Cardiovascular Risk Factors in Portuguese Obese Children and Adolescents: Impact of Small Reductions in Body Mass Index Imposed by Lifestyle Modifications



Henrique Nascimento1, 2, Elísio Costa 3, Petronila Rocha-Pereira 4, Carla Rego 5, Helena Ferreira Mansilha 6, Alexandre Quintanilha 2, 7, Alice Santos-Silva 1, 2, Luís Belo*, 1, 2
1 Departamento de Bioquímica, Faculdade de Farmácia, Universidade do Porto, 4050-047 Porto, Portugal
2 Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4150-180 Porto, Portugal
3 Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Rua Dr. António Bernardino de Almeida,P-4200-072 Porto, Portugal
4 Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, 6200-506 Covilhã, Portugal
5 Unidade de Nutrição / Serviço de Pediatria. UAG-MC. Hospital de S. João E.P.E. Faculdade de Medicina,Universidade do Porto; 4200-319 Porto, Portugal
6 Hospital Crianças Maria Pia - Centro Hospitalar do Porto; 4050-111 Porto, Portugal
7 Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4099-003 Porto, Portugal


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© Nascimento et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http: //creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Departamento de Bioquímica,Faculdade de Farmácia da Universidade do Porto, Rua Aníbal Cunha, 164,4050-047 Porto, Portugal; Tel: +351-222078906; Fax: +351-222003977;E-mail: luisbelo@ff.up.pt


Abstract

Objectives:

Evaluate cardiovascular risk factors in Portuguese obese children and adolescents and the long-term effects of lifestyle modifications on such risk factors.

Design:

Transversal cohort study and longitudinal study.

Setting:

University Hospital S. João and Children’s Hospital Maria Pia, Porto.

Patients/Participants:

148 obese children and adolescents [81 females (54.7%); mean age of 11.0 years] and 33 controls (sex and age matched) participated in a cross-sectional study. Sixty obese patients agreed to participate in an one year longitudinal study after medical and nutritionist appointments to improve lifestyle modification; a substantial body mass index (BMI) reduction was defined by a decrease in BMI z-score (BMI z-sc) of 0.3 or more over the studied period.

Main Outcome measures:

Lipid profile (triglycerides, cholesterol, HDLc, LDLc, lipoprotein (a), apolipoproteins A and B) and circulating levels of C-reactive protein (CRP), adiponectin, glucose, and insulin.

Results:

Compared with the lean children, obese patients demonstrated statistically significantly higher insulin resistance index [Homeostasis model assessment (HOMA)], and triglycerides, LDLc, apolipoprotein (apo) B, insulin and CRP concentrations, whereas their HDLc and apo A levels were significantly lower (cross-sectional study). In the longitudinal study (n=60), a substantial BMI reduction occurred in 17 (28.3%) obese patients which led to a significant reduction in triglycerides, cholesterol, LDLc, apo B, glucose and insulin levels and in HOMA. The ΔBMI values over the studied period correlated inversely and significantly with BMI (P<0.001) and HOMA (P=0.026) values observed at baseline. In multiple linear regression analysis, BMI at baseline remained associated to changes in BMI over the studied period (standardised Beta: -0.271, P=0.05).

Conclusion:

Our data demonstrates that small reductions in BMI-zc, imposed by lifestyle modifications in obese children and adolescents, improve the cardiovascular risk profile of such patients. Furthermore, patients with higher BMI and/or insulin resistance seem to experience a greater relative reduction in their BMI after lifestyle improvements.

Keywords: Lipid profile, insulin resistance, inflammation, childhood obesity, lifestyle modifications.