Ghrelin, Adipokines, Metabolic Factors in Relation With Weight Status in School-children and Results of a 1-year Lifestyle Intervention Program

Christine Rambhojan; Elodie Bouaziz-Amar; Laurent Larifla; Jacqueline Deloumeaux; Josiane Clepier; Jean Plumasseau; Jean-Marc Lacorte; Lydia Foucan

Disclosures

Nutr Metab. 2015;12(43)

Conclusion

Abdominal obesity and insulin resistance, that could precede other metabolic complications, were frequent in obese children highlighting their high risk of obesity and type 2 diabetes in adulthood. The 1-year collaborative lifestyle intervention, involving children parents and teachers seems rather beneficial, notably in obese children, with improvements in body composition, insulin, leptin and adiponectin levels. This improvement is probably the result of different factors including the fight against sedentary lifestyles and changes in eating habits in the families.

These results might be used to encourage parents to participate in prevention programs against overweight. In addition, sensitization of families (children and accompanying) on health risks related to sedentary behaviors must be continuous.

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Abbreviations
BMI: Body mass index; BMI z-score: Standard deviation score of body mass index; BP: Blood pressure; FBG: Fasting blood glucose; HDL-C: High-density lipoprotein Cholesterol; HOMA-IR: Homeostasis model assessment for insulin resistance; IOTF: International Obesity Task Force; LDL-C: Low-density lipoprotein Cholesterol; MetS: Metabolic syndrome; SD: Standard deviation; TG: Triglycerides; WC: Waist circumference; WHtR: Waist-to-height ratio

Acknowledgements
We would like to acknowledge all children and parents who participated in the study. Great thanks to the nurses and physicians of the AGREXAM Health Centre, to the teachers of physical education, to Mrs L Nesty, the headmaster of the middle school named "College Saint John Perse" located in Guadeloupe and to Dr M Meissonnier, the head of the Health Centre. We also thank Mrs Francine Mathis for language assistance.

Table 1. Characteristics of school-children 11 to 15 years according to weight status at baseline
Parameters	Overall n =120	Normal-weight n =44	Overweight n =39	Obese n =37	P
Sex (girls)	59.2 %	52.3 %	69.3 %	56.8 %	0.270
Age (Years)	12.4 ± 1.1	12.2 ± 1.0	12.5 ± 1.2	12.7 ± 1.1	0.130
BMI (Kg/m²)	24.1 ± 6.1	18.4 ± 2.3***	24.2 ± 1.6^¥¥¥	30.1 ± 4.9^§§§	*<0.001*
BMI z-score	1.08 ± 1.18	−0.17 ± 1.04***	1.47 ± 0.23^¥¥¥	2.15 ± 0.26^§§§	*<0.001*
WC (cm)	73.9 ± 12.9	62.9 ± 7.1***	75.1 ± 6.5^¥¥¥	86.6 ± 10.3^§§§	*<0.001*
WHtR	0.46 ± 0.08	0.39 ± 0.04***	0.47 ± 0.04^¥¥¥	0.53 ± 0.06^§§§	*<0.001*
Abdominal obesity (%)	32.5 %	2.3 %***	28.2 %^¥¥	73.0 %^§§§	*<0.001*
Tanner stage ≥ 3 (pubertal/post pubertal)	92.5 %	90.9 %	92.3 %	94.6 %	0.82
SBP (mmHg)	113 ± 10	110 ± 9**	113 ± 8	116 ± 12	*0.015*
DBP (mmHg)	68 ± 8	66 ± 6	69 ± 9	70 ± 7	0.126
HDL-Cholesterol (mmol/L)	1.32 ± 0.35	1.52 ± 0.36***	1.22 ± 0.28^¥¥¥	1.18 ± 0.28^§§§	*<0.001*
HDL-Cholesterol < 1.03 mmol/L(%)	21.7 %	11.4 %	28.2 %^¥	27.0 %	0.261
LDL-Cholesterol (mmol/L)	2.57 ± 0.67	2.55 ± 0.72	2.59 ± 0.62	2.57 ± 0.69	0.970
Triglycerides(mmol/L)	0.78 ± 0.44	0.66 ± 0.34***	0.74 ± 0.35	0.95 ± 0.57	*0.007*
Triglycerides ≥ 1.7 mmol/L (%)	4.2 %	0 %^*	5.1 %	8.1 %	0.287
Fasting blood glucose (mmol/L)	4.8 ± 0.4	4.7 ± 0.4	4.8 ± 0.4	4.9 ± 0.4	*0.019*
Insulin (μIU/mL)	21.3 ± 12.9	14.6 ± 4.6***	21.7 ± 13.9^¥	28.8 ± 14.3^§	*<0.001*
HOMA-IR	4.6 ± 3.0	3.5 ± 1.1***	4.7 ± 3.0^¥	6.5 ± 3.5^§	*<0.001*
HOMA-IR > 3.16 (%)	65.0 %	38.6 %***	71.8 %^¥¥	89.2 %	*<0.001*
Ghrelin (ng/L)	1379 ± 488	1541 ± 514^*	1355 ± 440	1221 ± 457	*0.012*
Leptin ng/mL	22.9 ± 20.4	8.5 ± 6.1***	23.6 ± 12.6^¥¥¥	39.6 ± 22.9^§§§	*<0.001*
Adiponectin μg/mL	5.4 ± 2.6	6.8 ± 2.8***	4.9 ± 2.2^¥¥	4.1 ± 1.8	*<0.001*

