title: Randomized controlled trial to improve adiposity, inflammation, and insulin resistance in obese African-American and Latino youth. Circulating concentrations of the adipocyte protein adiponectin are decreased in parallel with reduced insulin sensitivity during the progression to type 2 diabetes in rhesus monkeys. Reversal of obesity-related hypoadiponectinemia by lifestyle intervention: a controlled, randomized study in obese adolescents. Dietary restriction in obese children and its relation with eating behavior, fibroblast growth factor 21 and leptin: a prospective clinical intervention study Fasting gut hormone levels change with modest weight loss in obese adolescents. Influence of physical training on plasma leptin in obese youths. High-Protein Breakfast Promotes Weight Loss by Suppressing Subsequent Food Intake and Regulating Appetite Hormones in Obese Chinese Adolescents Interdisciplinary therapy changes superoxide dismutase activity and adiponectin in obese adolescents: a randomised controlled trial Normalizing eating behavior reduces body weight and improves gastrointestinal hormonal secretion in obese adolescents. Whole-grain intake favorably affects markers of systemic inflammation in obese children: a randomized controlled crossover clinical trial. School-based intervention acutely improves insulin sensitivity and decreases inflammatory markers and body fatness in junior high school students. A one-year school-based diet/exercise intervention improves non-traditional disease biomarkers in Mexican-American children. Changes in circulating satiety hormones in obese children: a randomized controlled physical activity-based intervention study. Effect of obesity intervention programs on adipokines, insulin resistance, lipid profile, and low-grade inflammation in 3- to 5-y-old children
abstract: The purpose of this study was to examine ethnic differences in the metabolic responses to a 16-week intervention design ed to improve insulin sensitivity ( SI ) , adiposity , and inflammation in obese African-American and Latino adolescents . A total of 100 participants ( African Americans : n = 48 , Latino : n = 52 ; age : 15.4 ± 1.1 years , BMI percentile : 97.3 ± 3.3 ) were r and omly assigned to interventions : control ( C ; n = 30 ) , nutrition ( N ; n = 39 , 1 × /week focused on decreasing sugar and increasing fiber intake ) , or nutrition + strength training ( N+ST ; n = 31 , 2 × /week ) . The following were measured at pre- and postintervention : strength , dietary intake , body composition ( dual-energy X-ray absorptiometry/magnetic resonance imaging ) and glucose/insulin indexes ( oral glucose tolerance test (OGTT)/intravenous glucose tolerance test ( IVGTT ) ) and inflammatory markers . Overall , N compared to C and N+ST reported significant improvements in SI ( + 16.5 % vs. -32.3 % vs. -6.9 % respectively , P < 0.01 ) and disposition index ( DI : + 15.5 % vs. -14.2 % vs. -13.7 % respectively , P < 0.01 ) . N+ST compared to C and N reported significant reductions in hepatic fat fraction ( HFF : -27.3 % vs. -4.3 % vs. 0 % respectively , P < 0.01 ) . Compared to N , N+ST reported reductions in plasminogen activator inhibitor-1 ( PAI-1 ) ( -38.3 % vs. + 1.0 % , P < 0.01 ) and resistin ( -18.7 % vs. + 11.3 % , P = 0.02 ) . There were no intervention effects for all other measures of adiposity or inflammation . Significant intervention by ethnicity interactions were found for African Americans in the N group who reported increases in total fat mass , 2-h glucose and glucose incremental areas under the curve ( IAUC ) compared to Latinos ( P 's < 0.05 ) . These interventions yielded differential effects with N reporting favorable improvements in SI and DI and N+ST reporting marked reductions in HFF and inflammation . Both ethnic groups had significant improvements in metabolic health ; however some improvements were not seen in African Americans Adiponectin is an adipose-specific plasma protein whose plasma concentrations are decreased in obese subjects and type 2 diabetic patients . This protein possesses putative antiatherogenic and anti-inflammatory properties . In the current study , we have analyzed the relationship between adiponectin and insulin resistance in rhesus monkeys ( Macaca mulatta ) , which spontaneously develop obesity and which subsequently frequently progress to overt type 2 diabetes . The plasma levels of adiponectin were decreased in obese and diabetic monkeys as in humans . Prospect i ve longitudinal studies revealed