Clinical Picture at Attendance and Response to Flexible FamilyBased Low-Carb Life Style Change in Children With Obesity

Authors

  • Hatice Mine Cakmak Department of Pediatric Hematology-Oncology, Eskisehir City Hospital, Eskisehir, Turkey
  • IlknurArslanoglu Department of Pediatric Endocrinology, Duzce University Faculty of Medicine, Duzce, Turkey
  • Mehmet Ali Sungur Department of Biostatistics, Duzce University Faculty of Medicine, Duzce, Turkey
  • Semih Bolu Department of Pediatric Endocrinology, Duzce University Faculty of Medicine, Duzce, Turkey

DOI:

https://doi.org/10.6000/1929-4247.2021.10.01.2

Keywords:

Children, Complications, Low-carbohydrate diet, Metformin, Obesity

Abstract

Aim: The study aims 1) to determine the clinical status of obese children at the admittance to the pediatric endocrinology referral center 2) to investigate the efficiency and compliance of the low-carb diet in a pediatric population with or without exercise, metformin

Material and Methods: All subjects with the complaint of obesity and BMI percentile >95 were recruited from January 2012-August 2014. We evaluated basal retrospectively, recommended low carbohydrate family-wide eating practice and exercise to all, and metformin to selected cases, and recorded Self-reported adherence at first, third, sixth, and twelfth months.

Results: Thirty-six subjects used metformin with a higher ratio of weight loss (90.0%, p=0.010) without a difference in the number of lost kilograms. In 160 cases without metformin; diet only, exercise only, and both diet and exercise groups lost weight significantly according to neither diet nor exercise group (OR:12.08, 95% CI 3.93-41.66, p<0.001; OR:3.04, 95% CI 1.18-7.84, p=0.022 and OR:32.80, 95% CI 7.14-150.77, p<0.001 respectively). Exercise plus diet (95.3%, p=0,002) and only diet (88.9%, p=0,023) were even more efficient than exercise alone (65.5%). In the twelfth month, 13.8% were on follow-up.

Conclusion: Obesity gives rise to metabolic complications in the very early stages. A low carbohydrate diet proved to be acceptable and useful. Long-term consistency remains a challenge.

