Effects of exercise training on glucose metabolism indicators and inflammatory markers in obese children and adolescents:A metaanalysis

BACKGROUND Obesity in children and adolescents is a serious problem,and the efficacy of exercise therapy for these patients is controversial.AIM To assess the efficacy of exercise training on overweight and obese children based on glucose metabolism indicators and inflammatory markers.METHODS The PubMed,Web of Science,and Embase databases were searched for randomized controlled trials related to exercise training and obese children until October 2023.The meta-analysis was conducted using RevMan 5.3 software to evaluate the efficacy of exercise therapy on glucose metabolism indicators and inflammatory markers in obese children.RESULTS In total,1010 patients from 28 studies were included.Exercise therapy reduced the levels of fasting blood glucose(FBG)[standardized mean difference(SMD):-0.78;95%confidence interval(CI):-1.24 to-0.32,P=0.0008],fasting insulin(FINS)(SMD:-1.55;95%CI:-2.12 to-0.98,P<0.00001),homeostatic model assessment for insulin resistance(HOMA-IR)(SMD:-1.58;95%CI:-2.20 to-0.97,P<0.00001),interleukin-6(IL-6)(SMD:-1.31;95%CI:-2.07 to-0.55,P=0.0007),C-reactive protein(CRP)(SMD:-0.64;95%CI:-1.21 to-0.08,P=0.03),and leptin(SMD:-3.43;95%CI:-5.82 to-1.05,P=0.005)in overweight and obese children.Exercise training increased adiponectin levels(SMD:1.24;95%CI:0.30 to 2.18,P=0.01)but did not improve tumor necrosis factor-alpha(TNF-α)levels(SMD:-0.80;95%CI:-1.77 to 0.18,P=0.11).CONCLUSION In summary,exercise therapy improves glucose metabolism by reducing levels of FBG,FINS,HOMA-IR,as well as improves inflammatory status by reducing levels of IL-6,CRP,leptin,and increasing levels of adiponectin in overweight and obese children.There was no statistically significant effect between exercise training and levels of TNF-α.Additional long-term trials should be conducted to explore this therapeutic perspective and confirm these results.

Changes of ghrelin following oral glucose tolerance test in obese children with insulin resistance

AIM： To characterize changes in ghrelin levels in response to oral glucose tolerance test （OGTT） and to correlate changes in ghrelin levels with changes in insulin and glucose following OGTT in Chinese obese children of Tanner Ⅰ and Ⅱ stage with insulin resistance. METHODS： 22 obese children with insulin resistance state were divided into four groups according to their Tanner stage and gender： boys of Tanner Ⅰ （fir- Ⅰ ）, boys of Tanner Ⅱ（BT-Ⅱ ）, girls of Tanner Ⅰ （GT- Ⅰ ）, girls of Tanner Ⅱ （GT-Ⅱ）. Ghrelin, insulin and glucose were measured at 0, 30, 60 and 120 rain following OGTT. The control children with normal BMI were divided into control boys of Tanner Ⅰ （CBT- Ⅰ, n = 6）, control boys of Tanner Ⅱ （CBT-Ⅱ, n = 5）, control girls of Tanner Ⅰ （CGT- Ⅰ, n = 6）, control girls of Tanner Ⅱ （CGT-Ⅱ, n = 5）. Fasting serum ghrelin levels were analyzed. RESULTS： Ghrelin levels were lower in obese groups. Ghrelin levels of control group decreased in Tanner Ⅱ stage （CGT- Ⅰ vs CGT-Ⅱ t = -4.703, P = 0.001; CBT- Ⅰ vs CBT- Ⅱ t = -4.794, P = 0.001）. Basal ghrelin levels in fir-Ⅱ decreased more significantly than that in BT- Ⅰ group （t = 2.547, P = 0.029）. Ghrelin levels expressed a downward trend after OGTT among obese children. The decrease in ghrelin levels at 60 min with respect to basal values was 56.9% in BT- Ⅰ. Ghrelin concentrations at 0 min correlated directly with glucose level at 0 min in fir- Ⅰ （r = 0.898, P = 0.015）. There wasn＇t a significant correlation of ghrelin changes with glucose changes and insulin changes during OGTT in obese children with insulin resistance. CONCLUSION： In conclusion, in obese children with insulin resistance, ghrelin levels decreased with advancing pubertal stage. Ghrelin secretion suppression following OGTT was influenced by gender and pubertal stage. Baseline ghrelin levels and ghrelin suppression after OGTT did not significantly correlate with the degree of insulin resistance and insulin sensitivity.

