Components of the metabolic syndrome are negative predictors of weight loss in obese children with lifestyle intervention.
OBJECTIVE
Insulin resistance has been proposed to be associated with weight gain in obesity. Therefore, we analyzed the impact of insulin resistance and its associated cardiovascular risk factors (CRFs) summarized in the Metabolic Syndrome (MetS) on change of weight status in obese children.


METHODS
We analyzed 484 obese children who had participated in a lifestyle intervention and 533 obese children without lifestyle intervention. The changes of BMI-SDS in the time period of 1-year were related to baseline fasting insulin resistance index HOMA, blood pressure, waist circumference, waist-to-height ratio, lipids, uric acid, and HbA1c.


RESULTS
In contrast to obese children without lifestyle intervention, BMI-SDS decreased and the majority of CRFs improved significantly in obese children with lifestyle intervention. Age, BMI, waist circumference, waist-to-height ratio, blood pressure, uric acid, triglycerides, and HOMA were negatively significantly related to reduction of BMI-SDS in children with lifestyle intervention. In multiple linear regression analysis adjusted for gender, pubertal stage, and treatment center (R² = 0.26), waist circumference (r = -0.016 [confidence interval -0.019 up to -0.013], p < 0.001) was the strongest negative predictor of weight loss in children with lifestyle intervention. In children without lifestyle intervention, we did not find significant relationships between change of BMI-SDS and CRFs including insulin resistance in multiple regression analysis.


CONCLUSIONS
Insulin resistance and components of the MetS were associated negatively with weight loss in lifestyle intervention. Waist circumference at baseline was the strongest negative predictor of weight loss suggesting that obese children with abdominal fat distribution need more intensive interventions. This study is registered at clinicaltrials.gov (NCT00435734).
Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany.
Yvonne
Y
Uysal
Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany.
Barbara
B
Wolters
Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany.
Caroline
C
Knop
Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany. Electronic address: T.Reinehr@kinderklinik-datteln.de.
Thomas
T
Reinehr
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control; D002648:Child; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000628:therapy*; D009765:Obesity / Q000097:blood* / Q000628:therapy*; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood; D055105:Waist Circumference; D049629:Waist-Hip Ratio; D015431:Weight Loss
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D008055:Lipids; D014280:Triglycerides; D014527:Uric Acid
Glucose metabolism; Insulin resistance; Lifestyle intervention; Prediction; Waist circumference; Weight loss