Metaboličke promene kod gojaznih adolescentkinja na hipokalorijskoj dijeti i aerobnom intervalnom treningu

Abstract

predstavlja značajan javno-zdravstveni problem i dostiže razmere pandemije. Imajući u vidu da je gojaznost u detinjstvu udružena sa endokrinološkim, metaboličkim, kardiovaskularnim i drugim poremećajima zdravlja, može se očekivati posledično smanjenje kvaliteta i prosečne dužine života kod odraslih. Mnoge studije su pokazale korisne efekte različitih dijeta i oblika fizičke aktivnosti na sastav tela, metaboličke parametre i kardiorespiratorni kapacitet gojazne dece i adolescenata, ali je malo studija koje su obuhvatile sve navedene parametre. Fizički trening, nezavisno od dijetetskih intervencija, dovodi do poboljšanja kardiorespiratornog kapaciteta i sastava tela gojazne dece. Ciljevi studije su bili ispitivanje uticaja hipokalorijske dijete i aerobnog intervalnog treninga na promene telesnog sastava, metaboličkih parametara, kardiorespiratornog kapaciteta, navika u ishrani, dnevnog energetskog unosa i nivoa bazalnog metabolizma gojaznih adolescentkinja. Materijal i metode: U ovu studiju prospektivnog tipa uključeno je četrdeset četiri adolescentkinje sa područja grada Beograda, uzrasta trinaest do devetnaest godina, koje su imale indeks telesne mase veći od 95. percentila za odgovarajući uzrast i pol, zbog čega su upućivane iz ustanova primarne zdravstvene zaštite u Institut za zdravstvenu zaštitu majke i deteta Srbije. Ispitanice su randomizovane u tromesečnu intervenciju i raspoređene u dve grupe: 1) adolescentkinjе koje su bile na uravnoteženoj hipokalorijskoj dijeti (n = 22) i 2) adolescentkinje koje su bile na uravnoteženoj hipokalorijskoj dijeti i aerobnom intervalnom treningu (n = 22). Izvršena su antropometrijska merenja, biohemijska i hormonska ispitivanja. Procenjen je kardiorespiratorni kapacitet, nivo fizičke aktivnosti i ishrana adolescentkinja. Insulinska rezistencija je procenjivana pomoću homeostatskog indeksa insulinske rezistencije (HOMA-IR), indeksa osetljivosti na insulin (ISI) Matsuda, AUCglukoze i AUCinsulina. Rezultati: Posle tromesečne intervencije, kod grupe adolescentkinja koja je vežbala došlo je do značajnog povećanja bazalnog metabolizma (Δ ± SD; 14 ± 46 kcal vs. 104 ± 80 kcal; p = 0,000, Dijeta vs. Dijeta + AIT, redom), ISI (-0,34 ± 1,52 vs. 1,05 ± 3,21; p = 0,001) i radnog opterećenja (0,6 ± 11,3 watts vs. 14,6 ± 20,2 watts; p = 0,024) i smanjenja AUCglukoze (-0,29 ± 4,69 vs. -0,98 ± 4,06; p = 0,040), AUCinsulina (-9,65 ± 117,9 vs. -98,7 ± 201,8; p = 0,003) i hsCRP (0,12 ± 1,92 mg/l vs. -1,47 ± 3,67 mg/l; p = 0,039) u poređenju sa grupom na dijeti...

The very high prevalence of obesity in population of children and adolescents worldwide is a significant public health problem and is reaching a pandemic levels. Given that childhood obesity is associated with endocrinological, metabolic, cardiovascular and other health disorders, a consequent decrease in quality and average life expectancy in adults can be expected. Many studies have shown the beneficial effects of different diets and forms of physical activity on body composition, metabolic parameters, and cardiorespiratory capacity of obese children and adolescents, but few studies have included all of these parameters. Physical training, independently of dietary interventions, leads to an improvement in cardiorespiratory capacity and body composition of obese children. The aim of the study was to examine the effect of hypocaloric diet and aerobic interval training on changes in body composition, metabolic parameters, cardiorespiratory capacity, eating habits, daily energy intake and basal metabolism levels of adolescent girls with obesity. Methods: Forty-four adolescent girls from Belgrade, aged thirteen to nineteen years, who had a body mass index greater than the 95th percentile for the appropriate age and gender were included in this prospective study and for that reason they were referred from Primary Health Care Centers to Mother and Child Healthcare Instutute of Serbia. Subjects were randomized to a three-month intervention and divided into two groups: 1) adolescent girls on a balanced hypocaloric diet (n = 22) and 2) adolescent girls who were on a balanced hypocaloric diet and aerobic interval training (n = 22). Anthropometric measurements, biochemical and hormonal testings were performed. Cardiorespiratory capacity, physical activity level, and adolescent diet were assessed. Insulin resistance was determined using the homeostatic model assessment (HOMA-IR), the insulin sensitivity index (ISI) of Matsuda, AUCglucose and AUCinsulin. Results: After 3-month intervention, Diet + AIT group significantly increased basal metabolic rate (Δ ± SD; 14 ± 46 kcal vs. 104 ± 80 kcal; p = 0.000, Diet vs. Diet + AIT, respectively),respectively), Insulin sensitivity index (-0.34 ± 1.52 vs. 1.05 ± 3.21; p = 0.001) and work load (0.6 ± 11.3 watts vs. 14.6 ± 20.2 watts; p = 0.024) and decreased AUCglc (-0.29 ± 4.69 vs. -0.98 ± 4.06; p = 0.040),respectively), Insulin sensitivity index (-0.34 ± 1.52 vs. 1.05 ± 3.21; p = 0.001) and work load (0.6 ± 11.3 watts vs. 14.6 ± 20.2 watts; p = 0.024) and decreased AUCglc (-0.29 ± 4.69 vs. -0.98 ± 4.06; p = 0.040), AUCins (-9.65 ± 117.9 vs. -98.7 ± 201.8; p = 0.003) and hsCRP (0.12 ± 1.92 mg/L vs. -1.47 ± 3.67 mg/L; p = 0.039) in comparison to Diet group. A statistically significant difference was observed between the groups after the intervention in the concentration of oxidative stress markers: uric acid (0.2 ± 53.5 μmol/L vs. -26.7 ± 77.7 μmol/L; p = 0.008), glutathione peroxidase, GPx (-118.1 ± 59.6 U/L vs. -73.8 ± 78.5 U/L; p = 0.002) and superoxide dismutase, SOD (49.0 ± 65.4 U/L vs. 39.2 ± 20.2 U/L; p = 0.035)...