饮食限制结合不同形式运动对肥胖儿童炎症因子及肠道菌群的影响

Effects of dietary restriction combined with different exercises on inflammatory factors and gut microbiota in obese children

目的 比较有氧运动、抗阻训练及有氧运动结合抗阻训练(联合运动)和饮食限制对肥胖儿童炎症因子及肠道菌群的影响,为改善肥胖儿童的健康水平提供参考。方法 于2022年8—9月,通过网上发布通知及家长群发放微信的形式招募闽江师范高等专科学校附属实验小学10~12岁的肥胖儿童70名,采用随机数字表法分为饮食限制组(DR组,18名)、有氧运动结合饮食限制组(AE+DR组,18名)、抗阻训练结合饮食限制组(RT+DR组,17名)及联合运动结合饮食限制组(ART+DR组,17名)。2022年9—11月各组进行不同方式干预,DR组每日饮食摄入的能量依据静息能耗确定;AE+DR组运动干预主要包括跳绳、有氧操、慢跑及体育游戏,每次50 min;RT+DR组抗阻训练强度为(65%~85%)1个重复一次的最大力量,共10个动作;ART+DR组运动训练包括抗阻训练(20 min)、有氧运动(20 min),准备及放松阶段各5 min。DR及运动干预时间为8周(每周4次,周一、二、四、五)。不同方式干预前后,采用酶联免疫吸附试验检测血清炎症因子水平,经平板菌落计数法计算粪便菌群含量。结果 与干预前比较,干预后AE+DR组、RT+DR组及ART+DR组血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及C-反应蛋白(CRP)水平和粪肠球菌、大肠杆菌含量均下降,乳酸杆菌及双歧杆菌含量均增加(t值分别为7.19,7.15,4.57,5.42,5.15,-3.51,-7.30;5.14,3.64,3.02,3.27,5.00,-3.09,-3.75;7.10,10.86,7.74,10.92,9.26,-6.63,-6.33);DR组仅血清TNF-α、CRP水平和粪肠球菌含量下降,乳酸杆菌及双歧杆菌含量均增加(t值分别为2.74,2.22,2.14,-2.21,-2.81)(P值均<0.05)。不同方式干预8周后,4组肥胖儿童粪肠球菌群、大肠杆菌、乳酸杆菌、双歧杆菌和血清TNF-α、IL-6、CRP水平变化量差异均有统计学意义(H值分别为22.22,23.75,13.44,28.33,18.02,33.64,25.14,P值均<0.01);且ART+DR组肥胖儿童粪肠球菌群和血清TNF-α、IL-6、CRP水平下降量,以及乳酸杆菌增加量均高于其他3组。结论 饮食限制及饮食限制结合不同形式运动均可使肥胖儿童炎症因子及肠道菌群发生有益的变化,联合运动及有氧运动结合饮食限制在肥胖儿童中更加有效。

Objective To compare the effects of aerobic exercise,resistance training,and a combination of aerobic exercise and resistance training(combined exercise)with dietary restrictions on inflammatory factors and gut microbiota in obese children,so as to provide the reference for improving the health level of obese children.Methods From August to September 2022,a total of 70 obese children aged 10-12 from the Affiliated Experimental Primary School of Minjiang Normal University were recruited through online notifications and WeChat distribution through parent groups.Participants were divided into dietary restriction(DR,n=18)group,aerobic exercise combined with dietary restriction(AE+DR,n=18)group,resistance training combined with dietary restriction(RT+DR,n=17)group and combined exercise combined with dietary restriction(ART+DR,n=17)group,through random number table method.From September to November 2022,each group received different interventions.The daily dietary intake of calories in the DR group was determined according to resting energy consumption.The AE+DR group intervention mainly included skipping rope,aerobics exercises,jogging and sports games,and were maintained for each session lasting 50 minutes.For RT+DR group,the exercise intensity of resistance training was(65%-85%)maximum strength,with a total of 10 actions.The ART+DR group included resistance training(20 minutes),aerobic exercise(20 minutes),preparation and relaxation phases for 5 minutes each.The DR and exercise intervention was administered for 8 weeks(4 times a week for Monday,Tuesday,Thursday and Friday).Before and after different intervention methods,serum inflammatory factors were detected by enzyme-linked immunosorbent assay(ELISA)and intestinal flora was calculated by plate colony counting method.Results Compared to those before intervention,the levels of serum TNF-α,IL-6 and CRP,and the contents of enterococcus and escherichia coli in the faeces significantly decreased,while the contents of lactobacillus and bifidobacterium in the faeces significantly increased after intervention(t=7.19,7.15,4.57,5.42,5.15,-3.51,-7.30;5.14,3.64,3.02,3.27,5.00,-3.09,-3.75;7.10,10.86,7.74,10.92,9.26,-6.63,-6.33,P<0.05)in AE+DR,RT+DR and ART+DR groups.The levels of serum TNF-αand CRP and enterococcus decreased significantly,and the contents of lactobacillus and bifidobacterium in the faeces increased significantly after intervention(t=2.74,2.22,2.14,-2.21,-2.81,P<0.05)in the DR Group.After 8 weeks of intervention with different methods,the change differences of enterococcus,escherichia coli,lactobacillus,bifidobacterium in the faeces,and serum TNF-α,IL-6 and CRP levels were statistically significantin the four groups of obese children(H=22.22,23.75,13.44,28.33,18.02,33.64,25.14,P<0.01).In addition,the decreases of enterococcus in the faeces and serum TNF-α,IL-6,CRP levels,and the increases of lactobacillus in the faeces were significantly higher than those in the other three groups.Conclusions Dietary restriction alone or combined with different exercises bring beneficial changes in the inflammatory factors and gut microbiota indicators in obese children.Combined exercise,as well as aerobic exercise combined with dietary restrictions are more reasonable and effective in obese children.