Non-alcoholic fatty liver disease and metabolic syndrome in obese children

I read with great interest the article of Fu et al who investigated whether non-alcoholic fatty liver disease(NAFLD)is an early mediator for prediction of metabolic syndrome,and whether liver B-ultrasound could be used for its diagnosis,in a study involving 861 obese children(6-16 years old).In this study,it was reported that NAFLD is not only a liver disease,but also an early mediator that reflects metabolic disorder,and that liver B-ultrasound can be a useful tool for metabolic syndrome(MS)screening.The authors reported that NAFLD and MS were present in 68.18%and 25.67%of obese children,respectively.Moreover,they observed that the prevalence of MS in NAFLD children was 37.64%,which was much higher than that in the non-NAFLD group.Criteria analogous to those of the Adult Treatment PanelⅢdefinition for MS were used for children in this study.The reported prevalence data on MS in the young has varied markedly,in large part because of disagreement among the variously proposed definitions of MS.Therefore,in my opinion,a study aiming to assess the association between MS components and NAFLD in obese children has to take into account a simple,easy-to-apply clinical definition proposed by the international diabetes federation for MS.Interpretation of the results of the Fu et al study are limited byanother major caveat:that the diagnosis or exclusion of NAFLD was based on liver enzymes and ultrasound imaging,but was not confirmed by liver biopsy.Indeed,it is known that liver enzymes may be within the reference interval in up to 70%of patients with diagnosed NAFLD and that the full histopathological spectrum of NAFLD may be present in patients with normal liver enzymes,which therefore cannot be reliably used to exclude the presence of NAFLD.

Comparison of the Effects of Physiotherapy Group Exercise and Basketball on Quality of Life of Obese Children

Aim: To compare the effects of group exercises under physiotherapist control and basketball program on the quality of life of obese children. Methods: 45 obese children aged 10 years were randomly included to the physiotherapy (n=14), basketball (n:15), and control group (n:16). The children were assessed before and after 12-week study duration. The Pediatric Quality of Life Inventory (PedsQL) was used to determine and compare their quality of life (QoL). Results: No difference was found when the subheadings of the PedsQL were compared among the groups (p>0.05). When the changes were investigated within the groups, only significant increase was determined in the physical and emotional subheadings of the physiotherapy group (pConclusion: Although no change was determined in the quality of life, physiotherapy group exercise was found to be more successful to affect physical and emotional status of obese children.

Effect of lifestyle intervention on non-alcoholic fatty liver disease in Chinese obese children

AIM: To investigate the effect of lifestyle intervention on non-alcoholic fatty liver disease (NAFLD) in Chinese obese children. METHODS: Seventy-six obese children aged from 10 to 17 years with NAFLD were enrolled for a one-month intervention and divided randomly into three groups. Group1, consisting of 38 obese children, was an untreated control group without any intervention. Group 2, consisting of 19 obese children in summer camp, was strictly controlled only by life style intervention. Group 3, consisting of 19 obese children, received oral vitamin E therapy at a dose of 100 mg/d. The height, weight, fasting blood glucose (FBG), fasting serum insulin (FINS), plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), total cholesterol (TCHO) and homeostasis model assent- insulin resistance (HOMA-IR) were measured at baseline and after one month. All patients were underwent to an ultrasonographic study of the liver performed by one operator who was blinded to the groups. RESULTS: The monitor indices of BMI, ALT, AST, TG, TCHO and HOMA-IR were successfully improved except in group 1. BMI and ALT in group 2 were reduced more significantly than in group 3 (2.44 ± 0.82 vs 1.45 ± 0.80, P = 0.001; 88.58 ± 39.99 vs 63.69 ± 27.05, P = 0.040, respectively).CONCLUSION: Both a short-term lifestyle intervention and vitamin E therapy have an effect on NAFLD in obese children. Compared with vitamin E, lifestyle intervention is more effective. Therefore, lifestyle intervention should represent the first step in the management of children with NAFLD.

