Prevention and treatment of obesity with lifestyle interventions: review and meta-analysis

Summary Objective: To assess the mid- to long-term effectiveness of lifestyle interventions in the prevention and treatment of obesity. Methods: A systematic literature review with meta-analysis was performed. Electronic databases, reference lists, books and reports covering topic of obesity were searched. The included studies were randomized clinical trials of lifestyle interventions in overweight and obese subjects that had a minimum observation period of one year. Outcomes evaluated were measurements of body weight, body mass index, waist circumference, systolic and diastolic blood pressure, blood lipids: total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride, blood glucose control: two-hour plasma glucose, fasting plasma glucose, and glycosylated haemoglobin. Results: Thirteen studies have been selected in the prevention and seventeen in the treatment of obesity. Compared with standard care, lifestyle intervention reduced significantly body weight, body mass index, waist circumference, blood pressure, blood lipids and blood glucose in overweight and obese people. The favorable effects were maintained up to three years. Conclusions: Lifestyle interventions were efficacious in the mid- to long-term prevention and treatment of obesity leading to a significant reduction in body weight and cardiovascular risk factors. Submitted: 18 October 2006; Revised: 6 June 2007; Accepted: 28 August 2007     

Prenatal Programming of Childhood Overweight and Obesity

Objective: To review the scientific evidence for prenatal programming of childhood overweight and obesity, and discuss its implications for MCH research, practice, and policy. Methods: A systematic review of observational studies examining the relationship between prenatal exposures and childhood overweight and obesity was conducted using MOOSE guidelines. The review included literature posted on PubMed and MDConsult and published between January 1975 and December 2005. Prenatal exposures to maternal diabetes, malnutrition, and cigarette smoking were examined, and primary study outcome was childhood overweight or obesity as measured by body mass index (BMI) for children ages 5 to 21. Results: Four of six included studies of prenatal exposure to maternal diabetes found higher prevalence of childhood overweight or obesity among offspring of diabetic mothers, with the highest quality study reporting an odds ratio of adolescent overweight of 1.4 (95% CI 1.0–1.9). The Dutch famine study found that exposure to maternal malnutrition in early, but not late, gestation was associated with increased odds of childhood obesity (OR 1.9, 95% CI 1.5–2.4). All eight included studies of prenatal exposure to maternal smoking showed significantly increased odds of childhood overweight and obesity, with most odds ratios clustering around 1.5 to 2.0. The biological mechanisms mediating these relationships are unknown but may be partially related to programming of insulin, leptin, and glucocorticoid resistance in utero. Conclusion: Our review supports prenatal programming of childhood overweight and obesity. MCH research, practice, and policy need to consider the prenatal period a window of opportunity for obesity prevention. Disclaimer: The opinions expressed in this paper are the authors’ and do not necessarily reflect the views or policies of the institutions with which the authors are affiliated.     

A comparison of the sensitivity and specificity of anthropometric measurements to predict unhealthy metabolic phenotype in overweight and obese women

Aim

Metabolically Healthy Obese (MHO) is called to obese people that their insulin sensitivity, lipid profiles and inflammatory profiles are favorable, and there are no signs of hypertension and cardio-metabolic diseases. The metabolically unhealthy obese (MUHO) is the opposite. A Body Shape Index (ABSI) is a marker to identifying abdominal obesity that is derived from weight, height and waist circumference (WC). Several studies have reported ABSI is associated with diabetes, metabolic syndrome, hypertension and higher mortality rate.

Association between short sleeping hours and overweight in adolescents: results from a US Suburban High School survey

Insufficient sleep may lead to adverse health effects, influencing body weight. This study quantified the prevalence of short sleep and the association between sleep duration and overweight in a sample of suburban students. Cross-sectional study was conducted in 2004, involving 529 students from Bay High School, Bay Village, OH, USA, using self-administered questionnaires assessing lifestyle and sleep behaviors. Students with a body mass index Z Score >85th percentile for sex and age were deemed overweight. Ninety percent of students reported average sleep time less than 8 h on school nights, with 19% reported less than 6 h of sleep per night. Twenty percent of the sample were overweight. Overweight was significantly associated with the male gender, increased caffeine consumption, and short sleep duration. Compared with students sleeping >8 h, the age and gender-adjusted odds ratio of overweight was 8.53 (95% CI: 2.26, 32.14) for those with <5 h sleep (P = 0.0036); 2.79 (1.03, 7.55) for those with 5–6 h sleep; 2.81 (1.14, 6.91) for those with 6–7 h sleep; and 1.29 (0.52, 3.26) for those with 7–8 h sleep. Short sleep duration was common and associated with overweight with evidence of a “dose–response” relationship. These results confirm a high prevalence of short sleep among suburban high school students and provide additional support suggesting significant association between short sleeping hours and overweight. There are no financial disclosures from any of the authors.     

High irisin levels in overweight/obese children and its positive correlation with metabolic profile,blood pressure,and endothelial progenitor cells

Background and aims

Irisin is involved in the compensatory mechanisms for metabolic regulation and appears to be associated with glucose homeostasis and lipid profile. However, it's possible implications on obesity-associated cardiometabolic complications have not been completely elucidated. This study aimed to investigate the association between irisin level and anthropometric data, metabolic parameters, blood pressure, and endothelial progenitor cells (EPCs) level among children with overweight/obesity.

