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OBJECTIVES: This study was conducted to assess the effectiveness of a simple office-based program for encouraging healthy lifestyle on controlling childhood obesity and associated cardiometabolic risk factors. METHODS: This non-randomized 24-week lifestyle modification trial was conducted among 457 obese children and adolescents, aged 2-18 years, who had at least one cardiometabolic risk factor in addition to obesity. This trial included three components of exercise, diet education and behavior modification, with all recommendations provided by a pediatrician, two general physicians and a nurse. Instead of strict inhibitory recommendations, healthier lifestyle was encouraged. RESULTS: Overall 448 (98.04%) of enrolled children completed the trial with a mean age of 9.6 ± 2.9 years. After the trial, the mean of anthropometric measures and cardiometabolic risk factors decreased significantly, the mean high-density lipoprotein cholesterol (HDL-C) increased significantly, and the prevalence of the metabolic syndrome decreased from 20.8% to 1.8%. Triglycerides, LDL-C, diastolic blood pressure and WC had the highest decrease in all age groups, with the most prominent changes in the 14-18-year age group. By each -1SD decline in BMI and WC, risk factors had significant improvement. CONCLUSION: Motivational office-based counseling can be effective in treatment of childhood obesity and its associated cardio-metabolic risk factors. Such approach can be implemented in the primary health care system; and can be of special concern in low- and middle-income countries with limited human and financial resources. We suggest that expanding the roles of non-physician clinicians such as nurse practitioners can help to increase the amount of time available for such services.

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This study aimed to assess the effects of a 2-month lifestyle modification trial on cardio-metabolic abnormalities and C-reactive protein (CRP) among obese adolescents with metabolic syndrome [phenotypically obese metabolically abnormal (POMA)] and obese adolescents without a cardio-metabolic disorder [phenotypically obese metabolically normal (POMN)], as well as in normal-weight adolescents with at least one cardio-metabolic disorder [phenotypically normal metabolically obese (PNMO)]. The study comprised 360 adolescents assigned in three groups of equal number of POMN, POMA and PNMO. They were enrolled in a trial consisting of aerobic activity classes, diet and behaviour modification, and were recalled after 6 months. Overall, 94.7% of participants completed the 2-month trial, and 87.3% of them returned after 6 months. The mean CRP was not significantly different between the POMA and PNMO groups, but was higher than in the POMN group. After the trial, body mass index (BMI) and waist circumference (WC) decreased in obese participants, and the mean body fat mass decreased in all groups. At 2 months, the mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and CRP decreased in the POMA and PNMO groups. After 2 and 6 months, the decrease in mean TC, LDL-C, TG, CRP and systolic blood pressure was greater in the POMA than in the POMN group. The magnitude of decrease in CRP correlated with that of BMI, WC, fat mass, TG, TC and LDL-C. Lifestyle modification programmes for primordial/primary prevention of chronic diseases would be beneficial at the population level and should not be limited to obese children.

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OBJECTIVE: To determine the association of cell blood count with obesity and cardiometabolic risk factors in children. METHODS: This cross-sectional study was conducted from 1st November 2007 to 1st October 2008 in the Obesity and Metabolic Syndrome Research Clinic of the Preventive Pediatric Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan, Iran. It comprised 326 (172 girls and 154 boys) obese children aged 6-12 years. RESULTS: The mean age of participants was 8.8 +/- 2.7 years. A significant increasing trend in the mean body mass index (BMI), waist circumference (WC), triglycerides (TG), total- and low density lipoprotein (LDL)- cholesterol were documented across the quartiles of the white blood cell (WBC) count, and for waist-to-hip ratio and total cholesterol across platelet quartiles. A similar increasing trend was documented for BMI, waist and hip circumference, diastolic blood pressure, LDL-C, and for TG from the second to the fourth quartile of the red blood cells. By the increase in the number of components of metabolic syndrome, the mean BMI, WBC, and TG increased significantly. The highest correlation was documented between WBC count and TG. The WBC count increased the risk of increased BMI (odds ratio [OR]=1.45, confidence interval [CI] 95%; 1.11-1.65, p=0.001), increased WC (OR; 1.47, CI 95%; 1.15-1.74, p=0.001), and high TG (CI 95%; 1.241.06-1.44, p=0.005 ). CONCLUSION: We found significant associations between CBC components and cardiometabolic risk factors in young obese children. These findings are confirmatory evidence of the pro-inflammatory state of obese individuals, even in young children.