that the plasma levels of adiponectin declined at an early phase of obesity and remained decreased after the development of type 2 diabetes . Hyperinsulinemic-euglycemic clamp studies revealed that the obese monkeys with lower plasma adiponectin showed significantly lower insulin-stimulated peripheral glucose uptake ( M rate ) . The plasma levels of adiponectin were significantly correlated to M rate ( r = 0.66 , P < 0.001 ) . Longitudinally , the plasma adiponectin decreased in parallel to the progression of insulin resistance . No clear association was found between the plasma levels of adiponectin and its mRNA levels in adipose tissue . These results suggest that reduction in circulating adiponectin may be related to the development of insulin resistance CONTEXT Hypoadiponectinemia and chronic sub clinical inflammation in adults are associated with the development of diabetes and cardiovascular disease . The potential relationship between adiponectin and inflammation and its modulation by lifestyle intervention in the pediatric obese population remain unclear . OBJECTIVES The objectives were to investigate in adolescents 1 ) the relationship between adiponectin and obesity-related inflammatory factors , C-reactive protein , and IL-6 ; and 2 ) the effect of a lifestyle intervention on adiponectin and whether these effects are related to changes in inflammatory factors . RESEARCH METHODS AND PROCEDURES Twenty-one obese and age-matched lean adolescents ( age , 14 - 18 yr ; Tanner stage , > or = IV ) were studied cross-sectionally . Fifteen obese adolescents also underwent a r and omized , controlled physical activity-behavior-diet-based lifestyle intervention for 3 months . Associations among adiponectin , fat mass , insulin resistance , and inflammatory factors at baseline as well as after the intervention were assessed . RESULTS Plasma adiponectin concentration was lower ( P < 0.001 ) in the obese vs. age-matched lean adolescents . Significant inverse relationships were observed between adiponectin and inflammatory factors , insulinemia , insulin resistance , and fat mass . Intervention produced a 34 % increase in adiponectin concentration ( P = 0.0004 ) despite negligible weight loss but with reductions in fat mass , hyperinsulinemia , insulin resistance , and inflammatory factors ( all P < 0.01 ) . CONCLUSIONS The data suggest that in adolescents , obesity-related hypoadiponectinemia is associated with sub clinical inflammation , and a short-term lifestyle intervention augments adiponectin concentrations . These effects appear to be related to reductions in fat mass and inflammatory factors . Based on our current underst and ing of adiponectin physiology , reversal of hypoadiponectinemia in obese adolescents may protect against risks for cardiovascular disease and diabetes Background Obesity is significant problem involving eating behavior and peripheral metabolic conditions . The effect of carbohydrate and fat restriction on appetite regulation , fibroblast growth factor 21 ( FGF21 ) and leptin in children has not been defined . Our objective was to compare the effect of both diets . Methods One hundred and twenty children with body mass index ( BMI ) higher than the equivalent of 30 kg/m2 for an adult , as corrected for gender and age were r and omly assigned to ( n = 60 ) a low-carbohydrate ( L-CHO ) diet or ( n = 60 ) a low-fat ( L-F ) diet for 2 months . Fifty-three ( 88.3 % ) subjects on the low-carbohydrate-diet and 45 ( 75 % ) on the low-fat diet completed the study .  Anthropometric measures , leptin and FGF21 levels were measured before and after the intervention . Comparison of the data for both of the diet groups was carried out using the t-test for independent variables . Intragroup comparisons before and after of each of the dietary treatments were performed using ANOVA for repeated measures . Factors associated with FGF21 , leptin levels and satiety , were analyzed by multiple regression . Results After both of the diets , weight , leptin , food responsiveness , and enjoyment of food significantly decreased and high density lipoprotein cholesterol ( HDL ) increased , but FGF21 decreased . Before and after both of the interventions FGF21 was associated with triglycerides . Before the diet , satiety was associated with lower screen time ( p < 0.04 ) and insulin levels ( p < 0.05 ) . Conclusions Both dietary restrictions improved the metabolic and hormonal parameters of obese children . FGF21 is an indicator of a beneficial