Metabolic Syndrome and Importance of Associated Variables in Children and Adolescents in Guabiruba - SC,Brazil

Background

The risk factors that characterize metabolic syndrome (MetS) may be present in childhood and adolescence, increasing the risk of cardiovascular disease in adulthood.

Objective

Evaluate the prevalence of MetS and the importance of its associated variables, including insulin resistance (IR), in children and adolescents in the city of Guabiruba-SC, Brazil.

Methods

Cross-sectional study with 1011 students (6-14 years, 52.4% girls, 58.5% children). Blood samples were collected for measurement of biochemical parameters by routine laboratory methods. IR was estimated by the HOMA-IR index, and weight, height, waist circumference and blood pressure were determined. Multivariate logistic regression models were used to examine the associations between risk variables and MetS.

Results

The prevalence of MetS, IR, overweight and obesity in the cohort were 14%, 8.5%, 21% and 13%, respectively. Among students with MetS, 27% had IR, 33% were overweight, 45.5% were obese and 22% were eutrophic. IR was more common in overweight (48%) and obese (41%) students when compared with eutrophic individuals (11%; p = 0.034). The variables with greatest influence on the development of MetS were obesity (OR = 32.7), overweight (OR = 6.1), IR (OR = 4.4; p ≤ 0.0001 for all) and age (OR = 1.15; p = 0.014).

Conclusion

There was a high prevalence of MetS in children and adolescents evaluated in this study. Students who were obese, overweight or insulin resistant had higher chances of developing the syndrome.     

Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer

ObjectiveAssess the effect of class III (body mass index [BMI, kg/m²] 40–49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle.DesignCohort studySettingAcademic centerPatientsPatients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5–24.9 (n = 4913), 25–29.9 (n = 1566) 30–34.9 (n = 559), 35–39.9 (n = 218), and ≥ 40 (n = 114).InterventionNoneMain outcome measureLive birth rateResultsFollowing embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55–4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = <0.001).ConclusionOverall, patients with a BMI > 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-020-02011-1.     

超重和肥胖对妊娠期糖尿病围产结局的影响

目的探讨超重和肥胖与妊娠期糖尿病患者妊娠结局的关系。方法 2010年1月～2011年12月在我院门诊产检确诊为妊娠期糖尿病患者,根据孕前体重指数(Body Mass Index BMI,kg/m2)分为:正常体重组(BMI 18.5～24.9)、超重组(BMI 25.0～29.9)、肥胖组(BMI≥30)。使用饮食控制或胰岛素治疗控制血糖水平。观察其妊娠并发症及妊娠结局。结果 604例妊娠期糖尿病孕妇中BMI正常体重241例(占39.90%),超重211例(占34.93%),肥胖152例(占25.17%)。超重与肥胖妊娠期糖尿病孕妇经辅助生育技术后妊娠,高龄产妇,巨大儿与急诊剖宫产的发生率显著高于正常组;肥胖组胎膜早破与子痫前期发生率,剖宫产率显著高于超重组及正常组;肥胖组顺产率显著低于正常组,肥胖组早产胎膜早破率显著高于正常组。结论妊娠前肥胖和超重可增加妊娠期糖尿病孕妇不良妊娠结局的风险。加强健康教育,适度控制孕前体重,可预防妊娠期糖尿病并发症,改善妊娠结局。     

2000年与2010年青岛市城乡中小学生营养状况分析

[目的]了解青岛市中小学生营养状况的变化,对学生进行营养指导提供科学依据。[方法]2011年9月,对2000年、2010年青岛市学生体质与健康调研资料中中小学生身高、体重检测资料进行分析。[结果]城区男生、城区女生、乡村男生、乡村女生,2000年分别调查891、819、909、948人,体重指数分别为20.33±4.07、19.09±3.59、18.51±3.42、17.91±2.99;2010年分别调查1 373、1 321、1 301、1 281人,体重指数分别为20.55±4.61、19.22±3.75、19.76±3.71、18.76±3.22(P>0.05、P>0.05、P<0.01、P<0.01)。调查对象营养不良率,2000年为6.31%,2010年为5.29%(P<0.05);超重、肥胖率,2000年为17.60%,2010年为26.19%(P<0.01)。[结论]2010年与2000年比较,青岛市城乡中小学生的营养不良率明显下降,超重、肥胖率明显升高。乡村学生超重、肥胖应重点关注。     

北京市西城区中学生体力活动情况及肥胖超重影响因素分析

目的了解北京市西城区中学生体力活动的情况,探讨中学生超重肥胖相关行为现状及影响因素,为制定干预措施提供科学依据。方法采取整群随机抽样方法,对北京市西城区9所中学59个班级1 930名在校生使用"北京市青少年健康相关行为调查问卷"进行调查。结果在过去7 d中,有74.8%和59.1%中学生分别参加体育锻炼和中等强度运动;平均每天看电视、玩电子游戏、上网超过2 h的报告率分别为24.9%,11.9%和31.9%。参加体育锻炼、中等强度运动、玩电子游戏行为报告率男生高于女生。职高学生、自感学习成绩差的中学生运动行为报告率较低,静态行为报告率较高。母亲文化程度越高,家庭类型为核心或大家庭中学生运动行为报告率越高,静态行为报告率越低。男生患超重肥胖的危险是女生的3.207倍;平均每天看电视超过4 h的中学生患超重肥胖的危险是平均每天看电视不足1 h中学生的1.755倍。结论广泛开展健康教育,增强中学生健康理念,引导科学运动,控制看电视、上网和玩电子游戏的时间,可以减少青少年超重和肥胖的发生。