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Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study.

ABSTRACT: Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200-1800 calories, 40-60 g of carbohydrate/day and 1.2-1.5 g protein/kg of ideal bodyweight was implemented over 12 months. Twenty-one participants enrolled in the study. Mean age 16.2 ± 1.4 years, females (76.2%) and mean weight at baseline was 119 ± 19.9 kg. Regardless of adherence to the rPSMF, the mean weight change at 1 month was -3.7 ± 3.5 kg, (range -13.5 kg to 0.9 kg); at 3 months was -5.5 ± 5.1 kg, (range -19.3 kg to 1.8 kg) and at 6 months was -4.7 ± 6.6 kg, (range -18.3 kg to 8.6 kg). At 12 months, the mean weight change was -1.3 ± 10.6 kg (range -17.7 kg to 14.8 kg). Parent and child-reported physical and psychosocial quality of life (HRQOL) improved. Despite limited adherence, the rPSMF diet resulted in clinically significant weight loss and improved HRQOL for children and adolescents with severe obesity.

SUBMITTER: Eneli I

PROVIDER: S-EPMC6747308 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study.

Eneli Ihuoma I Xu Jinyu J Tindall Alexis A Watowicz Rosanna R Worthington Jennifer J Tanner Kelly K Pratt Keeley K Walston Marnie M

International journal of environmental research and public health 20190823 17

Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200-1800 calories, 40-60 g of carbohydrate/day and 1.2-1.5 g protein/kg of ideal bodywe ...[more]

PMID: 31443606

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Project description:PurposeThe purpose of the study is to assess the effect of probiotic supplementation on gut microbiota and insulin resistance in adolescents with severe obesity.MethodsThrough a randomized, double blind, placebo-controlled, 12-week pilot clinical trial, 15 adolescents with severe obesity received either an oral probiotic 'Visbiome®' (n = 8) or placebo (n = 7). Anthropometry, fasting glucose, insulin, hs-CRP and stool for microbiome and calprotectin were collected at baseline (week 0) and 12 weeks after intervention.ResultsAmong completers (n = 4 in each of the two groups), mean change in fasting glucose was significantly lower in the probiotic group (0 ± 4 mg/dL) as compared to the placebo group (6.3 ± 1.7 mg/dL) (p = 0.028). Gut microbial Firmicutes to Bacteroidetes (F/B) ratio had a greater decline from week 0 to week 12 in the probiotic group (mean 17.7 ± 25.1 to 2.39 ± 2.0, respectively) but was not statistically significant (p = 0.06) as compared to in the placebo group (mean 12.8 ± 18.2 to 6.9 ± 5.61, respectively) (p = 0.89). Weight and BMI (mean ± SD) trended to remain stable in the treatment group (-1.07 ± 6.1 kg and -0.3 ± 2.2 kg/m2 respectively) as compared to the placebo group (3.9 ± 5.1 kg, 1.0 ± 1.6 kg/m2) but was not significant (p = 0.12 for weight and 0.38 for BMI). No significant change in the fasting insulin, HOMA-IR, or serum and stool inflammatory markers were noted between the two groups (p > 0.05). One participant in the treatment arm reported adverse effects of gastrointestinal intolerance.ConclusionProbiotic therapy with Visbiome® may improve the fasting glucose and possibly decrease the gut microbial F/B ratio as compared to placebo in adolescents with severe obesity. Future larger studies are required to confirm these findings.U.S. Clinical Trial Registry number: NCT03109587.Supplementary informationThe online version contains supplementary material available at 10.1007/s40200-021-00855-7.

Project description:IntroductionChildren and adolescents with overweight and obesity have an impaired health-related quality of life (HRQoL). However, it is unclear which of these children are most affected in their physical, psychological, and social functioning. Therefore, this study aimed to evaluate HRQoL in treatment-seeking children and adolescents with overweight, obesity, and severe obesity.MethodsA cross-sectional study was performed at the Centre for Overweight Adolescent and Children's Healthcare (COACH). Children and adolescents (8-17 years) with overweight, obesity, and severe obesity were included. The primary outcome was the self-reported HRQoL measured with the KIDSCREEN-27.ResultsA total of 419 participants with overweight (N = 121), obesity (N = 182), and severe obesity (N = 116) were included. One-way ANOVA analysis showed that children and adolescents with severe obesity reported significantly lower physical well-being (41.25 ± 13.14) compared to those with overweight (47.91 ± 12.53; p < 0.001) and obesity (46.74 ± 11.93; p < 0.001). Furthermore, impaired psychological well-being was found in the group with severe obesity (45.14 ± 13.27) in comparison to the group with overweight (50.90 ± 9.48; p < 0.001) and obesity (49.71 ± 10.95; p = 0.002). Multivariable linear regression analysis, while correcting for age, sex, cardio metabolic health risk, and ethnicity, revealed similar results. Additionally, children and adolescents with severe obesity scored lower regarding autonomy and parent relation than those with overweight (B = 3.95; p = 0.009). In almost all groups and dimensions of the KIDSCREEN-27, caregivers scored lower compared to the children and adolescents themselves. Furthermore, a low child-caregiver agreement seemed to exist, especially in the children and adolescents with overweight.ConclusionThe HRQoL of treatment-seeking children and adolescents with overweight and obesity was most affected in children and adolescents with the most severe grade of obesity. Following these findings, lifestyle intervention programs targeting childhood obesity should be aware of this even more vulnerable group so that treatments can be tailored according to their needs.

Dataset Information

Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study.

Publications

Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study.

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