Characterization of Wnt1-inducible Signaling Pathway Protein-1 in Obese Children and Adolescents

Wnt1-inducible signaling pathway protein-1(WISP1),a member of the CCN family,is increasingly being recognized as a potential target for obesity and type 2 diabetes mellitus.Recent studies have shown that WISP1 can regulate low-grade inflammation in obese mice,and circulating WISP1 levels are associated with obesity and type 2 diabetes mellitus in adults.Herein,we measured serum WISP1 levels in obese youth and explored its relationships with pro-inflammatory cytokine interleukin 18(IL-18)and other metabolic indexes.Totally,44 normal-weight and 44 obese children and adolescents were enrolled.Physical and laboratory data were recorded,and then serum levels of WISP1 and IL-18 were determined by enzyme-linked immunosorbent assays.Results showed that serum levels of WISP1 were significantly higher in obese children and adolescents than in normal-weight healthy controls (1735.444-15.29 vs. 1364.084-18.69 pg/mL).WISP1 levels were significantly positively correlated with body mass index (BMI)and BMI z-score (r=0.392,P=0.008;r=0.474,P=0.001,respectively) in obese group;circulating IL-18 was increased in obese individuals (1229.064-29.42 vs. 295.874-13.30 pg/mL).Circulating WISP1 levels were significantly correlated with IL-18 (r=0.542,P<0.001),adiponectin (r=0.585,P<0.001)and leptin (r=0.592,P<0.001).The multivariate stepwise regression analysis showed that higher IL-18 levels represented the main determinant of increased WISP1 levels after adjusting for BMI,waist circumference, fasting insulin,homeostatic model assessment of insulin resistance (HOMA-IR)and HbAlc in obese individuals (β=0.542,P=0.000).WISP1 can be involved in glucose/lipid metabolism in obese youth,which may be modulated by IL-18.Increased WISP1 levels may be a risk factor of obesity and insulin resistance,and WISP1 has a potential therapeutic effect on insulin resistance in obese children and adolescents.

Physical activity and obese children

Childhood obesity is an epidemic of global proportions,accompanied by an alarming increase in various metabolic disorders.It would appear that childhood obesity stems largely from excessive energy intake and that it is the ensuing obesity that leads to physical inactivity in children,as opposed to initial physical inactivity inducing obesity.How changes in body composition that accompany obesity influence physical activity (PA) and the mechanistic basis for this remains poorly understood.This review provides an overview of the PA habits and body composition of the obese children.We suggest skeletal muscle metabolism as a key driver of PA.The role both quantitative and qualitative changes in skeletal muscle may play in oxidative metabolism in the obese children are discussed.There is a real need for research examining the mechanistic basis of physical inactivity in the obese.The dearth of information on the role of skeletal muscle metabolism in the PA of obese youngsters and the emergence of new technologies allowing cellular and metabolite mechanisms to be explored provides plenty of scope for future work.

Obese children with fatty liver: Between reality and disease mongering

Following the current epidemic of obesity, the worldwide prevalence of nonalcoholic fatty liver disease(NAFLD)has increased with potential serious health implications. While it is established that in adults NAFLD can progress to end-stage liver disease in many cases, the risk of progression during childhood is less well defined. Since most obese children are not adherent to lifestyle modifications and hypocaloric diets, there is a growing number of studies on pharmacological interventions with the risk of disease mongering, the practice of widening the boundaries of illness in order to expand the markets for treatment. Here, we propose a critical appraisal of the best available evidence about long-term course of pediatric NAFLD and efficacy of treatments other than hypocaloric diet and physical exercise. As a result, the number of NAFLD children with a poor outcome is small in spite of the alarming tones used in some papers; large-scale longitudinal studies with longterm follow-up of pediatric NAFLD patients are lacking; the studies on ancillary pharmacological interventions have been performed in few patients with inconclusive and conflicting results.

Diets of obese and non-obese children

Aim: To compare diets between obese and non-obese in children. Methods: Thirty-four obese and ten non-obese school children were recruited and their habitual factors of obesity were asked. Intakes of food in the obesity and non-obesity groups were checked using a model nutritional balance chart (MNBC). Results: Average intake ratio of food relative to ideal food intake was significantly higher in the non-obesity group than the obesity group. The relationship between obesity and exercise was significant but not significant for intake ratio of food, times watching TV and playing games. Conclusion: Food intake is not a primary factor of obesity but exercise is a key factor for obesity in school children. Since the effect of diet intervention in obese children was slight, exercise habit would be a more important strategy to reduce obesity than diet in school children.

