Effect of a multicomponent intervention in components of metabolic syndrome: a study with overweight/obese low-income school-aged children

  • Caroline BrandEmail author
  • Rodrigo Antunes Lima
  • Taís Feitosa Silva
  • Dafne Souto Macêdo
  • Jorge Mota
  • Lars Bo Andersen
  • Clarice Maria de Lucena Martins
  • Anelise Reis Gaya
Original Article



Obesity is a multifactorial disease and it is related to the occurrence of metabolic syndrome and nonalcoholic fatty liver disease (NAFDL) in youth. This study aimed to investigate the effects of a 12-week multicomponent intervention program in markers of metabolic syndrome and NAFLD in Brazilian overweight/obese low-income school-aged children.


This quasi-experimental study comprised overweight/obese school-aged children, aged 7–13 years. The participants were assigned to intervention (n = 17) or control group (n = 18). The multicomponent intervention was developed during 12 weeks, consisting of exercise sessions (twice/week; 1 h), nutritional education sessions (once/month), and parental support (twice/week). The following variables were evaluated: anthropometric measures (height, body weight, waist circumference, percentage of body fat); biochemical assays (total cholesterol (TC), triglycerides-TG, high-density lipoprotein-HDL, glucose, aspartate aminotransferase-AST, alanine aminotransferase-ALT), cardiorespiratory fitness, and maturational stage. A cardiovascular disease (CVD) composite z-scores (percentage of body fat, glucose, AST, ALT, TG, and TC/HDL ratio) was also calculated. General linear models were used for data analysis.


Compared to the control group, intervention group participants decreased percentage of body fat (Δ − 0.97; p < 0.001), glucose levels (Δ − 0.15; p = 0.005), ALT (Δ − 2.84; p = 0.021), TC/HDL ratio (Δ − 0.93; p < 0.001), CVD composite score (Δ − 0.97; p < 0.001), and total food intake (Δ − 131.44; p = 0.03), while there was no differences between groups on waist circumference, AST, triglycerides, and CRF.


A 12-week multicomponent intervention was effective on decreasing some metabolic syndrome parameters in overweight/obese school-aged children.


