Effect of a family-based intervention on nutrient biomarkers, desaturase enzyme activities and cardiometabolic risk factors in overweight and obese children

Authors: MATTHAN, NIRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; WYLIE-ROSETT, JUDITH - Albert Einstein College Of Medicine; XUE, XIAONAN - Albert Einstein College Of Medicine; GAO, QI - Albert Einstein College Of Medicine; GROISMAN-PERELSTEIN, ADRIANA - Albert Einstein College Of Medicine; DIAMANTIS, PAMELA - Albert Einstein College Of Medicine; GINSBERG, MINDY - Albert Einstein College Of Medicine; MOSSAVAR-RAHMANI, YASMIN - Albert Einstein College Of Medicine; BARGER, KATHRYN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Current Developments in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/13/2019
Publication Date: 12/2/2019
Citation: Matthan, N.R., Wylie-Rosett, J., Xue, X., Gao, Q., Groisman-Perelstein, A.E., Diamantis, P.M., Ginsberg, M., Mossavar-Rahmani, Y., Barger, K., Lichtenstein, A.H. 2019. Effect of a family-based intervention on nutrient biomarkers, desaturase enzyme activities and cardiometabolic risk factors in overweight and obese children. Current Developments in Nutrition. 4(1). https://doi.org/10.1093/cdn/nzz138.
DOI: https://doi.org/10.1093/cdn/nzz138

Interpretive Summary: During the past two decades the prevalence of overweight and obesity in children has rapidly increased worldwide and is associated with adverse health outcomes throughout the lifespan. Family-based obesity interventions, especially lifestyle interventions with a dietary component, have been shown to lower rates of body weight gain or BMI-z score and decrease adverse cardiometabolic risk factors. However, it is challenging to accurately assess dietary intake, particularly in children. This study is the first to use a combination of nutrient biomarkers to objectively assess the extent to which a family-based weight loss intervention shifted dietary behaviors and impacted cardiometabolic risk factors in high risk children between the ages of 7-12 years. Families were randomized to either Standard Care or Standard Care + Enhanced Program with targeted diet/physical activity strategies for 12 months. Results suggest that providing targeted family-based behavioral counseling, as part of Standard Care can help overweight/obese children adopt healthier eating patterns that are associated with improvements in BMI z-score and several cardiometabolic risk factors. The Standard Care + Enhanced Program provided a modest additional benefit. These results provide critical data to design subsequent interventions in minority communities to increase the impact of family-based obesity prevention programs.

Technical Abstract: Background: Developing strategies to prevent excess weight gain during childhood is critical to stem the current obesity epidemic and associated adverse cardiometabolic consequences. Objective: To assess how participation in a family-based weight management intervention affected nutrient biomarkers and cardiometabolic risk factors (CMRF) in children (7-12 years; N=321) with baseline BMI z-score (BMIz) >/= 85th percentile. Design: Families were randomized to either Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations), or Standard Care + Enhanced Program (SC+EP; eight skill-building cores, monthly support sessions, targeted diet/physical activity strategies). Nutrient biomarkers (plasma carotenoids, fat soluble vitamins [A, D, E, K], RBC fatty acid profiles, desaturase indices) as well as CMRF were measured in the children at baseline and end of the 1-year intervention. Results: Children in both groups showed similar changes after 1-year, but the magnitude of improvement in biomarkers (carotenoids, PUFAn-3, SFA, trans fatty acids) and CMRF (BMIz, lipid profile, hsCRP, IL6, liver enzymes) was greater in the SC+EP group. Multivariate logistic regression (adjusted for sex, age, study group, and baseline CMRF value) indicated that carotenoids (fruit and vegetable biomarkers) were negatively, and endogenously synthesized SFA, MUFA and PUFA n-6, and estimated desaturase enzyme indices (de novo lipogenesis biomarkers) were positively associated with BMIz, blood pressure, lipid profile, glucose metabolism, inflammatory biomarkers, adipokines and liver enzymes. Trans fatty acids (ruminant/partially hydrogenated fat biomarkers) were associated with improvements in BMIz, glucose metabolism and leptin, but had less favorable effects on inflammatory markers and adiponectin. Conclusions: Providing targeted family-based behavioral counseling, as part of SC can help overweight/obese children adopt healthier eating patterns that are associated with improvements in BMIz and several CMRF. SC+EP provided a modest additional benefit. These results provide critical data to design subsequent interventions in minority communities to increase the impact of family-based obesity prevention programs.