Читать книгу Nutrition and Growth - Группа авторов - Страница 45

López-Alarcón M¹, Inda-Icaza P^1,2, Márquez-Maldonado MC¹, Armenta-Álvarez A¹, Barbosa-Cortés L¹, Maldonado-Hernández J¹, Piña-Aguero M¹, Barradas-Vázquez A¹, Núñez-García BA¹, Rodríguez-Cruz M¹, Fernández JR³

¹Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico; ²Facultad de Ciencias de la Salud, Universidad Anáhuac, Anahuac, Mexico; ³Department of Nutrition Sciences and Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

Pediatr Obes 2019;14:12499

Background: Paediatric obesity and insulin resistance (IR) are potentially reversible inflammatory conditions. Long chain polyunsaturated fatty acids omega-3 (LCPUFA-ω3) show anti-inflammatory and metabolic properties, but their clinical efficacy is unclear.

Objective: The objective of this study is to evaluate whether supplementation with LCPUFA-ω3 for 3 months reduces insulin resistance and weight to adolescents with obesity.

Methods: Double-blind trial of 366 adolescents with obesity randomly assigned to 1.2-g LCPUFA-ω3 (DO3) or 1-g sunflower oil (DP) daily for 3 months; both groups received an energy-restricted diet. Children attended monthly for anthropometric, dietary, and clinical measurements. Basal and final blood samples were obtained to measure metabolic markers and erythrocytes fatty acids. Regression models were used for analysis.

Results: A total of 119 DO3 and 126 DP children completed follow-up. At baseline, 92% of children presented IR, 66% hypertriglyceridemia, 37% low-grade inflammation, and 32% metabolic syndrome. Despite erythrocytes LCPUFA-ω3 increased more in DO3 (Median differences = 0.984 w/w%; 95 IC = 0.47, 1.53, p < 0.001), body weight, insulin, and HOMA changed similarly in both groups at the end of intervention. Adjusting for basal values, changes in weight, insulin, and HOMA was not related with supplementation.

Conclusions: Supplementation with LCPUFA-ω3 does not affect body weight or insulin in adolescents with obesity.

Reprinted with permission from John Wiley & Sons, Inc.

Comments

Both obesity and insulin resistance (IR) are potentially reversible, but the strategies used to reverse them have been disappointing; therefore, the search for effective therapies continues.The pathophysiological events linking obesity with IR include augmented production of adipokines that generate oxidative stress, inflammation, and IR. Thus, the use of anti-inflammatory agents as adjuvants in the treatment of obesity seems appropriate.Experimental studies have demonstrated that the long-chain polyunsaturated fatty acids omega-3 (LCPUFA-ω3), eicosapentaenoic (EPA), and docosahexaenoic (DHA) exert anti-inflammatory properties and stimulate the expression of genes involved in the metabolic pathways of insulin action [27], making them potential candidates in the treatment of obesity and IR, but their effectiveness is not well established.LCPUFA-ω3 are increasingly being used in the prevention and management of several cardiovascular risk factors. LCPUFA-ω3 are effective modulators of the inflammation that accompanies several cardiometabolic abnormalities. Taking into consideration the pleiotropic nature of their actions, it can be concluded that dietary supplementation with LCPUFA-ω3 can lead to improvements in cardiometabolic health parameters.A previous study [28] analyzed the effect of supplementation with LCPUFA-ω3 on adipokine concentration and IR of prepubertal and pubertal children, independent of weight loss. The researchers found that supplementation with n3-LCPUFA was a potential beneficial tool for the reduction of IR.However, the results of the current study are disappointing, since it did not detect any effect of LCPUFA-ω3 supplementation on weight, insulin, or HOMA even after adjusting for their corresponding baseline values in children and adolescents who already have obesity and metabolic disturbances. Nevertheless, these results do not discount previous findings of the preventive effect of LCPUFAs-ω3 in healthy children or adolescents. We may speculate that LCPUFAs-ω3 has a protective role without a therapeutic effect. Therefore, LCPUFAs-ω3 supplementation does not reverse the already stabilized IR as seen in obese children but may provide other metabolic benefits.The strengths of this study are the design of a double-blind, randomized, placebocontrolled, parallel study and the inclusion of a large number of participants.

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