-C02-01 from the Spanish Ministry of Education (MEC) and AP 002/07 from Consejería de Sanidad (Valencia, Spain). The EVASYON study was supported by grants from Spanish Ministry of Health (PI051574).Peer reviewe