The association of circulating interleukin-18 with fasting insulin and weight loss in obese children

Obesity is an independent risk factor for developing cardiovascular disease and increases insulin resistance in children. Interleukin (IL)-18 is a novel pro-inflammatory cytokine with potential atherogenetic properties. This study ai- med to identify circulating levels of IL-18 in obese children and examine the effects of combined nutritional education-physical activity course on circulating IL-18. Plasma IL-18, body mass index (BMI), fasting glucose and insulin, homeostasis model assessment insulin resistance (HOMA IR), lipid profile, uric acid, high- sensitive C-reactive protein (hs-CRP), and homocysteine were determined in 70 obese children aged 10-12 years before and after attending a 13-week weight reduction program, which included physical activities and nutritional education. Twenty-five age-matched non-obese children served as controls. At baseline, obese children had significantly higher levels of BMI, fasting insulin, HOMA IR, triglyceride (TG), uric acid, hs-CRP, and IL-18 but lower high-density lipoprotein-cholesterol (HDL-C) than non-obese children. Plasma IL-18 levels in obese children decreased significantly after the weight reduction program. At baseline, plasma IL-18 levels in obese children positively correlated with BMI, HOMA IR, insulin and TG but negatively correlated with HDL-C. There was a significant relationship between plasma IL-18 and BMI changes. Moreover, fasting insulin was responsible for IL-18 variability in obese children. These findings suggest that elevated plasma IL-18 levels in obese children are partly associated with parameters of obesity and insulin resistance, and are significantly affected by modest weight loss.

A New Mixed Clustering-Based Method to Analyze the Gait of Children with Cerebral Palsy

Cerebral palsy is a group of persistent central movement and posturaldevelopmental disorders, and restricted activity syndromes. This syndrome iscaused by non-progressive brain damage to the developing fetus or infants. Cerebralpalsy assessment can determine whether the brain is behind or abnormal. If itexists, early intervention and rehabilitation can be carried out as soon as possibleto restore brain function to the greatest extent. The direct external manifestation ofcerebral palsy is abnormal gait. Accurately determining the muscle strengthrelatedreasons that cause this abnormal gait is the primary problem for treatment.In this paper, clustering methods were used to compare and analyze the differencesbetween the abnormal and normal gait parameters of children with andwithout cerebral palsy. Since the collected data contains overlapping data thatmay be mutated, while the centroids are also different, the expected result is stratified.To solve this problem, a mixed clustering method is proposed that combinesthe advantages of K-means and hierarchical clustering, meaning that eachset of data shows a similar trend to specific parameters. Experiment results showthat this method can detect cerebral palsy through the difference between theabnormal gait of children with cerebral palsy and that of normal children.

Different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children

Objective: To explore the different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children. Methods: A total of 218 obese children who were treated in this hospital between September 2015 and February 2018 were selected and randomly divided into the living high - training low group (n=109) and living low - training low group (n=109). Living high - training low group received living high- training low intervention, living low - training low group received living low - training low intervention, and the intervention of both groups lasted for 4 weeks. The differences in serum levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines were compared between the two groups of children before intervention and after 4 weeks of intervention. Results: Before intervention, the levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines in serum were not significantly different between the two groups of obese children. After 4 weeks of intervention, serum insulin sensitivity-related indexes ISI, FPIR and GDR levels of living high-training low group were higher than those of living low - training low group;appetite-related hormones CCK and PYY3-36 contents were higher than those of living low - training low group whereas Ghrelin content was lower than that of living low - training low group;adipocytokines omentin-1 and APN contents were higher than those of living low - training low group whereas chemerin and LEP contents were lower than those of living low - training low group. Conclusion: Compared with traditional living low - training low intervention, living high - training low intervention is more effective in improving the insulin sensitivity and balance the secretion of appetite-related hormones and adipocytokines in obese children.

Relationship of Vitamin D deficiency with Lipid metabolism, micro-inflammatory response and endothelial injury in obese children

Objective:To study the relationship of vitamin D deficiency with lipid metabolism, micro-inflammatory response and endothelial injury in obese children.Methods: a total of 68 cases of obese children who received examination in our hospital were chosen as obese group, 56 cases of overweight children who received examination in our hospital were chosen as overweight group, and 50 cases of normal children who received vaccination in our hospital were chosen as normal control group. The differences in peripheral blood 1,25-(OH)D3 content as well as serum contents of lipid metabolism, micro-inflammatory reaction and endothelial injury indexes were compared among three groups. Pearson test was used to evaluate the internal relationship between 1, 25-(OH)D3 and the degree of environmental disturbance in obese children.Results:1,25-(OH) D3 contents in obese group and overweight group were lower than that in normal control group, and 1,25-(OH) D3 content in obese group was lower than that in overweight group. Serum contents of lipid metabolism indexes TC, TG and LDL-C in obese group and overweight group were higher than those in normal control group while HDL-C content was lower than that in normal control group;contents of micro-inflammation indexes CRP, IL-6 and TNF-α were higher than those in normal control group;serum content of endothelial injury index ET-1 was higher than that in normal control group while NO, CGRP and PGI2 contents were lower than those in normal control group;the changes in serum contents of above indexes in obese group were larger than those in overweight group. Conclusion: There is vitamin D deficiency in obese children, and the degree of deficiency is directly related to the degree of abnormal lipid metabolism, micro-inflammation and endothelial injury.

