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      New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT

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          Abstract

          Objective: To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). Method: search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition). Results: 1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m 2 and BW (body weight) in kg. Conclusions: Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.

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          2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.

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            The concept of normal weight obesity.

            Individuals with normal body weight by body mass index (BMI) and high body fat percentage show a high degree of metabolic dysregulation. This phenomenon, defined as normal weight obesity, is associated with a significantly higher risk of developing metabolic syndrome, cardiometabolic dysfunction and with higher mortality. Recently, we have also shown that coronary artery disease patients with normal BMI and central obesity have the highest mortality risk as compared to other adiposity patterns. Therefore, it is important to recognize these high-risk groups for better adiposity-based risk stratification. There is a need for an updated definition of obesity based on adiposity, not on body weight. © 2014.
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              A clinical perspective of obesity, metabolic syndrome and cardiovascular disease

              The metabolic syndrome is a condition characterized by a special constellation of reversible major risk factors for cardiovascular disease and type 2 diabetes. The main, diagnostic, components are reduced HDL-cholesterol, raised triglycerides, blood pressure and fasting plasma glucose, all of which are related to weight gain, specifically intra-abdominal/ectopic fat accumulation and a large waist circumference. Using internationally adopted arbitrary cut-off values for waist circumference, having metabolic syndrome doubles the risk of cardiovascular disease, but offers an effective treatment approach through weight management. Metabolic syndrome now affects 30–40% of people by age 65, driven mainly by adult weight gain, and by a genetic or epigenetic predisposition to intra-abdominal/ectopic fat accumulation related to poor intra-uterine growth. Metabolic syndrome is also promoted by a lack of subcutaneous adipose tissue, low skeletal muscle mass and anti-retroviral drugs. Reducing weight by 5–10%, by diet and exercise, with or without, anti-obesity drugs, substantially lowers all metabolic syndrome components, and risk of type 2 diabetes and cardiovascular disease. Other cardiovascular disease risk factors such as smoking should be corrected as a priority. Anti-diabetic agents which improve insulin resistance and reduce blood pressure, lipids and weight should be preferred for diabetic patients with metabolic syndrome. Bariatric surgery offers an alternative treatment for those with BMI ≥ 40 or 35–40 kg/m2 with other significant co-morbidity. The prevalence of the metabolic syndrome and cardiovascular disease is expected to rise along with the global obesity epidemic: greater emphasis should be given to effective early weight-management to reduce risk in pre-symptomatic individuals with large waists.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                06 July 2018
                July 2018
                : 10
                : 7
                : 878
                Affiliations
                [1 ]Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; ejalbertperez@ 123456gmail.com (E.A.P.); victoriamateu94@ 123456hotmail.es (V.M.O.)
                [2 ]Division of Biochemistry and Molecular Biology, Department of Agrochemistry and Biochemistry, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain; rosa.martinez@ 123456ua.es
                [3 ]Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain; mariola.molina@ 123456ua.es
                [4 ]Department of Mathematics, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain
                [5 ]Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, Avda Copayapu 2862, III Region, Copiapo 1530000, Chile
                Author notes
                [* ]Correspondence: manuel.reig@ 123456uda.cl ; Tel.: +56-9-7534-7350
                Author information
                https://orcid.org/0000-0001-6575-3503
                https://orcid.org/0000-0002-9438-2008
                https://orcid.org/0000-0003-2679-135X
                https://orcid.org/0000-0002-1767-2714
                https://orcid.org/0000-0002-4428-0652
                Article
                nutrients-10-00878
                10.3390/nu10070878
                6073719
                29986479
                48759612-acdc-43d5-b4df-dadf7a691a07
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 24 May 2018
                : 02 July 2018
                Categories
                Review

                Nutrition & Dietetics
                metabolic syndrome,children,adolescents,diet,exercise,body composition,weight and fat

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