Girls and Boys Have a Different Cardiometabolic Response to Obesity Treatment

Abstract

Background: Childhood obesity exposes individuals to cardiometabolic disturbances. We analyzed how family-based multidisciplinary obesity treatment influenced children's cardiometabolic health. Materials and methods: In this retrospective, two-year, follow-up study of 654 2- to 18-year-old children treated for obesity in three Finnish pediatric clinics in 2005-2012, blood pressure (BP), metabolic parameters, and the influence of sex, puberty and a change in body mass index standard deviation score (BMI SDS) were analyzed. Results: At baseline, at least one cardiovascular risk factor was present in 474 (80%) cases. Boys presented with more significant changes in cardiometabolic parameters than girls during the treatment. Boys' total cholesterol (TC) improved by 12 months (P = 0.009), and their low-density lipoprotein C (LDL-C) and glycosylated hemoglobin ameliorated by 12 months (P = 0.030 and 0.022, respectively) and 24 months (P = 0.043 and 0.025, respectively). Boys' triglycerides, insulin, homeostasis model assessment for insulin resistance (HOMA-IR) and systolic BP deteriorated at 24 months (P < 0.001, 0.004, 0.002, and 0.037, respectively). In all children, the number of acceptable TC, LDL-C, insulin, and HOMA-IR values increased if BMI SDS reduced 0.25 or more by 12 months. Conclusion: Minor cardiometabolic improvements were found during the obesity treatment. These findings indicate the need to assess treatment methods and focus on prevention.

Keywords: BMI SDS; blood pressure; cardiometabolic; childhood obesity; fatty liver; metabolism; specialist care; treatment outcomes.

Figure 1

Changes in metabolic and BP measurements, their directions, and the significance of the change at 12 and 24 months from baseline revealed in mixed model analyses adjusted for age and body mass index standard deviation score at baseline presented using the traffic light method. fP-ALT, plasma alanine transferase; fP-TC, fasting plasma cholesterol; fP-LDL-C, fasting plasma low-density lipoprotein; fP-HDL-C, fasting plasma high-density lipoprotein; fP-TG, fasting plasma triglyceride; fP-Gluc, fasting plasma glucose; fS-INS, fasting serum insulin; HOMA-IR, homeostasis model assessment for insulin resistance calculated by using the formula fS-INS (mU/l) × fP-Gluc (mmol/l)/22.5; B-HbA1c, blood glycosylated hemoglobin; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 2

The influence of the staged change in body mass index standard deviation score (BMI SDS) on categorized metabolic variables at 12 months (M) compared to the situation at baseline. A BMI SDS reduction of 0.25 units or more from baseline was defined as good change, 0–0.24 borderline, and no reduction as poor. Plasma total cholesterol (TC) in mmol/l was categorized: acceptable < 4.40, high ≥ 5.18; plasma low-density lipoprotein cholesterol (LDL-C) in mmol/l, acceptable < 2.84, high ≥ 3.36; plasma high-density lipoprotein cholesterol (HDL-C) in mmol/l, acceptable > 1.17, low < 1.04; plasma triglyceride (TG) in mmol/l for < 10-year-olds, acceptable < 0.84, high ≥ 1.12 and for ≥ 10-year-olds, acceptable < 1.02 and high ≥ 1.47 (28). Plasma glucose (GLUC) cut-off for normal and elevated was 5.6 mmol/l (29). Serum insulin (INS) was classified as normal or high with cut-offs: in pre-puberty 15 mU/l, puberty 30 mU/l, and in postpuberty 20 mU/l (30). Homeostasis model assessment for insulin resistance (HOMA-IR) was calculated by the formula: fS-INS (mU/l) × fP-Gluc (mmol/l)/22.5 and its cut-offs for normal and high were 2.67 in prepubertal boys, 5.22 in pubertal boys and in girls 2.22 and 3.82, respectively (30). Plasma alanine transferase (ALT) values ≥ 40 IU/l expressed fatty liver (31). McNemar's test, **P 0.001–0.010, *P < 0.05.