Clinical gait analysis in older children with autism spectrum disorder

Individuals with autism spectrum disorder(ASD)often exhibit motor deficits that increase their risk of falls.There is a lack of understanding regarding gait biomechanics demonstrated by older children with ASD.The purpose of the study was to determine differences in gait patterns between older children with ASD and typically developing children.Eleven children with ASD and 11 age-and gender-matched typically developing children were recruited for the study.Participants walked on a force-instrumented treadmill at a constant speed(1.1 m/s-1.2 m/s)for five minutes(min).Participants performed maximal voluntary contractions to assess their knee muscular strength.Differences between individuals with ASD and matched control participants were examined through paired t-tests with a significance level of p0.05.Individuals with ASD demonstrated a smaller knee extensor torque compared to controls(p=0.002).Participants with ASD exhibited a shorter stride length(p=0.04),a greater cadence(p=0.03),and a higher variation in stride width(p=0.04)compared to control participants.The individuals with ASD experienced a greater braking ground reaction force(p=0.03)during loading response.The results indicate older children with ASD develop a unique gait pattern signified by a reduced stride length,increased cadence,and an increase of variation in stride width.This unique gait pattern may represent a movement strategy used by the individuals with ASD to compensate for the weakness associated with their knee extensor muscles.Individuals with ASD who demonstrate these unique gait deviations may face reduced postural stability and an increased risk of fall-related injuries.

Global research trends and hotspots in overweight/obese comorbid with depression among children and adolescents: A bibliometric analysis

BACKGROUND Overweight/obesity combined with depression among children and adolescents(ODCA)is a global concern.The bidirectional relationship between depression and overweight/obesity often leads to their comorbidity.Childhood and adolescence represent critical periods for physical and psychological development,during which the comorbidity of overweight/obesity and depression may increase the risk of adverse health outcomes.AIM To evaluate the relationship between ODCA,we conduct a bibliometric analysis to aid in formulating prevention and treatment strategies.METHODS From 2004 to 2023,articles related to ODCA were selected using the Science Citation Index Expanded from the Web of Science Core Collection.Bibliometric analysis of relevant publications,including countries/regions,institutions,authors,journals,references,and keywords,was conducted using the online bibliometric analysis platforms,CiteSpace,VOSviewer,and bibliometrix.RESULTS Between 2004 and 2023,a total of 1573 articles were published on ODCA.The United States has made leading contributions in this field,with Harvard University emerging as the leading contributor in terms of research output,and Tanofsky being the most prolific author.The J Adolescent Health has shown significant activity in this domain.Based on the results of the keyword and reference analyses,inequality,adverse childhood experiences,and comorbidities have become hot topics in ODCA.Moreover,the impact of balancedrelated behavior and exploration of the biological mechanisms,including the potential role of key adipocytokines and lipokines,as well as inflammation in ODCA,have emerged as frontier topics.CONCLUSION The trend of a significant increase in ODCA publications is expected to continue.The research findings will contribute to elucidating the pathogenic mechanisms of ODCA and its prevention and treatment.

Serum 25-Hydroxyvitamin D Level Might Be a Useful Indicator of Disease Severity in Obese Children With Atopic Dermatitis:A Case-Control Study

