Clinical ScienceThe one year exercise and lifestyle intervention program KLAKS: Effects on anthropometric parameters, cardiometabolic risk factors and glycemic control in childhood obesity
Introduction
Childhood overweight and obesity are worldwide health problems [1]. Prevalence rates have reached very high levels during the past decades [2], although there seems to be a trend towards stabilization at a still alarmingly high level [3], [4]. Many obese children and adolescents already present with features of the metabolic syndrome, including disturbed glucose metabolism, dyslipidaemia, elevated transaminases, non-alcoholic fatty liver disease and others [5], [6], [7], [8], [9], [10]. Especially abdominal obesity, defined as increased waist circumference, is associated with increased risk for cardiometabolic comorbidities and the metabolic syndrome already in childhood [11], [12]. Thus, early and effective treatment of childhood obesity and prevention of comorbidities are essential, and regular physical activity and the avoidance of sedentary habits play an important role not only for the stabilization or reduction of body weight but also for the avoidance of associated cardiometabolic comorbidities and for psychosocial well-being [13]. A recent guideline on prevention of type 2 diabetes in adults provides clear recommendations: Even a modest change in lifestyle that includes adopting a healthy diet, increasing physical activity and maintaining a healthy body weight, may effectively prevent the risk for diabetes later in life, and these results have since been the basis for worldwide prevention programs [14].
Current pediatric guidelines recommend at least 60, or preferably 90 and more minutes of physical activity per day, however, this amount is reached only by a small number of children [13]. The optimal therapeutic intervention to reduce (abdominal) obesity and cardiometabolic risk factors in childhood obesity is largely unknown, and available studies that have investigated the impact of different exercise regimens or the “optimal” exercise modality are scarce to date [15]. The aim of the present study is to evaluate the effects of the one year combined exercise/lifestyle intervention (KLAKS program) on anthropometric parameters and body composition, glycemic control and cardiometabolic risk markers in childhood obesity.
Section snippets
Participants
Children and adolescents aged 7–18 years with overweight (BMI > 90th percentile) and accompanying comorbidities (impaired glucose tolerance, features of the metabolic syndrome or a family history (siblings or parents) for obesity/type 2 diabetes) or obesity (BMI > 97th percentile) according to German reference percentiles [16] were eligible for program participation. In addition, overweight siblings of obese participants were also invited to participate in the KLAKS program to facilitate lifestyle
Participants
142 participants started the intervention and provided complete anthropometric baseline measurements. Mean age at start of the program was 12.2 ± 0.2 years (72 boys; 51%). Complete anthropometric follow up data were available from 115 candidates. The flow of participants through each stage of the intervention, presented as diagram according to the CONSORT/TREND statement [29], is shown in Fig. 1. Mean age after completion of the program was 13.2 ± 0.2 years (58 boys; 50%), showing that the
Discussion
The aim of the present study was to evaluate the impact of a combined exercise/lifestyle intervention on anthropometric parameters and body composition, glycemic control and cardiometabolic risk markers in childhood obesity. The study was performed within the standardized and approved obesity therapy program KLAKS for obese children and adolescents.
We show that a standardized obesity therapy program for one year significantly reduces anthropometric parameters of body fat content and body fat
Conclusion and translational potential
In summary, we show that regular exericse within a structured lifestyle program for childhood obesity significantly improves marker of the body fat content and body fat distribution as well as metabolic risk markers for the metabolic syndrome. As (subclinical) impairments of glucose homeostatis are also significantly improved, the intervention may beneficial to prevent the development of impaired glucose tolerance or type 2 diabetes in obese children and adolescents. A recent European guideline
Author contribution
SB: study design and conduct of the study, data collection and analysis, data interpretation, manuscript writing
DP: analysis and interpretation of data, statistical expertise, manuscript writing
AW: study design, conduct of the study, revision of the manuscript
KW: study concept and design, revision of the manuscript
RG: data collection and analyses, revision of the manuscript
TK: conduct of analyses for biochemical parameters, interpretation of biochemical data, revision of manuscript
MW: physical
Funding
Part of the work was supported by the Federal Ministry of Education and Research, Germany (Integrated Research and Treatment Center IFB “Adiposity Diseases”, FKZ: 01E01001) as well as by grants from the Roland-Ernst-Stiftung für Gesundheitsförderung, the TANITA Healthy Weight Community Trust as well as the Saxonian Ministry for Social Affairs (to SB).
Conflict of interest
The authors have nothing to disclose.
Acknowledgments
We would like to thank all persons who are involved in the conduct of the KLAKS program. We are also very grateful to all children, adolescents and their parents who participated in this project.
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