Poster Presentation Australian & New Zealand Obesity Society Annual Scientific Meeting 2013

Changes in systemic inflammation in obese children with prediabetes after a 12 month lifestyle intervention; RESIST, a randomised control trial (#168)

Charmaine Tam 1 2 , Jing Lu 2 , Megan Gow 3 4 , Mandy Ho 3 4 , Chris Cowell 3 5 , Louise Baur 4 5 , Sarah Garnett 3 4 5
  1. The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, NSW, Australia
  2. Charles Perkins Centre and School of Biological Sciences, The University of Sydney, Sydney, NSW, Australia
  3. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
  4. The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
  5. Kids Research Institute, The Children's Hospital at Westmead, Sydney, Australia

 Obesity is a state of chronic low-grade inflammation which may lead to impaired insulin signaling and type 2 diabetes. Whether a structured lifestyle intervention combined with metformin therapy ameliorates raised levels of inflammatory markers in obese children with insulin resistance and/or prediabetes is unknown. 

111 free-living obese children with insulin resistance and/or prediabetes (45 boys; mean age= 13.1±1.9y; mean BMI z score= 2.4±0.3) participated in a 12 month randomised control trial of metformin therapy with two structured lifestyle interventions, differing in dietary macronutrient content (high- carbohydrate or moderate- carbohydrate, increased protein). Inflammatory markers chemokine ligand 2 (CCL2), high-sensitivity c-reactive protein (hsCRP) and interleukin 6 (IL6) were measured at baseline, 3, 6 and 12 months. Mixed modeling analyses were performed and data are presented as estimated marginal means (95% CI).

At 12 months, BMI expressed as a percent of the 95th centile, percent body fat, and body weight decreased by 6.8, 2.4 and 4.9% respectively and insulin sensitivity index increased by 0.23; there were no differences between diet groups. There were no significant effects of diet group on inflammatory markers after the 12 month intervention, thus results have been pooled. CCL2, a chemokine secreted predominantly from macrophages [Baseline= 179.5 (162.9-197.7); Month 3= 171.4 (154.2-190.5); Month 6= 175.4 (158.1-195.0); Month 12= 146.2 (129.1-165.2)pg/ml; p=0.004], and hsCRP, a classical marker of inflammation and predictor of cardiovascular risk [Baseline= 2.4 (2.0-3.0); Month 3= 2.1 (1.7-2.6); Month 6= 2.0 (1.6-2.6); Month 12= 2.0 (1.6-2.6)mg/L; p=0.01] were both significantly lower after 12 months. There were no significant effects of time on IL-6.

In conclusion, our study showed that a 12 month lifestyle intervention with metformin therapy resulting in modest weight loss improved markers of inflammation in obese children with prediabetes.