metabolic response in younger children . After 2 months an adaptation of the eating behavior to food restriction was observed BACKGROUND Gut hormones change with weight loss in adults but are not well studied in obese youth . OBJECTIVE The primary aim was to evaluate how gut hormones and subjective appetite measure change with dietary weight loss in obese adolescents . METHODS Participants were a subset of those taking part in the ' Eat Smart Study ' . They were aged 10 - 17 years with body mass index ( BMI ) > 90th centile and were r and omized to one of three groups :  wait-listed control , structured reduced carbohydrate or structured low-fat dietary intervention for 12 weeks . Outcomes were fasting glucose , insulin , leptin , adiponectin , total amylin , acylated ghrelin , active glucagon-like peptide-1 , glucose-dependent insulinotropic polypeptide ( GIP ) , pancreatic polypeptide ( PP ) and total peptide tyrosine-tyrosine . Pre- and postpr and ial subjective sensations of appetite were assessed using visual analogue scales . RESULTS Of 87 ' Eat Smart ' participants , 74 participated in this sub- study . The mean ( st and ard deviation ) BMI z-score was 2.1 ( 0.4 ) in the intervention groups at week 12 compared with 2.2 ( 0.4 ) in the control group . Fasting insulin ( P = 0.05 ) and leptin ( P = 0.03 ) levels decreased , while adiponectin levels increased ( P = 0.05 ) in the intervention groups compared with control . The intervention groups were not significantly different from each other . A decrease in BMI z-score at week 12 was associated with decreased fasting insulin ( P < 0.001 ) , homeostatic model of assessment -insulin resistance ( P < 0.001 ) , leptin ( P < 0.001 ) , total amylin ( P = 0.03 ) , GIP ( P = 0.01 ) , PP ( P = 0.02 ) and increased adiponectin ( P < 0.001 ) . There was no significant difference in appetite sensations . CONCLUSIONS Modest weight loss in obese adolescents leads to changes in some adipokines and gut hormones that may favour weight regain Little is known about the effects of different intensities of physical training on plasma leptin . This study examined the effect of two intensities of physical training on leptin in obese teenagers , and explored correlates at baseline and in response to 8 months of physical training . The participants were 55 obese youths 12 - 16 years of age who completed both baseline and posttesting . The youths were r and omized to engage in lifestyle education only ( LSE ) , moderate-intensity physical training and LSE , or high-intensity physical training and LSE .  Baseline leptin was positively associated with fat mass . Girls had higher leptin levels at lower levels of fasting insulin than boys . The 8-mo physical training doses prescribed to obese teenagers did not result in significant group differences in mean change in leptin , although there was large variability in individual response . The change in leptin was inversely associated with baseline leptin and change in cardiovascular fitness . Diet , physical activity level , visceral adiposity , and glucose concentrations were not associated with leptin , neither at baseline nor in response to physical training . At baseline , total fat mass rather than visceral adiposity was associated with higher leptin levels . Over the 8-mo intervention period , regardless of group membership , youths who had the lowest increase in cardiovascular fitness tended to have the highest increase in leptin Objective : A high-protein diet may decrease food intake through regulating satiety and appetite hormones and can be an effective strategy for weight loss . Few studies exist on obese Chinese adolescents . Methods and Material s : 156 obese Chinese adolescents were enrolled and r and omly assigned to one of two isoenergetic breakfasts , either with egg or steamed bread . Subsequent lunchtime food intake was recorded 4 h later . Appetite was assessed with a visual analog scale . Anorexigenic hormones peptide YY ( PYY ) , glucagon-like peptide-1 ( GLP-1 ) and orexigenic hormone ghrelin were determined with radioimmunoassay at 0 , 30 , and 180 min . Body weight was recorded . The tests were repeated 3 months later . Analysis was performed between two tests and then two groups . Pearson 's correlation was used for association analysis . Results : Subsequent lunchtime food intake and body weight were decreased while satiety was increased in subjects on an egg breakfast , which is associated with an increase of serum PYY and GLP-1 ( p < 0.001 , respectively ) . There were strong correlations between weight loss , appetite , subsequent food intake and changes of appetite hormones . Conclusion : A high-protein breakfast promotes weight loss in obese Chinese adolescents , possibly through its regulation of satiety , subsequent food intake and appetite hormones Abstract The objective of this study is to evaluate the effect of interdisciplinary therapy in the parameters of the oxidative stress and the anti-inflammatory responses of obese adolescents . We selected 57 participants , who were r and omly divided into 2 groups : interdisciplinary therapy group and a control group . After 6 months of intervention , 17 participants of the interdisciplinary therapy group and 8 of the control group returned for re-evaluation . The interdisciplinary therapy group participated in a treatment with 4 weekly sessions of exercise , a weekly group therapy session and a weekly nutritional education session .  Blood parameters of oxidative stress and anti-inflammatory response were evaluated . The results demonstrated that there were significant increases in the interdisciplinary therapy group for superoxide dismutase activity ( 6.56 ± 3.22 to 11.40 ± 7.49 ) and ferric-reducing antioxidant potential concentration ( 532.91 ± 106.48 to 573.25 ± 112.57 ) , although adiponectin levels did not reduce ( 40.9 ± 29.34 to 49.05 ± 41.22 ) . A significant decrease in nitrite levels was also found ( 14.23 ± 8.48 to 11.45 ± 6.05 ) . In the control group , significant reduction was found in adiponectin ( 31.56 ± 18.88 to 18.01 ± 11.66 ) . This study suggests that interdisciplinary therapy for 6 months was effective in improving the anti-inflammatory responses and the antioxidant defences in obese adolescents HYPOTHESIS Retraining obese adolescents to eat more slowly will lead to beneficial changes in circulating concentrations of gastrointestinal satiety hormones . METHODS Ghrelin and peptide tyrosine-tyrosine were measured during an oral glucose tolerance test , at baseline and at 12 months during a r and omized trial assessing the clinical effectiveness of a device ( M and ometer ) design ed to retrain eating behavior . This computerized scale provided real-time feedback during meals in the intervention arm ( n = 14 ) to slow down the speed of eating . The control group ( n = 13 )  received only st and ard care aim ed at improving lifestyle behavior . The M and ometer elicited greater improvements in weight loss than st and ard care . RESULTS Compared with baseline , only those using the M and ometer exhibited lower mean levels of fasting ghrelin ( 48.14 ± 18.47 vs. 68.45 ± 17.78 pg/ml ; P = 0.002 ) and mean ghrelin area under the curve ( 72.08 ± 24.11 vs. 125.50 ± 29.72 pg/ml × min ; P < 0.001 ) at 12 months . Absolute mean suppression in ghrelin at 60 min was enhanced ( -40.50 ± 21.06 vs. -12.14 ± 19.74 pg/ml × min ; P = 0.001 ) . Peptide tyrosine-tyrosine response at 90 min remained unaltered in the st and ard care arm , whereas those in the M and ometer arm increased ( P < 0.001 ) : the mean 90-min response increased by 72 pg/ml [ 95 % confidence interval ( CI ) 52 - 92 pg/ml ] between baseline and 12 months . In a partial correlation analysis adjusting for change ( Δ ) in body mass index sd scores , Δ meal duration correlated negatively with Δ absolute suppression in ghrelin at 60 min ( r = -0.58 ; P = 0.037 ; 95 % CI -0.79 to -0.27 ) and Δ ghrelin area under the curve ( r = -0.62 ; P = 0.025 ; 95 % CI -0.81 to -0.31 ) . CONCLUSIONS Retraining obese adolescents to eat more slowly has a significant impact on the gastrointestinal hormone response to a carbohydrate load , suggesting that externally modifiable eating behaviors actually regulate the hormonal response to food SCOPE Whole-grain foods have been reported to affect serum levels of inflammatory cytokines . However , we are aware of no study examining the effect of whole-grain intake on inflammatory biomarkers among children . The present study aim ed to determine the effect of whole-grain intake on serum levels of inflammatory biomarkers in overweight or obese children . METHODS AND RESULTS In this r and omized crossover clinical trial , 44 overweight or obese girls aged 8 - 15 years participated . After a 2-week run-in period , subjects were r and omly assigned to either whole-grain or control groups . Subjects in the whole-grain group were given a list of whole-grain foods and were asked to obtain half of their needed servings of grains from whole-grain foods