References

[1] WHO Technical Report Series 894 Obesity: Preventing and Managing The Global Epidemic. World Health Organization; Geneva, Switzerland: 2000 Zitsman JL, Inge TH, Reichard KW, Brown AF, Harmon CM, Miachalsky MP. Pediatric and adolescent obesity: Management, options for surgery, and outcomes. J Pediatr Surg 2014; 49: 491-4.
https://doi.org/10.1016/j.jpedsurg.2013.11.067
[2] Yuca SA, Y?lmaz C, Cesur Y, Engiz Ö. Prevalence of overweight and obesity in children and adolescents in eastern Turkey. J Clin Res Pediatr Endocrinol 2010; 2: 159-63.
https://doi.org/10.4274/jcrpe.v2i4.159
[3] Saglam H, Tarim O, Uncu Y. Prevalence and correlates of obesity in schoolchildren from the city of Bursa, Turkey. J Clin Res Pediatr Endocrinol 2008; 1: 80-88.
https://doi.org/10.4008/jcrpe.v1i2.15
[4] Kalkan-Ucar S, Dizdarer C, Darcan S, Korkmaz S, Denler YE, As?lsoy S, et al. prevalence of obesity and overweight among children in Izmir, Turkey: effects of nutritional and socioeconomic factors. Obesity and Metabolism 2009; 5: 99-106.
[5] Simsek E, Akpinar S, Bahcebasi T, Senses DA, Kocabay K. The prevalence of overweight and obese children aged 6-17 years in the West Black Sea region of Turkey. Int J Clin Pract 2008; 62: 1033-8.
https://doi.org/10.1111/j.1742-1241.2007.01421.x
[6] Sharma N, Lee J, Youssef I, Salifu MO, McFarlane SI et al. Obesity, Cardiovascular Disease, and Sleep Disorders: Insights into the Rising Epidemic. J Sleep Disord Ther 2017; 6: 260.
https://doi.org/10.4172/2167-0277.1000260
[7] Hoffmann S, Stücker R, Rupprecht M. Orthopedic Problems in Overweight and Obese Children. Klin Padiatr 2016; 228: 55-61.
https://doi.org/10.1055/s-0035-1565214
[8] Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linking diabetes mellitus and obesity.Diabetes Metab Syndr Obes 2014; 7: 587-91.
https://doi.org/10.2147/DMSO.S67400
[9] Zeller MH, Roehrig HR, Modi AC, Daniels SR, Inge TH. Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery. Pediatrics 2006; 117: 1155-61.
https://doi.org/10.1542/peds.2005-1141
[10] Speiser PW, Rudolf MCJ, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A, et al. Consensus Statement: Childhood Obesity. J Clin Endocrinol Metab 2006; 90: 1871-87.
https://doi.org/10.1210/jc.2004-1389
[11] Sherafat-Kazemzadeh R, Yanovski SZ, Yanovski JA. Pharmacotherapy for childhood obesity: present and future prospects. Int J Obes 2013; 37: 1-15.
https://doi.org/10.1038/ijo.2012.144
[12] Pala L, Barbaro V, Dicembrini I, CM Rotella. The therapy of insulin resistance in other diseases besides type 2 diabetes. Eat Weight Disord 2014; 19: 275-83.
https://doi.org/10.1007/s40519-014-0139-y
[13] Hamilton-Shield JH, Goodred J, Powell L, Thorn J, Banks J, Hollinghurst S, et al. Changing eating behaviors to treat childhood obesity in the community using Mandolean: the Community Mandolean randomized controlled trial (ComMando) – a pilot study. Health Technol Assess 2014; 18: 1-75.
https://doi.org/10.3310/hta18470
[14] Mâsse LC, Watts AW, Barr SI, Tu AW, Panagiotopoulos C, Geller J, et al. individual and household predictors of adolescent's adherence to a web-based ?ntervention. Ann Behav Med 2015; 49: 371-83.
https://doi.org/10.1007/s12160-014-9658-z
[15] McCallum Z, Wake M, Gerner B, Baur LA, Gibbons K, Gold L, et al. Outcome data from the leap (live, eat and play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int J Obes 2007; 31: 630-36.
https://doi.org/10.1038/sj.ijo.0803509
[16] Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240-43.
https://doi.org/10.1136/bmj.320.7244.1240
[17] Mickey E, Brooke B. Tanner Stages. In: StatPearls [Internet]. Treasure Island (FL) StatPearls Publishing 2020 Jan. 2020 Dec 18. PMID. 29262142.
[18] Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006; 95: 194-8.
https://doi.org/10.1080/08035250500334738
[19] Yazici MK, Kurtoglu S, Kendirci M, Atabek ME, Yaz?c? C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005; 115: e500-503.
https://doi.org/10.1542/peds.2004-1921
[20] Neal WA. Disorders of Lipoprotein Metabolism and Transport. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, WB Saunders Company, 2011: 470.
[21] World Health Organization. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. Geneva: WHO; 2011.