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OBJECTIVES: This study, which to the best of our knowledge is the first of its kind, aimed to determine the acute and long-term effects of the consumption of grape and pomegranate juices on endothelium function in adolescents with metabolic syndrome, and to compare the effects of these two kinds of juices. METHODS: This randomised controlled clinical trial was conducted in 2008 among 30 adolescents, aged 12-15 years, with metabolic syndrome. Participants were randomly assigned to two groups of equal number; one group was asked to drink 18 millilitre per kilogram per day of natural grape juice and the other group was asked to drink 240 millilitre per day of natural pomegranate juice once daily for 1 month. Juices were homemade without any added sweetener. Basal brachial artery dimension and flow-mediated dilation as an index of endothelial function and endothelial-dependent dilation after receiving nitoglycerin spray were evaluated by high-resolution B mode ultrasonography before juice consumption, 4 hours and 30 days after regular daily consumption. RESULTS: Flow-mediated dilation at 90 seconds and after nitoglycerin significantly improved at 4 hours and at 1 month after drinking both kinds of juices, without significant difference between the two groups. The change at 1 month versus 4 hours was significant only in the grape juice group. CONCLUSION: Daily consumption of diets rich in antioxidants might improve endothelial function in adolescents with metabolic syndrome. These effects began as soon as 4 hours after juice consumption. Such beneficial effects should be considered in dietary recommendations for the paediatric age group, notably in obese individuals.

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BACKGROUND: In view of the growing trend of obesity around the world, including in our country, and the effect of reduced physical activity in increasing the incidence of obesity and overweight in children and adolescents and limitations of families in providing transport for their children to attend exercise classes, as well as time limitations of students in taking part in these classes, accessing appropriate methods for presenting physical activity training seems essential. METHODS: This non-pharmacological clinical trial was performed during six months from May to November 2007 on 105 children and adolescents aged 6-18 years with obesity, randomly assigned to 3 groups of thirty-five. Nutrition and treatment behavior were the same in all groups, but physical activity training in the first group was taking part in physical activity training classes twice a week, in the second group by providing a training CD, and in the third group via face-to-face training. Before and after the intervention, anthropometric indicators were measured and recorded. RESULTS: Mean body mass index (BMI) of participants in group attended physical activity training classes, and in the group undergone training with CD, after the interventions was significantly lower than that before the intervention. CONCLUSION: Our findings demonstrated that training using CDs can also be effective in reducing BMI in overweight and obese children and adolescents as much as face-to-face education and participation in physical training classes. Extending such interventions can be effective at the community level.

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OBJECTIVES: This study aimed to determine the prevalence of the metabolic syndrome, abnormalities of liver enzymes and sonographic fatty liver, as well as the inter-related associations in normal weight, overweight and obese children and adolescents. METHODS: This cross-sectional study was conducted among a sample of 1107 students (56.1% girls), aged 6-18 years in Isfahan, Iran. In addition to physical examination, fasting blood glucose, serum lipid profile and liver enzymes were determined. Liver sonography was performed among 931 participants. These variables were compared among participants with different body mass index (BMI) categories. RESULTS: From lower to higher BMI category, alanine aminotransferase (ALT), total cholesterol, LDL-cholesterol, triglycerides and systolic blood pressure increased, and HDL-cholesterol decreased significantly. Elevated ALT, aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were documented in respectively 4.1%, 6.6% and 9.8% of normal weight group. The corresponding figure was 9.5%, 9.8% and 9.1% in overweight group, and 16.9%, 14.9% and 10.8% in obese group, respectively. In all BMI categories, ALT increased significantly by increasing the number of the components of the metabolic syndrome. Odds ratio for elevated liver enzymes and sonographic fatty liver increased significantly with higher number of the components of the metabolic syndrome and higher BMI categories before and after adjustment for age. CONCLUSIONS: Because of the interrelationship of biochemical and sonographic indexes of fatty liver with the components of the metabolic syndrome, and with increase in their number, it is suggested to determine the clinical impact of such association in future longitudinal studies.

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BACKGROUND: The association of changes in oxidative and proinflammatory states with vascular function after diet and exercise intervention among obese children has not been previously explored. METHODS: In this 6-week diet and exercise intervention study in 35 obese children, age 12 to 18 years, we evaluated the relationship between changes in anthropometric indices, measures of insulin resistance, C-reactive protein (CRP), oxidized LDL (ox-LDL), and oxidative stress markers with changes in carotid intima-media thickness (C-IMT) and flow mediated dilation (FMD) of the brachial artery. RESULTS: At the end of the study, body mass index (BMI), waist circumference, and percentage body fat were decreased (P <0.05), but participants remained overweight (BMI > or = 95th percentile). Although FMD improved (P <0.05), the improvement in C-IMT did not reach statistical significance. The changes in BMI, waist circumference, fat mass, ox-LDL, malondialdehyde (MDA), CRP, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) had an inverse correlation with the changes in mean FMD after adjustment for age and sex, with the highest correlations documented for ox-LDL, CRP, and WC. The age- and sex-adjusted changes in ox-LDL, waist circumference, CRP, MDA, and body fat mass had the highest correlations with changes in C-IMT. CONCLUSIONS: Our findings suggest that a common inflammatory stress condition associated with childhood obesity, notably with abdominal fat deposition, may play a role in the development of the earliest stages of proatherosclerotic inflammatory processes and subsequent vascular dysfunction. These changes might be partially reversible by short-term diet and exercise intervention, even if patients do not reach ideal body weight.

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