Cardiovascular risk factors after intervention

Nutrition Research Newsletter, Oct, 2006

As many studies have showed us, obese children tend to become obese adults. Some obese children and adolescents go on to exhibit a characteristic profile of hypertension, high low-density lipoprotein (LDL) and total cholesterol and insulin resistance. This profile may create favorable conditions for atherogenic CVD.

The correct approach to reducing the obesity-related health risk is to lose weight and to change body composition. Only a few studies show that a reduction in BMI in childhood leads to an improvement in the atherogenic risk-factor profile. The data on whether these benefits regarding the CVD risk factors are sustained after an intervention are limited. Therefore, a group of German researchers analyzed the changes in weight status and in the atherogenic risk-factor profile of obese children participating in a one-year intervention program one year after the end of intervention.

Two hundred and forty obese children aged 6 years to 14 years and 12 normal weight children of the same age and sex were included in this study. Of the obese children, 203 of them participated in an outpatient long-term intervention program over the course of two years, which included physical exercise, nutrition education, and behavior therapy. BMI, blood pressure (BP), lipids and homeostasis model assessment index of insulin resistance (HOMA-IR) were analyzed over the course of two years.

At baseline, the obese children had significantly higher BP, HOMA-IR, and insulin, triacylglycerol, and LDL-cholesterol concentrations and lower high-density lipoprotein (HDL)-cholesterol concentrations than did normal weight children. Of the children who completed the intervention program, standard deviation score (SDS)-BMI decreased in 126 children (72%), whereas 48 children had no reduction. In these 126 children who reduced their SDS-BMI, BP (8% and 12% decreases in systolic and diastolic BP, respectively), lipids (12% and 5% decreases in triacylglycerol and LDL-cholesterol, respectively), insulin (13% decrease) and HOMA-IR (17% decrease) improved significantly. No significant improvement in CVD risk factors in the children without SDS-BMI reduction in the intervention group was observed. Reduction in SDS-BMI and all benefits regarding CVD risk factors were sustained one year after the end of the intervention in the children whose SDS-BMI decreased.

The results showed that a long-term multidisciplinary intervention led to a reduction in SDS-BMI in most of the children, which was associated with a clinically significant improvement in CVD risk factors. Some limitations of this study included that it was not randomized and that data on fat distribution, which is also closely related to CVD risk factors, was not available for the German children. Thomas Reinehr, Gideon de Sousa, Andre Michael Toschke, and Werner Andler, Long-Term Follow-Up of Cardiovascular Disease Risk Factors in Children After an Obesity Intervention, Am J Clin Nutr; 84:490-496 (September 2006) [Address reprint requests and correspondence to T Reinehr, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, DrF Steiner STrasse 5,45711 Datteln, Germany. E-mail: t.reinehr@kinderklinikdatteln.de]