Tratamiento de la obesidad infantil y sus complicaciones mediante la implementación de un programa de ejercicio físico en el marco del estudio 5-10

Abstract

The World Health Organization (WHO) defines obesity as a situation in which accumulated body fat can cause health problems. Until a few years ago childhood obesity was considered a minor problem, as it did not have harmful consequences in the short term. However, it is now known that, as in the adult, a series of complications that may become irreversible, such as insulin resistance and the subsequent development of type 2 diabetes mellitus, hypertension or dyslipidemia, among others. All these entities are grouped in what is known as the metabolic syndrome (MS). The sum of body fat accumulation and its complications may trigger inflammatory mechanisms leading to the onset of lesions, such as nonalcoholic fatty liver (NAFDL) or atherosclerosis. The main measures of treatment of childhood obesity are the correction of eating habits and physical exercise (PE) on a regular basis. Objective: Given the above, the main objective of this study is to verify the effectiveness of PE as a treatment of childhood obesity, its metabolic comorbidities and some of the complications derived from it, namely, subclinical atherosclerosis and NAFDL. Material and method: This is a prospective, study in which a sample of 135 children with excess weight, aged between 4 and 10 years, carried out a structured program of moderate to high intensity PE and 8 months of duration, adding 3 hours a week to the usual daily PA. The diagnosis of MS was established following the Adult Treatment Panel III criteria. For the data that required it body mass index (BMI), body fat, waist circumference and tensional figures, standardized and validated charts for children were used. Analytical parameters and hepatic echogenicity and carotid intima-media thickness (IMT) were also measured. Statistical analysis was used for paired data, taking p <0.05 as significant. Results: mean age at baseline was 8.1 ± 1.7. 52.6% of the participants were male. Following the completion of the PE program, significant improvements were found in the z-score of BMI (from 2.5 ± 1 SD to 2.2 ± 0.9, p<0.001). The percentage of body fat was reduced from 30.9 ± 6.2% to 29.5 ± 6.5%, p=0.001. There were also significant improvements in the levels of glutamic-pyruvic transaminase (GPT), High Density Lipoprotein (HDLc) and triglyceride levels. On the other hand, carotid IMG went from 0.48 ± 0.08 mm to 0.37 ± 0.07 mm, p<0.001. High Density Lipoprotein (HDLc) and triglyceride levels. On the other hand, carotid IMG went from 0.48 ± 0.08 mm to 0.37 ± 0.07 mm, p <0.001, this variation being related to the initial carotid IMG regardless of gender and age. The number of diagnosed NAFDLs decreased significantly from 40.5% to 7.2%, (p<0.0001), this variation was associated with changes in body fat% and age-dependent BMI. The remaining parameters were not significantly modified. Likewise, the number of cases of MS was also reduced from 26.1% to 14.4%, (p=0.015). Conclusions: The implementation of a structured program of moderate-intense PE may decrease the excess weight and cardiovascular health in school-aged children, reducing the prevalence of MS. Although metabolic pathologies are a reality in children, their association with excess weight is more difficult to establish than in adults, perhaps because of the short evolution time of both.