title: The role of multicomponent therapy in the metabolic syndrome, inflammation and cardiovascular risk in obese adolescents.
abstract: Obesity is characterised by low-grade inflammation, which increases the metabolic syndrome (MetS) and cardiovascular risks. The aim of the present study was to verify the role of multicomponent therapy in controlling the MetS, inflammation and carotid intima-media thickness (cIMT) in obese adolescents. The second aim was to investigate the relationships between adipokines, the MetS parameters and cIMT. A total of sixty-nine obese adolescents participated in the present study and completed 1 year of multicomponent therapy (a combination of strategies involving nutrition, psychology, physical exercise and clinical therapy), and were divided according to their MetS diagnosis as follows: MetS (n 19); non-MetS (n 50). Blood analyses of glucose, lipid and adipokine concentrations (adiponectin, leptin, plasminogen activator inhibitor 1 (PAI-1) and C-reactive protein) were collected. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index and homeostasis model assessment-adiponectin. cIMT and visceral and subcutaneous fat were estimated using ultrasonography. At baseline, the MetS group presented higher waist circumference, glucose and insulin levels, and systolic and median blood pressures compared with the non-MetS group. After therapy, both groups showed improvements in the anthropometric profile, body composition, insulin level, insulin resistance, insulin sensibility, TAG and VLDL-cholesterol, adiponectin, leptin and PAI-1 levels, blood pressure and cIMT. The prevalence of the MetS was reduced from 27·5 to 13·0 %. Metabolic syndrome patients showed resistance in the attenuation of total cholesterol and LDL-cholesterol (LDL-C) levels and leptin:adiponectin and adiponectin:leptin ratios. In the MetS group, the variation in the adiponectin:leptin ratio was correlated with variations in glucose, insulin sensibility, total cholesterol, LDL-c and systolic blood pressure. Additionally, the number of MetS parameters was correlated with the carotid measurement. Moreover, the variation in cIMT was correlated with the variations in insulin sensibility, total cholesterol and LDL-c. For the entire group, the number of MetS alterations was correlated with the leptin level and leptin:adiponectin ratio and adiponectin:leptin ratio after therapy. In conclusion, multicomponent therapy was effective in controlling the MetS, inflammation and cIMT in the obese adolescents. However, the MetS patients showed resistance in the attenuation of the atherogenic lipid profile and leptin:adiponectin ratio and adiponectin:leptin ratio. These results suggest that the MetS patients have increased cardiovascular risks, and that it is important to attempt to control the inflammatory process that occurs due to obesity in clinical practice in order to improve the health of adolescents.
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Deborah C L
authors.initials: DC
authors.lastname: Masquio
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Aline
authors.initials: A
authors.lastname: de Piano
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Raquel M S
authors.initials: RM
authors.lastname: Campos
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Priscila L
authors.initials: PL
authors.lastname: Sanches
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: June
authors.initials: J
authors.lastname: Carnier
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Flávia C
authors.initials: FC
authors.lastname: Corgosinho
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Bárbara D M
authors.initials: BD
authors.lastname: Netto
authors.affiliation: Post-Graduate Program of Interdisciplinary Health Science, Universidade Federal de São Paulo,Santos-SP,Brasil.
authors.forename: Joana P
authors.initials: JP
authors.lastname: Carvalho-Ferreira
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Lila M
authors.initials: LM
authors.lastname: Oyama
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Claudia M O
authors.initials: CM
authors.lastname: Nascimento
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Marco T
authors.initials: MT
authors.lastname: de Mello
authors.affiliation: Department of Psycobiology,Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Post-Graduate Program of Nutrition, Universidade Federal de São Paulo,São Paulo-SP,Brasil.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Dâmaso
mesh_terms: D054392:Adipokines / Q000097:blood; D052242:Adiponectin / Q000097:blood; D050154:Adiposity; D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001823:Body Composition; D015992:Body Mass Index; D001938:Brazil; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D003131:Combined Modality Therapy; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D044623:Nutrition Therapy; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011613:Psychotherapy; D012307:Risk Factors; D016896:Treatment Outcome; D055105:Waist Circumference
chemical_list: D054392:Adipokines; D052242:Adiponectin; D001786:Blood Glucose; D007328:Insulin; D020738:Leptin; D008055:Lipids; D017395:Plasminogen Activator Inhibitor 1; D002097:C-Reactive Protein
keywords: Adiponectin; Carotid intima-media thickness; Inflammation; Leptin; Metabolic syndrome; Obesity