Objective:To assess the relationship between the severity of atopic dermatitis(AD)in children of varying weight categories and their serum 25-hydroxyvitamin D[25(OH)D]levels.Methods:The study population comprised 899 patients with AD and 854 age-and sex-matched controls.The Mann-Whitney U test and Kruskal-Wallis H tests were used to assess differences between groups,and Spearman correlation analysis was used to test correlation.Results:The 25(OH)D level in the AD group was M(Q_(25),Q_(75)),24.0(19.7,28.4)ng/mL,which was significantly lower than the control group(26.4[23.6,29.9]ng/mL;Z=-3.34,P=0.001).25(OH)D levels in children with AD were negatively correlated with body mass index(r=-0.30,P<0.001),Severity scoring of Atopic Dermatitis(SCORAD;r=-0.14,P<0.001),total immunoglobulin E(r=-0.13,P<0.001),and eosinophil(r=-0.08,P=0.017).There were statistically significant differences in 25(OH)D(H=18.46,P<0.001),total immunoglobulin E(H=9.13,P=0.010),eosinophil(H=67.17,P<0.001),and SCORAD(H=10.49,P=0.005)among groups with different body mass index classification.The 25(OH)D levels were 22.3(17.5,27.1)ng/mL in the overweight AD group and 22.3(17.6,25.7)ng/mL in the obese AD group,which were significantly lower than those in the normal-weight AD group(24.7[20.4,25.5]ng/mL;P=0.003,P=0.004).25(OH)D levels were negatively correlated with SCORAD in obese AD patients(r=-0.25,P=0.010).Conclusion:Vitamin D insufficient or deficient is obvious in children AD patients.The 25(OH)D levels in the overweight/obese AD group are significantly lower than those in the normal-weight AD group.Vitamin D level is negatively correlated with SCORAD in obese children with AD.

Gait analysis of children with spastic hemiplegic cerebral palsy

An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy. With permission of their parents, 200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment. Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital, China were also enrolled in this experiment. Standard data were collected by simultaneously recording gait information from two digital cameras. DVracker was used to analyze the standard data. The children with hemiplegic cerebra palsy had a longer gait cycle, slower walking speed, and longer support phase than did the healthy children. The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy. There were significant differences in the angles of the hip, knee, and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering, and during pedal extension. Children with hemiplegic cerebral palsy had poor motor coordination during walking, which basically resulted in a short stride, high stride frequency to maintain speed, more obvious swing, and poor stability.

A 6-week diet and exercise intervention alters metabolic syndrome risk factors in obese Chinese children aged 11-13 years

Purpose:A randomized,controlled trial was conducted to determine whether a 6-week low calorie diet and aerobic exercise intervention could alter metabolic syndrome(MetS) risk factors in pre-pubescent obese Chinese children.Methods:The subjects were randomized into diet and exercise(DE) and control(C) groups.The DE group ingested 1600-2000 kcal/day adjusted to each participant’s basal metabolic rate,and engaged in high-volume aerobic exercise(6 days/week,twice daily,for 3 h per session) for 6 weeks.A total of 215 obese children between the ages of 11 and 13 years were recruited into the study,with 167 subjects(DE,n=95;C,n=72) completing all phases.Pre-and post-study measures included body weight,body mass index,waist circumference,body fat percentage,blood pressure and other MetS-related markers from fasting blood samples(serum cholesterol,triglycerides,insulin,and glucose).Results:Compared to controls,the DE subjects experienced significantly reduced levels for all outcome markers(p 【 0.05),except for fasting blood glucose in boys(p=0.09).Conclusion:An intensive,6-week diet and exercise intervention had favorable effects in altering MetS risk factors in obese Chinese children aged 11 to 13.

Evaluating the predictive factors of resting energy expenditure and validating predictive equations for Chinese obese children

Background To study the predictive factors of resting energy expenditure(REE)and evaluate the accuracy of predicted equations with indirect calorimeter(IC)in Chinese school-age children,particularly for the obese population.Methods Recruited children were from the department of child healthcare in Nanjing children's hospital during July 2014-September 2015.Anthropometric parameters and body composition were measured by bioelectrical impedance.Measured REE was assessed by IC.Predicted REE was estimated using ten published equations.Results 248 children aged 7-13 years were recruited,including 148 obese[body mass index standard deviation score(BMISDS)=2.48±0.91]and 100 non-obese(BMISDS=-0.96±1.08).The unit mass of REE(REE/kg)in obese group(29.06±5.74)was lower than that in non-obese group(37.51±6.56).The stepwise regression showed that age,BMISDS and fat-free mass(FFM)had a major impact on REE/kg as the regression equation:Y=54.41-1.36×X_(1)-2.25×X_(2)-0.16×X_(3)(Y REE/kg,X_(1)age,X_(2)BMISDS,X_(3)FFM;R=0.633,R^(2)=0.401,P<0.01).The accuracy of predicted REE in obese subjects was 62.16%by the new predictive equations.Conclusions The REE/kg in obese children was lower and closely correlated with age,BMISDS and FFM.It is necessary to validate the new predictive equation in a larger sample to estimate energy requirements,particularly for children with obesity.