The Predictive Value of Adipokines and Metabolic Risk Factors for Dropouts and Treatment Outcomes in Children With Obesity Treated in a Pediatric Rehabilitation Center

Abstract

Background: Inpatient pediatric obesity treatments are highly effective, although dropouts and weight regain threaten long-term results. Preliminary data indicate that leptin, adiponectin, and cardiometabolic comorbidities might predict treatment outcomes. Previous studies have mainly focused on the individual role of adipokines and comorbidities, which is counterintuitive, as these risk factors tend to cluster. This study aimed to predict the dropouts and treatment outcomes by pre-treatment patient characteristics extended with cardiometabolic comorbidities (individually and in total), leptin, and adiponectin.

Methods: Children aged 8-18 years were assessed before, immediately after and 6 months after a 12-month inpatient obesity treatment. Anthropometric data were collected at each visit. Pre-treatment lipid profiles; glucose, insulin, leptin, and adiponectin levels; and blood pressure were measured. The treatment outcome was evaluated by the change in body mass index (BMI) standard deviation score (SDS) corrected for age and sex.

Results: We recruited 144 children with a mean age of 14.3 ± 2.2 years and a mean BMI of 36.7 ± 6.2 kg/m² corresponding to 2.7 ± 0.4 BMI SDS. The 57 patients who dropped out during treatment and the 44 patients who dropped out during aftercare had a higher pre-treatment BMI compared to the patients who completed the treatment (mean BMI, 38.3 ± 6.8 kg/m² vs 35.7 ± 5.5 kg/m²) and those who completed aftercare (mean BMI, 34.6 ± 5.3 kg/m² vs 37.7 ± 6.3 kg/m²) (all p<0.05). Additionally, aftercare attenders were younger than non-attenders (mean age, 13.4 ± 2.3 years vs 14.9 ± 2.0, p<0.05).Patients lost on average 1.0 ± 0.4 SDS during treatment and regained 0.4 ± 0.3 SDS post-treatment corresponding to regain of 43 ± 27% (calculated as the increase in BMI SDS post-treatment over the BMI SDS lost during treatment). A higher BMI and more comorbidities inversely predicted BMI SDS reduction in linear regression (all p<0.05).The absolute BMI SDS increase after returning home was predicted by pre-treatment leptin and systolic blood pressure, whereas the post-treatment BMI SDS regain was predicted by pre-treatment age, leptin, and adiponectin levels (all p<0.05) in multivariate linear regressions.

Conclusion: Patients who need treatment the most are at increased risk for dropouts and weight regain, emphasizing the urgent need for interventions to reduce dropout and support inpatients after discharge. Furthermore, this study is the first to report that pre-treatment leptin and adiponectin levels predict post-treatment BMI SDS regain, requiring further research.

Keywords: adipokines; patient dropout; pediatric obesity; treatment outcome; weight reduction programs.

Figure 1

Visual representation of the patients their BMI SDS evolution, * = statistically significant from baseline, $ = statistically significant from post-treatment. Both were p<0.001.

Figure 2

Visual overview of factors predictive for dropout and treatment outcome.The middle panel represents the number of study patients at every visit. The left side depicts the factors predictive of the treatment outcomes. Pre-treatment BMI and total number of metabolic risk factors inversely affected the BMI SDS reduction during treatment. Post-treatment absolute BMI SDS change was predicted by systolic blood pressure (+), expressed as Z-score and baseline leptin (-), whereas post-treatment BMI SDS regain was predicted by age (+), leptin (-), and adiponectin (-). On the right side, factors predictive of dropout during and after treatment were identified. During treatment, higher weight and lower adiponectin levels were risk factors for premature treatment cessation, whereas during aftercare, only those at older age (which coincides with a higher BMI) were found to be at increased risk for dropout. + or – indicates whether the factor is positively or inversely predictive of the dependent variable, that is, treatment outcome or dropout.