Spillover Effects of a Family-Based Childhood Obesity Intervention on Parental Nutrient Biomarkers and Cardiometabolic Risk Factors

Objectives

To evaluate the impact of a family-based weight management intervention for children with overweight/obesity on parental nutrient biomarker concentrations and cardiometabolic risk factors (CMRF).

Methods

Secondary analysis from a randomized-controlled, parallel-arm clinical trial. Families were recruited from a largely Hispanic population and assigned to either Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations) or Standard Care + Enhanced Program (SC + EP; eight skill-building cores, subsequent monthly support sessions, targeted diet/physical activity strategies). Nutrient biomarkers (plasma carotenoids and fat soluble vitamins; red blood cell [RBC] fatty acid profiles) and CMRF (BMI, blood pressure, plasma glucose, insulin, lipid profile, inflammatory markers and adipokine concentrations) were measured in archived samples collected from the parents at baseline and at the end of the 1-year intervention.

Results

Parents of children in both groups (SC = 106; SC + EP = 99) had significantly lower total SFA (−3%) and trans fatty acid (−14%), and higher MUFA (2%), PUFAn-6 (2%), PUFAn-3 (7%) and beta-carotene (20%) concentrations, indicative of decreased partially-hydrogenated fat and increased vegetable oil, fish and fruit/vegetable intake, respectively. In both groups, there were significant reductions in inflammatory markers (hsCRP [−21%], TNFα [−19%] and IL-6 [−19%]), but not in BMI, blood pressure or lipid profile. Parents with children assigned to the SC + EP group had additional improvements in serum insulin (−6%) and leptin (−1.3%) concentrations. Using multiple linear regression models adjusted for sex, age, group, baseline BMI, and baseline CMRF values, improvements in circulating inflammatory and glucose metabolism markers, and adipokine concentrations were associated with higher carotenoid and PUFAn-3 (specifically 20:5n-3), and lower SFA and trans fatty acid concentrations, at the end of the 1-year intervention.

Conclusions

These results suggest that a family-based childhood obesity intervention can spill over to parents, resulting in apparent healthier dietary shifts that are associated with modest improvements in some CMRF.

Funding Sources

NIH, NIDDK, USDA.

Differences in Cardiometabolic Risk between Insulin-Sensitive and Insulin-Resistant Overweight and Obese Children

BACKGROUND

It is known that 15-30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management.

METHODS

Baseline data from 7- to 12-year-old, overweight, and obese children enrolled in a weight management program at an urban hospital were analyzed. Homeostatic model assessment for insulin resistance (HOMA-IR) <2.6 was used to define insulin-sensitive and HOMA-IR ≥2.6 was used to defined insulin-resistant participants. Demographics, physical activity measures, and cardiometabolic risk factors were compared between the two phenotypes. Odds ratios (ORs) examining the association between intermediate endpoints (metabolic syndrome [MetS], nonalcoholic fatty liver disease [NAFLD], systemic inflammation, and microalbuminuria) and the two metabolic phenotypes were evaluated.

RESULTS

Of the 362 overweight/obese participants, 157 (43.5%) were insulin sensitive and 204 (56.5%) were insulin resistant. Compared to the insulin-sensitive group, the insulin-resistant group was older (8.6±1.6 vs. 9.9±1.7; p<0.001) and had a higher BMI z-score (1.89±0.42 vs. 2.04±0.42; p=0.001). After multivariable adjustment, compared to the insulin-sensitive group, the insulin-resistant group had higher odds of having MetS (OR, 5.47; 95% confidence interval [CI]: 1.72, 17.35; p=0.004) and NAFLD (OR, 8.66; 95% CI, 2.48, 30.31; p=0.001), but not systemic inflammation (OR, 1.06; 95% CI: 0.56, 2.03; p=0.86) or microalbuminuria (OR, 1.71; 95% CI, 0.49, 6.04; p=0.403).

CONCLUSIONS

Using a HOMA-IR value of ≥2.6, clinical providers can identify prepubertal and early pubertal children most at risk. Focusing limited resources on aggressive weight interventions may lead to improvement in cardiometabolic health.