[22] Romualda MC, Nobrega FJ, Escrivao MA. Insulin resistance in obese children and adolescents. J Pediatr 2014; 90: 600-07.
https://doi.org/10.1016/j.jped.2014.03.005
[23] Khan UL, McGinn AP, Isasi CR, Perelstein AG, Diamantis PM, Ginsberg M. Differences in cardiometabolic risk between insulin-sensitive and insulin-resistant overweight and obese children. Child Obes 2015; 11: 289-96.
https://doi.org/10.1089/chi.2014.0112
[24] An?k A, Çatl? G, Abac? A, Bober E. Fasting and postprandial levels of a novel anorexigenic peptide nesfatin in childhood obesity. J Pediatr Endocrinol Metab 2014; 27: 623-8.
https://doi.org/10.1515/jpem-2013-0475
[25] Brufani C, Ciampalini P, Grossi A, Fiori R, Fintini D, Tozii A, et al. Glucose tolerance status in 510 children and adolescents attending an obesity clinic in Central Italy. Pediatr Diabet 2010; 11: 47–54.
https://doi.org/10.1111/j.1399-5448.2009.00527.x
[26] Gilardini L, Croci M, Pasqualinotto L, Caffetto K, Invitti C. Dietary habits and cardiometabolic health in obese children. Obes Facts 2015; 8: 101–9.
https://doi.org/10.1159/000381157
[27] Michaliszyn SF, Mari A, Lee S, Bacha F, Tfayli H, Farchoukh L, et al. ?-Cell function, incretin effect, and incretin hormones in obese youth along the span of glucose tolerance from normal to prediabetes to type 2 diabetes. Diabetes 2014; 63: 3846-55.
https://doi.org/10.2337/db13-1951
[28] Casavalle PL, Lifshitz F, Romano LS, Pandolfo M, Caamaño A, Boyer PM. Prevalence of dyslipidemia and metabolic syndrome risk factor in overweight and obese children. Pediatr Endocrinol Rev 2014; 12: 213-23.
[29] Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009; 21: CD001872.
https://doi.org/10.1002/14651858.CD001872.pub2
[30] Janicke DM, Sallinen BJ, Perri MG. Lutes LD, Silverstein JH, Huerta MG, et al. Sensible treatment of obesity in rural youth (STORY): design and methods. Contemp Clin Trials 2008; 29: 270–80.
https://doi.org/10.1016/j.cct.2007.05.005
[31] Foster GD, Sundal D, McDermott C, Janicke DM, Sallinen BJ, Perri MG, et al. Feasibility and preliminary outcomes of a scalable community-based treatment of childhood obesity. Pediatrics 2012; 130: 652-9.
https://doi.org/10.1542/peds.2012-0344
[32] Nowicka P, Flodmark CE. Family in pediatric obesity management: a literature review. Int J Pediatr Obes 2008; 3: 44–50.
https://doi.org/10.1080/17477160801896994
[33] Araz NÇ, Balat A, Araz M. Metabolic syndrome prevalence in childhood obesity and assessment of obesity-related conditions. Med-Sci 2012; 1: 271-82.
https://doi.org/10.5455/medscience.2012.01.8027
[34] August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, et al. prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008; 93: 4576–99.
https://doi.org/10.1210/jc.2007-2458
[35] Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003; 348: 2074-81.
https://doi.org/10.1056/NEJMoa022637
[36] Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L. Position for the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatment of Pediatric Overweight and Obesity. J Acad Nutr Diet 2013; 113: 1375-94.
https://doi.org/10.1016/j.jand.2013.08.004
[37] Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factors in overweight adolescents. J Pediatr 2003; 142: 253-58.
https://doi.org/10.1067/mpd.2003.4
[38] Siegel RM, Rich W, Joseph EC Linhardt J, Knight J, Khoury J, et al. A 6 month, Office-based low carbohydrate diet ?ntervention in obese teens. Clin Pediatr 2009; 48: 745-49.
https://doi.org/10.1177/0009922809332585
[39] K?rk S, Brehm B, Saelens BE, Woo JG, Kissel E, Dalessio D, et al. Role of carbohydrate modification in weight management among children: A randomized clinical trial. J Pediatr 2012; 161: 320-27.
https://doi.org/10.1016/j.jpeds.2012.01.041
[40] Fock KM, Khoo J. Diet, and exercise in management of obesity and overweight. J Gastroenterol Hepatol 2013; 28: 59-63.
https://doi.org/10.1111/jgh.12407
[41] Brufani C, Fintini D, Nobili V, Patera PI, Cappa M, Brufani M. Use of metformin in pediatric age. Pediatr Diabet 2011; 12: 580-58.
https://doi.org/10.1111/j.1399-5448.2010.00741.x

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2021-02-26

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