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01-12-2015 | Original Article

Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention

Authors: Fabian Springer, Verena Ballweg, Roland Schweizer, Fritz Schick, Michael B. Ranke, Gerhard Binder, Stefan Ehehalt, for the DISKUS Study Group

Published in: European Journal of Pediatrics | Issue 12/2015

Abstract

The aim of this study was to analyze changes in adipose tissue (AT) distribution, intrahepatic lipids (IHL), and insulin resistance (IR) among a group of obese adolescents undergoing a 7-months low-level lifestyle intervention. Thirty-nine obese Caucasian adolescents (mean age 13.9 years, body mass index standard deviation score (BMI-SDS_LMS) 2.14) were included. AT and IHL were determined by T1-weighted magnetic resonance (MR) imaging and single-voxel MR spectroscopy; IR was estimated using the homeostatic model assessment (HOMA-IR). The lifestyle intervention led to a reduction of both BMI-SDS_LMS (boys 2.27 to 2.17; girls 2.00 to 1.82) and HOMA-IR (boys 6.1 to 4.4 (p = 0.008); girls 6.2 to 4.7 (p = 0.030)). IHL dropped in both genders (boys 7.5 to 4.3 %; girls 4.6 to 3.4 %) positively correlating with HOMA-IR (boys r = 0.52; girls r = 0.68), while in contrast visceral AT did not change significantly.

Conclusions: Although the lifestyle intervention only slightly reduced BMI-SDS_LMS, insulin sensitivity improved in both genders and came along with a marked reduction of IHL. This suggests that IHL might play the dominant role regarding insulin resistance in the youth, especially if compared to other AT compartments such as visceral AT.

What is Known:

• MR imaging/spectroscopy can be used to evaluate body fat distribution and intrahepatic lipids in the youth.

• The strength of associations between body fat compartments and insulin resistance is under scientific debate.

What is New:

• The study emphasizes that even a low-level lifestyle intervention has a beneficial effect.

• The study suggests that intrahepatic lipids are an important factor in the development of insulin resistance.

Bell LM, Watts K, Siafarikas A, Thompson A, Ratnam N, Bulsara M, Finn J, O'Driscoll G, Green DJ, Jones TW, Davis EA (2007) Exercise alone reduces insulin resistance in obese children independently of changes in body composition. J Clin Endocrinol Metab 92:4230–4235. doi:10.1210/jc.2007-0779 CrossRefPubMed

Benfield LL, Fox KR, Peters DM, Blake H, Rogers I, Grant C, Ness A (2008) Magnetic resonance imaging of abdominal adiposity in a large cohort of British children. Int J Obes (Lond) 32:91–99. doi:10.1038/sj.ijo.0803780 CrossRef

Brodie DA, Stewart AD (1999) Body composition measurement: a hierarchy of methods. J Pediatr Endocrinol Metab 12:801–816. doi:10.1515/JPEM.1999.12.6.801 CrossRefPubMed

Caranti DA, de Mello MT, Prado WL, Tock L, Siqueira KO, de Piano A, Lofrano MC, Cristofalo DM, Lederman H, Tufik S, Damaso AR (2007) Short- and long-term beneficial effects of a multidisciplinary therapy for the control of metabolic syndrome in obese adolescents. Metabolism 56:1293–1300. doi:10.1016/j.metabol.2007.05.004 CrossRefPubMed

Cole TJ, Freeman JV, Preece MA (1995) Body mass index reference curves for the UK, 1990. Arch Dis Child 73:25–29PubMedCentralCrossRefPubMed

Fishbein MH, Miner M, Mogren C, Chalekson J (2003) The spectrum of fatty liver in obese children and the relationship of serum aminotransferases to severity of steatosis. J Pediatr Gastroenterol Nutr 36:54–61. doi:10.1097/00005176-200301000-00012 CrossRefPubMed

Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit JM (2005) Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr 164:216–222. doi:10.1007/s00431-004-1586-7 CrossRefPubMed

Gutin B, Owens S (1999) Role of exercise intervention in improving body fat distribution and risk profile in children. Am J Hum Biol 11:237–247. doi:10.1002/(SICI)1520-6300(1999)11:2<237::AID-AJHB11>3.0.CO;2-9 CrossRefPubMed

Hasson RE, Adam TC, Davis JN, Kelly LA, Ventura EE, Byrd-Williams CE, Toledo-Corral CM, Roberts CK, Lane CJ, Azen SP, Chou CP, Spruijt-Metz D, Weigensberg MJ, Berhane K, Goran MI (2012) Randomized controlled trial to improve adiposity, inflammation, and insulin resistance in obese African-American and Latino youth. Obesity (Silver Spring) 20:811–818. doi:10.1038/oby.2010.343 CrossRef

10.

Kersting M, Alexy U, Clausen K (2005) Using the concept of food based dietary guidelines to develop an optimized mixed diet (OMD) for German children and adolescents. J Pediatr Gastroenterol Nutr 40:301–308. doi:10.1097/01.MPG.0000153887.19429.70 CrossRefPubMed

11.

Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC (2001) Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 149:807–818. doi:10.1007/s001120170107 CrossRef

12.

Lobstein T, Frelut ML (2003) Prevalence of overweight among children in Europe. Obes Rev 4:195–200. doi:10.1046/j.1467-789X.2003.00116.x CrossRefPubMed

13.

Machann J, Thamer C, Schnoedt B, Stefan N, Stumvoll M, Haring HU, Claussen CD, Fritsche A, Schick F (2005) Age and gender related effects on adipose tissue compartments of subjects with increased risk for type 2 diabetes: a whole body MRI/MRS study. Magn Reson Mater Phy 18:128–137. doi:10.1007/s10334-005-0104-x CrossRef

14.

Machann J, Thamer C, Stefan N, Schwenzer NF, Kantartzis K, Haring HU, Claussen CD, Fritsche A, Schick F (2010) Follow-up whole-body assessment of adipose tissue compartments during a lifestyle intervention in a large cohort at increased risk for type 2 diabetes. Radiology 257:353–363. doi:10.1148/radiol.10092284 CrossRefPubMed

15.

Molleston JP, White F, Teckman J, Fitzgerald JF (2002) Obese children with steatohepatitis can develop cirrhosis in childhood. Am J Gastroenterol 97:2460–2462. doi:10.1111/j.1572-0241.2002.06003.x CrossRefPubMed

16.

Savoye M, Shaw M, Dziura J, Tamborlane WV, Rose P, Guandalini C, Goldberg-Gell R, Burgert TS, Cali AM, Weiss R, Caprio S (2007) Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA 297:2697–2704. doi:10.1001/jama.297.24.2697 CrossRefPubMed

17.

Schwartz B, Jacobs DR Jr, Moran A, Steinberger J, Hong CP, Sinaiko AR (2008) Measurement of insulin sensitivity in children: comparison between the euglycemic-hyperinsulinemic clamp and surrogate measures. Diabetes Care 31:783–788. doi:10.2337/dc07-1376 CrossRefPubMed

18.

Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C (2006) Prevalence of fatty liver in children and adolescents. Pediatrics 118:1388–1393. doi:10.1542/peds.2006-1212 CrossRefPubMed

19.

Shen W, Wang Z, Punyanita M, Lei J, Sinav A, Kral JG, Imielinska C, Ross R, Heymsfield SB (2003) Adipose tissue quantification by imaging methods: a proposed classification. Obes Res 11:5–16. doi:10.1038/oby.2003.3 PubMedCentralCrossRefPubMed

20.

Siegel MJ, Hildebolt CF, Bae KT, Hong C, White NH (2007) Total and intraabdominal fat distribution in preadolescents and adolescents: measurement with MR imaging. Radiology 242:846–856. doi:10.1148/radiol.2423060111 CrossRefPubMed

21.

Taylor RW, Gold E, Manning P, Goulding A (1997) Gender differences in body fat content are present well before puberty. Int J Obes Relat Metab Disord 21:1082–1084. doi:10.1038/sj.ijo.0800522 CrossRefPubMed

22.

Turner RC, Holman RR, Matthews D, Hockaday TD, Peto J (1979) Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations. Metabolism 28:1086–1096. doi:10.1016/0026-0495(79)90146-X CrossRefPubMed

23.

van der Heijden GJ, Toffolo G, Manesso E, Sauer PJ, Sunehag AL (2009) Aerobic exercise increases peripheral and hepatic insulin sensitivity in sedentary adolescents. J Clin Endocrinol Metab 94:4292–4299. doi:10.1210/jc.2009-1379 PubMedCentralCrossRefPubMed

24.

van der Heijden GJ, Wang ZJ, Chu ZD, Sauer PJ, Haymond MW, Rodriguez LM, Sunehag AL (2010) A 12-week aerobic exercise program reduces hepatic fat accumulation and insulin resistance in obese, Hispanic adolescents. Obesity (Silver Spring) 18:384–390. doi:10.1038/oby.2009.274 CrossRef

25.

Vitola BE, Deivanayagam S, Stein RI, Mohammed BS, Magkos F, Kirk EP, Klein S (2009) Weight loss reduces liver fat and improves hepatic and skeletal muscle insulin sensitivity in obese adolescents. Obesity (Silver Spring) 17:1744–1748. doi:10.1038/oby.2009.171 CrossRef

26.

Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27:1487–1495. doi:10.2337/diacare.27.6.1487 CrossRefPubMed

27.

Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, Boselli L, Barbetta G, Allen K, Rife F, Savoye M, Dziura J, Sherwin R, Shulman GI, Caprio S (2003) Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet 362:951–957. doi:10.1016/S0140-6736(03)14364-4 PubMedCentralCrossRefPubMed

Title: Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention
Authors: Fabian Springer
Verena Ballweg
Roland Schweizer
Fritz Schick
Michael B. Ranke
Gerhard Binder
Stefan Ehehalt
for the DISKUS Study Group
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 12/2015
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-015-2577-6

At a glance: The STEP trials

Springer Medicine

Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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