Avaliação dos níveis de vitamina D e sua relação com índices antropométricos, marcadores metabólicos e inflamatórios séricos antes e após pelo menos 1 ano de intervenção baseada na orientação sobre mudanças de estilo de vida em crianças e adolescentes com sobrepeso e obesidade

Abstract

The approach to childhood obesity requires a multidisciplinary structure with the goal of improving adherence to treatment and higher rates of success. The extra-skeletal effects of vitamin D and its relationship with obesity have been studied in recent years. Although the physiological mechanisms are not fully understood, there is evidence of the association of vitamin D with some cardiovascular risk factors in children. The aim of this study was to evaluate vitamin D levels and their behavior in relation to anthropometric indices, metabolic and inflammatory markers at baseline and after at least 1 year of intervention based on lifestyle changes without specific guidance for vitamin D intake, through a multidisciplinary program in overweight children and adolescents. A longitudinal intervention study was performed on 49 children and adolescents aged 5 to 15 years. The intervention was based on the guidelines of the American Academy of Pediatrics. Participants were assessed at baseline and after at least 1 year of intervention. Evaluations occurred every 3 months and those who did not attend 4 consecutive evaluations were considered non-regular follow-up. There was no statistically significant change in vitamin D levels. In the regularly monitored group, there was a positive correlation of the vitamin D delta with the waist-height midpoint (p = 0.018) and waist-toheight ratio iliac crest (p = 0.025). There was no correlation between vitamin D and metabolic and serum inflammatory markers. There was a statistically significant discrete improvement in the anthropometric indices, since there was a fall in the Z score of body mass index (3.01- 2.83 p = 0.0001), Z waist circumference score (2.17-2.02 p = 0.0001) and mean waist-height ratio (0.60-0.59 p = 0.025) in the regularly monitored group. There were no statistically significant changes in metabolic and inflammatory markers. In the group with non-regular follow-up, there was worsening in the anthropometric indices, increase in systolic blood pressure (110-120 p = 0.033) and waist-to-mid-height ratio (0.59-0.61 p = 0.031). In the comparison of the two groups, it was observed that waist variation / follow-up time was higher in the non-regular group than in those who maintained regularity in nutritional follow-up (3.81-0.99 p = 0.022), as well as waist-to-height ratio mean (0.61-0.59 p = 0.034) and systolic blood pressure (120-110 p = 0.026). The results show that there was no difference in vitamin D levels and these were not correlated with metabolic and inflammatory markers after at least 1 year of the intervention, regardless of the regularity of the treatment. The findings support the idea that childhood obesity is a chronic disease, which requires specific health care, intensive dedication and time investment of health professionals in the long term, supporting the need for a model of chronic care treatment.