Dietary and metabolic effects of a 2-year lifestyle intervention in overweight and obese children

Sammanfattning: Background Childhood overweight and obesity have increased during the past decades and there is a need for effective intervention programs both for treatment and prevention to interrupt the increased trend. Overweight and obesity result from a combination of genetic predisposition and lifestyle where an imbalance in energy intake (EI) and total energy expenditure (TEE) is the key factor. The objective of this thesis is to evaluate the impact of a 2-year lifestyle intervention on food habits, anthropometry and metabolic markers on children with overweight and obesity.Methods Overweight and obese children 8-12 years old were recruited to participate in a 2-year randomized controlled trial (RCT). One hundred and five children agreed to participate and were randomized into one intervention group and one control group. Both groups participated in the same measurements while the intervention group also participated in a lifestyle program aiming at improving food habits and increasing physical activity. The first year of the program consisted of 14 group sessions and the second year of the intervention was web-based. Food habits were assessed at baseline and at endpoint by a diet history interview (DHI) and by a 4-day food record at 1-year measurement. At baseline 22 randomly chosen children were included in a validation study to validate reported EI against TEE measured by doubly labeled water (DLW) method and SenseWear Armband Pro 2 and 3 (version 5.1) (SWA). Anthropometric and biochemical parameters were measured at baseline, 1-year and endpoint.Results The DHI underestimated EI by 14% when validated against measured TEE by DLW and SWA. At the 1-year measurement the intervention group had a lower intake of fat (g and E%), monounsaturated fat (MUFA) (g) and polyunsaturated fat (PUFA) (g and E%) compared to the control group. At endpoint the intervention group had a lower intake of fat (g), MUFA (g) and cholesterol compared to the control group. Children in the intervention group consumed less sugar sweetened beverages at endpoint and had increased their intake of keyhole labeled foods compared to the control group. During the first year the growing children in both groups remained stable with respect to BMI and had decreased their BMI zscore.Conclusion The 2-year lifestyle intervention resulted in some improvements regarding food habits, but overall the effects on anthropometrics and metabolic markers were limited. This strongly supports that efforts should primarily be aimed at primary prevention of childhood overweight and obesity.