Data in this table are mean ± SD and column percentage
BMI body mass index, WC waist circumference, WHtR wait-to-height ratio, SBP systolic blood pressure, DBP diastolic blood pressure, HDL-C high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, TG triglycerides, HOMA-IR homeostasis model assessment-insulin resistance
P: P value for global comparison between the three groups
Comparison for normal-weight vs obese children *P < 0.05, **P < 0.01, ***P < 0.001
Comparison for normal-weight vs overweight children ^¥ P < 0.05, ^¥¥ P < 0.01, ^¥¥¥ P < 0.001
Comparison for overweight vs obese children: ^§ P < 0.05, ^§§ P < 0.01, ^§§§ P < 0.001
All p-values are in italic and significant p-value are in bolditalic

Table 2. Correlations between Ghrelin, Adiponectin and Leptin and anthropometric and metabolic parameters among school-children by gender 11 to 15 years at baseline
Parameters	2a: Boys						2b: Girls
	Ghrelin (ng/L)		Leptin(ng/mL)		Adiponectin (μg/mL)		Ghrelin (ng/L)		Leptin(ng/mL)		Adiponectin (μg/mL)
	r	P	r	P	r	P	r	P	r	P	r	P
BMI z-score	−0.59	*<0.001*	0.70	*<0.001*	−0.40	*0.005*	−0.08	0.523	0.66	*<0.001*	−0.40	*0.001*
WC (cm)	−0.64	*<0.001*	0.78	*<0.001*	−0.46	*0.001*	−0.12	0.313	0.79	*<0.001*	−0.46	*<0.001*
WHtR	−0.51	*<0.001*	0.85	*<0.001*	−0.36	*0.013*	−0.10	0.399	0.73	*<0.001*	−0.50	*<0.001*
FBG (mmol/L)	−0.37	*0.001*	0.25	0.087	−0.10	0.483	0.07	0.587	0.36	*0.003*	−0.32	*0.006*
HDL-C (mmol/L)	0.41	*0.005*	−0.36	*0.013*	0.57	*<0.001*	0.16	0.190	−0.39	*0.001*	0.46	*<0.001*
LDL-C (mmol/L)	0.36	*0.014*	0.28	0.058	0.11	0.485	0.17	0.149	−0.05	0.707	−0.02	0.881
TG (mmol/L)	−0.10	0.492	0.53	*<0.001*	−0.18	0.238	0.21	0.076	0.25	*0.038*	−0.07	0.585
Insulin (μU/mL)	−0.52	*<0.001*	0.55	*<0.001*	−0.44	*0.002*	−0.13	0.267	0.47	*<0.001*	−0.35	*0.003*
HOMA-IR index	−0.53	*<0.001*	0.57	*<0.001*	−0.44	*0.002*	−0.11	0.357	0.50	*<0.001*	−0.36	*0.003*

BMI body mass index, WC waist circumference, WHtR wait-to-height ratio, FBG Fasting blood glucose, HDL-C high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, TG triglycerides, HOMA-IR homeostasis model assessment-insulin resistance
All p-values are in italic and significant p-value are in bolditalic

