1. Obese adolescents treated with residential supervision of diet and exercise showed improved endothelial function after 10 months compared to those treated as outpatients.
2. Residentially-treated adolescents showed improvement in their BMI and exercise capacity and a significant reduction in cardiovascular risk factors compared to the outpatient group.
Evidence Rating Level: 2 (Good)
Study Rundown: Obesity is a major risk factor for the development of cardiovascular disease. As the proportion of obese children increases, practices that effectively curb this trend become increasingly more relevant. There is an established connection between obesity, endothelial damage, and subsequent development of heart disease. This study is the first to track endothelial microparticles (EMP), a marker for endothelial damage, and progenitor cells (EPC), a marker for repair, in obese patients as a measure of diet and exercise efficacy. Obese adolescents were treated in a residential facility with supervised diet and exercise regimens. This cohort was compared to a group of adolescents on the waiting list for this program, who were treated as outpatients. By the end of the 10-month program, the intervention group had decreased BMI and body fat percentage and increased exercise capacity. This group also demonstrated an improvement in other cardiovascular risk factors, such as low level inflammation, cholesterol, adiponectin levels, and hypertension. Endothelial function, measured by EMP and EPC levels, improved in the intervention group. In contrast, the outpatient group demonstrated increased BMI, reduced exercise capacity, and increased endothelial damage over the same time period. Although this study is the first to measure the direct effect of diet and exercise on endothelial function, it is limited by the small sample size.
Study Author, Dr. Luc Bruyndonckx, MD, PhD, talks to 2 Minute Medicine: University Hospital Antwerp Laboratory of Cellular and Molecular Cardiology, Department of Pediatrics, Cardiovascular diseases research group and Laboratory of Experimental Medicine and Pediatrics, Antwerp, Belgium:
“Obese adolescent have an increased risk of cardiovascular morbidity and mortality at adult age, if not treated optimally. We were the first to demonstrate that ten months of diet and exercise training improves microvascular endothelial function (the first step in the development of atherosclerosis) in obese adolescents, reducing their cardiovascular risk. In addition we gained further insights in the underlying physiological mechanisms of this improvement of endothelial dysfunction”.
In-Depth [quasi-experiment]: Participants included 48 obese 12- to 18-year olds from a specialized inpatient treatment center for obese children in Belgium. Twenty seven teens admitted to the inpatient program constituted the intervention group, while 21 teens were recruited off the waiting list to serve as controls. BMI, EPC, and EMP, among other parameters, were evaluated at baseline, halfway through the study, and at the end of the 10-month treatment period. The intervention group BMI decreased from 36.44 to 27.39, while body fat percentage decreased from 51% to 39% (P < .001 for both). EMP was significantly reduced from 304.3 at baseline to 229 (P=.004). EPC increased from 15.6 to 25.4 at 5 months and 17.4 at 10 months (P=.01 and P=.12, respectively). The authors postulated that this biphasic response was due to physiologic readjustment to improved endothelial health, warranting decreased progenitor cells over time. Concurrently, there was an increase in both BMI and body fat percentage in the control group, from 36.72 to 39.10 and 51% to 52%, respectively. The EPC decreased from 22.9 to 16.9 while the EMP increased from 199.0 to 281.9 over the 10 month period, suggesting a decrease in EPC and a concomitant increase in EMP.
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