each day for 6 weeks . Individuals in the control group were also given a list of whole-grain foods and were asked not to consume any of these foods during the intervention phase of the study . A 4-week washout period was applied following which subjects were crossed over to the alternate arm for an additional 6 weeks . Fasting blood sample s were taken before and after each phase of the study to quantify markers of systemic inflammation . Mean age , weight , and BMI of study participants were 11.2 ± 1.49 years , 51.2 ± 10.2 kg , and 23.5 ± 2.5 kg/m(2 ) , respectively . No significant effect of whole-grain intake on weight and BMI was seen compared with the control group . We found a significant effect of whole-grain  intake on serum levels of high-sensitive C-reactive protein ( -21.8 versus + 12.1 % , p = 0.03 ) , soluble intercellular adhesion molecule-1 ( -28.4 versus + 6.3 % , p = 0.02 ) , serum amyloid A ( -17.4 versus + 9.9 % , p = 0.02 ) , and leptin ( -9.7 versus + 39.2 % , p = 0.02 ) after 6 weeks . A trend toward the significant effect of whole-grain intake on serum levels of soluble vascular cell adhesion molecule-1 ( -36.2 % versus -7.8 % , p = 0.07 ) was also observed . CONCLUSION This study provides evidence supporting the beneficial effects of whole-grain foods on biomarkers of systemic inflammation in obese children CONTEXT Risk factors for type 2 diabetes mellitus ( T2DM ) include obesity , family history , dyslipidemia , a proinflammatory state , impaired insulin secretory capacity , and insulin resistance . OBJECTIVE The aim of this study was to examine the effects of a 3- to 4-month school-based intervention consisting of health , nutrition , and exercise classes plus an aerobic exercise program on diabetes risk . DESIGN This study was a r and omized before/after controlled trial . METHODS Seventy-three eighth- grade students in a predominantly Hispanic New York City public school were divided into a control group ( studied twice without receiving the intervention ) and an experimental group ( studied before and after the intervention ) . OUTCOME MEASURES We measured body fatness ( bioelectrical impedance ) , insulin sensitivity , beta-cell function ( insulin release in response to an iv glucose load corrected for insulin sensitivity ) , lipid profiles , and circulating concentrations of IL-6 , C-reactive protein , adiponectin , and TNF-alpha . RESULTS Participation in the intervention was associated with significant reductions in body fatness , insulin resistance , and circulating concentrations of C-reactive protein and IL-6 , irrespective of somatotype on enrollment . CONCLUSION Short-term school-based health , nutrition , and exercise intervention is beneficial to all students and affects multiple diabetes risk factors School-based interventions are an effective way to treat  childhood obesity . The purpose of the present study was to biologically vali date an established school-based intervention design ed to reduce st and ardised body mass index ( z BMI ) over a period of 12 months . This intervention focused on a subset of Mexican-American children who were participating in a larger clinical weight loss study . Plasma sample s were analysed from self-identified Mexican-American children ( 12 - 14 years ) who were r and omised to either a school-based intervention ( IN , n = 152 ) or self-help control ( CN , n = 69 ) . Treatment was 4 days week⁻¹ of exercise ( 45 min day⁻¹ ) and 1 day week⁻¹ of nutritional counselling for 6 months . Fasting ( > 8 h ) blood sample s were collected at baseline , 6 months ( end of active intervention ) and 12 months ( 6 months after the end of the active intervention ) . Plasma resistin , adiponectin and leptin concentration were measured using a multiplex assay . Separate linear mixed models and a P < 0.05 were used to test for significance . Significant group × time interactions were found for resistin ( P < 0.0001 ) , adiponectin ( P = 0.001 ) and leptin ( P = 0.013 ) . For resistin , IN was 12 % lower at 6 months than CN . Adiponectin concentration in IN was greater at 6 months ( 26 % ) and 12 months ( 8 % ) than CN . Leptin concentration was 22 % lower for IN at 12 months than CN . We have previously reported that our school-based intervention reduced z BMI and now reported alterations in biologically relevant disease biomarkers . Some of the observed changes were only present at the end of the active intervention ( resistin ) , while others persisted until 12 months ( leptin and