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Primary prevention of atherosclerosis in children with obesity: the effect of multidisciplinary interventions

Comment by Maria Antonopoulou, Primary Care and Risk Factor Management Section

Risk Factors and Prevention

Since children's obesity results in premature cardiovascular disease (CVD), primary prevention is required and early intervention using multidisciplinary programs are being considered as a gold standard. However the effectiveness and the sustainability of such interventions are still to be sufficiently proven.

In this article (1) the results of one randomised controlled trial (RCT) study of children with obesity, recruited from the Obesity Clinic of Geneva Children’s Hospital, about the effectiveness of a 6-month lifestyle intensive multidisciplinary interventions (individually or group therapy) compared to standard care, mainly to BMI and CVD risk factors, were reported. Both medium-intensity individually delivered intervention (treatment A, comprised of 7 monthly 60-minute sessions with the child and his/her parent/s, conducted by a trained pediatrician and a dietician, plus 44 hours of physical activity) and high-intensity group intervention (treatment B, comprised of 14 sessions of total 35 hours with dieticians and psychologists or paediatricians, plus 44 hours of physical activity) resulted in significant reductions at 6 months in abdominal fat and low-grade inflammation (hs-CRP) in pre-pubertal children with obesity, compared to standard care (3 hours of pediatric consultations). Treatment B was also effective for reducing BMI and BMI z-score at 6 and 12 months, when compared to controls, as well as waist circumference, total and abdominal fat and vascular reactivity mediated by smooth muscle cells (NTGMD) at 12 months. Carotid arterial stiffness was also reduced at 12 months in treatment B compared to A. LDL-C was also significantly reduced with treatment B compared to controls at 6 months.

Both interventions were costly and time consuming, but also showed significant reductions of obesity and CVD risk factors. This study suggests that efficient multidisciplinary interventions, especially the less costly individual approach, with the proper health policy planning and professional training, could be transferred in primary care settings for the primary prevention of atherosclerosis in children with obesity.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Maria Antonopoulou commented on this article:

1. Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre-pubertal children.
Farpour-Lambert NJ, Martin XE, Bucher Della Torre S, von Haller L, Ells LJ, Herrmann FR, Aggoun Y. Clinical Obesity 2019 Dec;9(6):e12335. doi: 10.1111/cob.12335. Epub 2019 Aug 15