Table 3. Multivariate linear regression for Ghrelin, Adiponectin and Leptin levels in 120 schoolchildren 11 to 15 years, at baseline
Variables	Model 1 Ghrelin (ng/L)		Model 2 – Adiponectin (μg/mL)		Model 3 Leptin (ng/mL)
	r ² = 0.15		r ² = 0.26		r ² = 0.58
	Adjusted r ² = 0.11		Adjusted r ² = 0.22		Adjusted r ² = 0.56
	nSRC (SE)	P	nSRC (SE)	P	nSRC (SE)	P
Age (Years)	−113 (88)	0.205	0.44 (0.44)	0.318	3.18 (2.61)	0.226
Gender (girls)	−71 (102)	0.488	0.68 (0.51)	0.187	7.87 (3.02)	*0.010*
Weight Status
Overweight	−81 (109)	0.455	−1.67 (0.53)	*0.002*	13.88 (3.15)	*<0.001*
Obese	−164 (119)	0.171	−2.10 (0.59)	*0.001*	26.36 (3.49)	*<0.001*
Tanner stage 2 to 5	52 (135)	0.689	−0.45 (0.68)	0.508	−0.73 (4.01)	0.856
HOMA-IR	−29 (16)	0.071	−0.21 (0.08)	*0.010*	1.50 (0.47)	*0.002*

nSRC non standardized regression coefficient, SE standard error, HOMA-IR homeostasis model assessment forinsulin resistance
All p-values are in italic and significant p-value are in bolditalic

Table 4. Clinical and biological parameters in 83 children at baseline and after 1 year of a lifestyle intervention program
Parameters	Normal-weight (n = 28)			Overweight (n = 28)			Obese (n = 27)
Parameters	Baseline	T1-year	P	Baseline	T1-year	P	Baseline	T1-year	P
BMI z-score	−0.10 ± 1.03	−0.16 ± 0.85	0.446	1.47 ± 0.24	1.33 ± 0.44	*0.021*	2.18 ± 0.27	2.08 ± 0.40	*0.008*
FBG (mmol/L)	4.67 ± 0.38	4.63 ± 0.34	0.690	4.82 ± 0.42	4.69 ± 0.42	*0.047*	4.95 ± 0.40	4.69 ± 0.35	*0.002*
HDL-C (mmol/L)	1.59 ± 0.36	1.45 ± 0.31	*<0.001*	1.21 ± 0.28	1.18 ± 0.21	0.425	1.19 ± 0.29	1.14 ± 0.28	0.248
LDL-C (mmol/L)	2.61 ± 0.75	2.37 ± 0.66	*0.018*	2.68 ± 0.59	2.48 ± 0.48	*0.015*	2.46 ± 0.59	2.43 ± 0.47	0.410
TG (mmol/L)	0.55 ± 0.26	0.56 ± 0.24	0.945	0.78 ± 0.40	0.73 ± 0.39	0.682	0.86 ± 0.32	0.80 ± 0.36	0.254
Insulin (μU/mL)	13.4 ± 3.6	11.8 ± 6.1	*0.048*	19.9 ± 12.5	15.8 ± 7.0	*0.019*	28.4 ± 13.7	26.2 ± 17.7	*0.019*
HOMA-IR index	2.80 ± 0.86	2.48 ± 1.37	0.065	4.18 ± 3.04	3.31 ± 1.56	0.079	6.32 ± 3.19	5.53 ± 3.95	*0.011*
Leptin (ng/mL)	6.0 ± 5.19	6.78 ± 1.9	0.234	25.0 ± 13.0	25.5 ± 18.1	0.857	37.7 ± 22.5	33.4 ± 24.2	*0.008*
Adiponectin (μg/mL)	6.43 ± 2.51	7.98 ± 3.56	*0.001*	5.17 ± 2.39	6.71 ± 2.77	*0.002*	3.96 ± 1.84	5.0 ± 2.41	*<0.001*

FBG fasting blood glucose, BMI body mass index, WC waist circumference, HOMA-IR homeostasis model assessment for insulin resistance
All p-values are in italic and significant p-value are in bolditalic