adiponectin ) . These changes underscore the effectiveness of our school-based intervention at not only improving z BMI but also at reducing disease risk The aims of this study are to examine in children : ( i ) obesity-related alterations in satiety factors such as leptin , ghrelin , and obestatin ; ( ii ) the link between satiety factors and cardiometabolic risk factors ; and ( iii ) the impact of a physical activity-based lifestyle intervention on the levels of these satiety factors in the obese . We studied a total of 21 adolescents ( BMI percentile , 99.0 + /- 0.6 for 15 obese and 56.2 + /- 1.1 for 6 lean ) . The obese subjects underwent a 3-month r and omized controlled physical activity-based lifestyle intervention .  Leptin , soluble leptin receptor ( sOB-R ) , ghrelin , and obestatin levels were determined as the primary outcome measures . Other markers of cardiometabolic disease such as inflammation and insulin resistance were also determined . Body composition was measured by dual-energy X-ray absorptiometry . The concentrations of ghrelin , obestatin , and sOB-R were significantly lower in the obese children compared to the lean controls , whereas that of leptin was higher ( all P < 0.05 ) . Although intervention led to a net increase in obestatin ( P < 0.01 ) and no change in ghrelin levels , the balance between ghrelin and obestatin ( ratio of ghrelin to obestatin , G/O ) decreased ( P < 0.02 ) . Intervention reduced leptin and increased sOB-R ( P < 0.01 for both ) . Significant associations between satiety factors and other cardiometabolic risk factors were also observed . Taken together , alterations in the levels of satiety factors are evident early in the clinical course of obesity , but physical activity-based lifestyle intervention either prevented their continued increase or normalized their levels . These beneficial effects appear to aid in the maintenance of body weight and reduction in cardiovascular risk Background : Childhood obesity can cause the development of cardiovascular risk factors . We assessed the effect of a multidisciplinary intervention program on cardiovascular risk factors and compared this effect with a usual-care program in 3- to 5-y-old overweight or obese children . Methods : Seventy-five children were r and omly assigned to a multidisciplinary intervention or a usual-care program . Anthropometry , body composition , and abdominal adipose tissue were assessed at the start and end of a 16-wk program . Concurrently , fasting concentrations of serum lipids , glucose , insulin , HbA1c , leptin , adiponectin , high-sensitive C-reactive protein ( hsCRP ) , tumor necrosis factor (TNF)-α , and interleukin (IL)-6 were determined . Results : In both groups , insulin sensitivity improved , demonstrated by decreased insulin concentrations and a decreased HOMA2-IR . In the multidisciplinary intervention group , there was also a decrease of HbA1c and TNF-α . In the usual-care group , an increase in glucose concentrations was found . Comparing both groups , changes over time were not different , besides trends in the decrease in total cholesterol and TNF-α , in favor of the multidisciplinary intervention group . Combining the results of both groups , a correlation was found between the decrease in body fat percentage ( BF% ) , and both HOMA2-IR and triglyceride ( TG ) concentrations . Conclusion : In 3- to 5-y-old children , both obesity intervention programs improved insulin sensitivity , in parallel with a reduced BF%
target: Leptin levels decreased as BMI decreased .
  Evidence regarding the relationships of ghrelin and adiponectin with BMI was inconclusive .
  Conclusions : Despite known effects of maturation on hormones , studies did not consistently differentiate findings by maturational stage .
  BMI and leptin levels have a positive relationship , but evidence on ghrelin and adiponectin was inconclusive
background: Problem : To address the complex phenomenon of pediatric obesity , one must underst and the physiological mechanisms regulating energy intake and inflammation .
  The peptide hormones leptin , ghrelin , and adiponectin are involved in both , but their functions are dysregulated in obesity .
  The purpose of this systematic review is ( 1 ) to characterize studies of nutrition interventions for weight management in children who measure these peptides as outcomes , ( 2 ) to assess risk of bias in the studies , and ( 3 ) to determine the relationships between these peptides and body mass index ( BMI ) .