The pro- and anti inflammatory marker study: Children and adolescents with overweight or obesity.

The prevalence of childhood obesity and overweight is increasing dramatically,
becoming one of the most alarming public health issues. Obesity is associated
with significant health problems in the pediatric age. Cardiovascular risk
factors (hypertension, dyslipidemia, and type 2 diabetes) are increasingly
recognized in obese children It is associated with increased risk of
cardiovascular mortality and morbidity in adulthood.
Visceral adipose tissue and its adipose tissue resident macrophages produce
many proinflammatory cytokines like Tumor Necrosis Factor-α (TNF- α),
Interleukin-6 (IL-6), less adiponectine and interleukin-10 (IL-10). Circulating
inflammatory markers (TNF-α, high sensitivity C- reactive protein (hsCRP),
IL-6) and hemostatic markers (fibrinogen, von Willebrand Factor (vWF), D-dimer,
Thrombin-Antithrombin complex (TAT)) are higher in obese children in comparison
with non-obese children. Adiponectine levels are decreased and leptin levels
increased in obese children. Few studies have addressed the effects of
long-term multidisciplinary intervention on pro- and anti-inflammatory cytokine
levels. More and more evidence suggest that low-grade inflammation predicts an
increased risk of chronic disease and promotes its progression. The association
between diet, physical activity and obesity is well established, and between
obesity and inflammation. There may, however, also be indirect associations
between dietary compounds, patterns of physicial activity and fitness with
inflammation. Because of the severe consequences of childhood overweight and
obesity treatment is necessary. In hospital Gelderse Vallei children with
obesity are treated by means of a multidisciplinairy program. The treatment
programs are Aan Tafel! (children aged 3 to 8 years), de Dikke Vrienden Club
(children 8 to 12 years), SLIM2 (adolescents aged 12-18 years).The reduction of
visceral fat/substantial weight loss in obese adolescents (interdisciplinary
lifestyle therapy) showed a decreased pro-inflammatory and an increased
anti-inflammatory state. According to the literature about 30% of the patients
participating in a multidisciplinairy programs will have a substantial weight
loss resulting in an improvement of cardiovascular risk factors. About 40-60%
of the patients have no substantial weight loss and about 4-15% of the patients
have a detorioration in BMI-SDS score. Our hypothesis is that we expect that
patients without substantial weight loss with an improved lifestyle will show a
lower grade of inflammation than patients without substantial weight loss not
improving their lifestyle. In addition we expect patients with a substantial
weight loss will show a decrease in inflammation while an increase in weight
will shower higher grade of inflammation.

The first objective of our study to explore the relation between pro- and anti-
inflammatory markers (hsCRP, TNF-α, IL-1ß, IL-6, IL-8, leptin, adiponectin) and
BMI z-score in obese children participating in our intervention programs
(AanTafel!, de Dikke Vrienden Club and SLIM2) followed by the maintenance
program in an observational setting. The second objective is to ascertain if a
healthier lifestyle (adequate caloric intake according to age and gender and
more physical activity) causes a decline in pro- inflammatory markers and an
increase in anti-inflammatory markers in children without substantial weight
loss after 1 year of treatment.

Longitudinal observational study

The burden and risks associated with participation to this study are minimal.
Before the start of the treatment program, at the end of the intensive part and
at the end of the program HRQoL, eating behaviour, coping style (only
adolescents) and pro- and anti-inflammatory markers will be measured. The
HRQoL, eating behaviour, and coping style will be both assessed by a
questionnaire. Completing both questionnaires will take 40-60 minutes. No
additional vena punction is required. Blood samples for research purposes will
be taken at the same time as the blood samples taken for standard care.
Usually no extra hospital visits are needed for this study. There will be no
benefit for the individual participating in this study.