Metabolic risk factors Health Youth 



Metabolic syndrome




High-density lipoprotein cholesterol


Low-density lipoprotein cholesterol


Cardiovascular disease


Nonalcoholic Fatty Liver Disease


Aspartate aminotransferase


Alanine aminotransferase


Body mass index


Physical education


Heart rate


Physical activity


Percentage of body fat


Cardiorespiratory fitness


Intervention group


Control group



This work was supported by the “National Council for Scientific and Technological Development” (ID: 477893/2013-9), Coordination for the Improvement of Higher Education Personnel (CAPES) and Foundation for science and technology: SFRH/BSAB/142983/2018 and UID/DTP/00617/2019.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics and Research Committee of the Health Sciences Center of the Federal University of Paraíba-number 0390/14) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC et al (2011) Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 8:98CrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carrol MD, Kit BK, Flegal KM (2012) Prevalence of obesity and trends in body mass index among US Children and Adolescents, 1999–2010. J Am Med Assoc 307:483CrossRefGoogle Scholar
  3. 3.
    Wijnhoven TM, Van Raaij JM, Spinelli A, Starc G, Hassapidou M, Spiroski I et al (2014) WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010. BMC Public Health 14:806CrossRefGoogle Scholar
  4. 4.
    Weiss R, Bremer AA, Lustig RH (2013) What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci 1281:123–140CrossRefGoogle Scholar
  5. 5.
    Andersen LB, Lauersen JB, Brønd JC, Anderssen SA, Sardinha LB, Steene-Johannessen J et al (2015) A new approach to define and diagnose cardiometabolic disorder in children. J Diabetes Res 2015Google Scholar
  6. 6.
    Papandreou D, Karavetian M, Karabouta Z, Andreou E (2017) Obese children with metabolic syndrome have 3 times higher risk to have nonalcoholic fatty liver disease compared with those without metabolic syndrome. Int J Endocrinol 2017:1–5CrossRefGoogle Scholar
  7. 7.
    Barshop NJ, Sirlin CB, Schwimmer JB, Lavine JE (2008) Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease. Aliment Pharmacol Ther 28:13–24CrossRefGoogle Scholar
  8. 8.
    Siegel AB, Zhu AX (2009) Metabolic syndrome and hepatocellular carcinoma: two growing epidemics with a potential link. J Asian Econ 19:389–399Google Scholar
  9. 9.
    Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R et al (2017) NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 64:319–334CrossRefGoogle Scholar
  10. 10.
    Sartorio A, Del Col A, Agosti F, Mazzilli G, Bellentani S, Tiribelli C et al (2007) Predictors of non-alcoholic fatty liver disease in obese children. Eur J Clin Nutr 61:877–883CrossRefGoogle Scholar
  11. 11.
    Kim JY, Cho J, Yang HR (2018) Biochemical predictors of early onset non-alcoholic fatty liver disease in young children with obesity study subjects. J Korean Med Sci 33:1–11CrossRefGoogle Scholar
  12. 12.
    World Health Organization (2016) Draft Final Report of the Commission on Ending Childhood Obesity. World Health Organization, GenevaGoogle Scholar
  13. 13.
    Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M et al (2012) Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics 130:2012-1176CrossRefGoogle Scholar
  14. 14.
    Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J (2006) An ecological approach to creating active living communitites. Annu Rev Public Health 27:297–322CrossRefGoogle Scholar
  15. 15.
    Ranucci C, Pippi R, Buratta L, Aiello C, Gianfredi V, Piana N et al (2017) Effects of an intensive lifestyle intervention to treat overweight/obese children and adolescents. Biomed Res Int 2017Google Scholar
  16. 16.
    Davis JN, Ventura EE, Shaibi GQ, Byrd-williams CE, Alexander KE, Vanni AK et al (2010) Interventions for improving metabolic risk in overweight Latino youth 5:451–455Google Scholar
  17. 17.
    Davis JN, Kelly LA, Lane CJ, Ventura EE, Byrd- CE, Alexandar KA et al (2010) Randomized control trial to improve adiposity and insulin resistance in overweight Latino adolescents. Obesity 17:1542–1548CrossRefGoogle Scholar
  18. 18.
    Silveira DS, Lemos LFGBF, Tassitano RM, Cattuzzo MT, Feitoza AHP, Aires LMSMC, Mota JP et al (2018) Effect of a pilot multi-component intervention on motor performance and metabolic risks in overweight/obese youth. J Sport Sci 36:2317–2326CrossRefGoogle Scholar
  19. 19.
    World Medical Association (2013) Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. JAMA 310:2191–2194CrossRefGoogle Scholar
  20. 20.
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243CrossRefGoogle Scholar
  21. 21.
    Weineck J (2005) Biologia do Esporte. Manole, São PauloGoogle Scholar
  22. 22.
    Aires L, Silva G, Martins C, Marques E, Lagoa MJ, Ribeiro JC et al (2016) Exercise intervention and cardiovascular risk factors in obese children. Comparison between obese youngsters taking part in a physical activity school-based programme with and without individualised diet counselling: the ACORDA project. Ann Hum Biol 43:183–190CrossRefGoogle Scholar
  23. 23.
    Nascimento H, Costa E, Rocha S, Lucena C, Rocha-Pereira P, Rêgo C et al (2014) Adiponectin and markers of metabolic syndrome in obese children and adolescents: impact of 8-mo regular physical exercise program. Pediatr Res 6:1–7Google Scholar
  24. 24.
    Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization reference manual. Human Kinetics Books, ChampaignGoogle Scholar
  25. 25.
    Services UD (1996) NHANES III. Anthropometric procedures. WashingtonGoogle Scholar
  26. 26.
    Leger LA, Mercier D, Gadoury C, Lambert J (1988) The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci 6:93–101CrossRefGoogle Scholar
  27. 27.
    Noonan RJ, Boddy LM, Knowles ZR, Fairclough SJ (2017) Fitness, fatness and active school commuting among liverpool schoolchildren. Int J Environ Res Public Health 14:995CrossRefGoogle Scholar
  28. 28.
    Rodriguez-Ayllon M, Cadenas-Sanchez C, Esteban-Cornejo I, Migueles JH, Mora-Gonzalez J, Henriksson P et al (2017) Physical fitness and psychological health in overweight/obese children: a cross-sectional study from the ActiveBrains project. J Sci Med Sport 21:179–184CrossRefGoogle Scholar
  29. 29.
    Artero EG, España-Romero V, Castro-Piñero J, Ortega FB, Suni J, Castillo-Garzon MJ et al (2011) Reliability of field-based fitness tests in youth. Int J Sports Med 32:159–169CrossRefGoogle Scholar
  30. 30.
    Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502PubMedGoogle Scholar
  31. 31.
    Tanner JM (1986) Normal growth and techniques of growth assessment. Clin Endocrinol Metab 15:411–451CrossRefGoogle Scholar
  32. 32.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, HillsdaleGoogle Scholar
  33. 33.
    Kelder SH, Mitchell PD, McKenzie TL, Derby C, Strikmiller PK, Luepker RV et al (2003) Long-term implementation of the catch physical education program. Heal Educ Behav 30:463–475CrossRefGoogle Scholar
  34. 34.
    Perry CL, Sellers DE, Johnson C, Pedersen S, Bachman KJ, Parcel GS et al (1997) The Child and Adolescent Trial for Cardiovascular Health (CATCH): intervention, Implementation, and Feasibility for Elementary Schools in the United States. Heal Educ Behav 24:716–735CrossRefGoogle Scholar
  35. 35.
    McKay HA, Macdonald HM, Nettlefold L, Masse LC, Day M, Naylor P-J (2005) Action Schools! BC implementation: from efficacy to effectiveness to scale-up. Br J Sports Med 49:210–218CrossRefGoogle Scholar
  36. 36.
    McKenzie TL, Strikmiller PK, Stone EJ, Woods SE, Ehlinger SS, Romero KA et al (1994) CATCH: physical activity process evaluation in a multicenter trial. Health Educ Q 2:73–89CrossRefGoogle Scholar
  37. 37.
    Bugge A, El-Naaman B, Dencker M, Froberg K, Holme IMK, McMurray RG et al (2012) Effects of a three-year intervention: the Copenhagen School Child Intervention Study. Med Sci Sport Exerc 44:1310–1317CrossRefGoogle Scholar
  38. 38.
    Africa JA, Newton KP, Schwimmer JB (2016) Lifestyle interventions including nutrition, exercise, and supplements for nonalcoholic fatty liver disease in children. Dig Dis Sci 61:1375–1386CrossRefGoogle Scholar
  39. 39.
    Tanrikulu MA, Agirbasli M, Berenson G (2016) Primordial prevention of cardiometabolic risk in childhood. Adv Exp Med Biol 956:489–496CrossRefGoogle Scholar
  40. 40.
    Van Buren DJ, Tibbs TL (2014) Lifestyle interventions to reduce diabetes and cardiovascular disease risk among children. Curr Diab Rep 14:557CrossRefGoogle Scholar
  41. 41.
    García-Hermoso A, Carmona-López MI, Saavedra JM, Escalante Y (2014) Physical exercise, detraining and lipid profile in obese children: a systematic review. Arch Argent Pediatr 112:519–525PubMedGoogle Scholar
  42. 42.
    Bianchini JAA, da Silva DF, Nardo CCS, Carolino IDR, Hernandes F, Nardo NJ (2013) Multidisciplinary therapy reduces risk factors for metabolic syndrome in obese adolescents. Eur J Pediatr 172:215–221CrossRefGoogle Scholar
  43. 43.
    Elvsaas IKO, Giske L, Fure B, Juvet LK (2017) Multicomponent lifestyle interventions for treating overweight and obesity in children and adolescents: a systematic review and meta-analyses. J Obes 2017:5021902CrossRefGoogle Scholar
  44. 44.
    Bleich SN, Vercammen KA, Zatz LY, Frelier JM, Ebbeling CB, Peeters A (2018) Interventions to prevent global childhood overweight and obesity: a systematic review. Lancet Diabetes Endocrinol 6(4):332–346CrossRefGoogle Scholar
  45. 45.
    Nybo L, Sundstrup E, Jakobsen MD, Mohr M, Hornstrup T, Simonsen L et al (2010) High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc 42:1951–1958CrossRefGoogle Scholar
  46. 46.
    Guo H, Zeng X, Zhuang Q, Zheng Y, Chen S (2015) Intervention of childhood and adolescents obesity in Shantou city. Obes Res Clin Pract 9(4):357–364CrossRefGoogle Scholar
  47. 47.
    Wang Y, Xu D (2017) Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis 16:1–8CrossRefGoogle Scholar
  48. 48.
    Carrel AL, Clark RR, Peterson SE, Nemeth BA, Sullivan J, Allen DB (2005) Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study. Arch Pediatr Adolesc Med 159:963–968CrossRefGoogle Scholar
  49. 49.
    Romero AJ (2005) Low-income neighborhood barriers and resources for adolescents’ physical activity. J Adolesc Heal 36:253–259CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  • Caroline Brand
    • 1
    Email author
  • Rodrigo Antunes Lima
    • 2
  • Taís Feitosa Silva
    • 3
  • Dafne Souto Macêdo
    • 3
  • Jorge Mota
    • 4
  • Lars Bo Andersen
    • 5
  • Clarice Maria de Lucena Martins
    • 6
  • Anelise Reis Gaya
    • 1
  1. 1.Project Esporte Brasil (PROESP-Br), School of Physical Education, Physiotherapy and DanceFederal University of Rio Grande do SulPorto AlegreBrazil
  2. 2.Institute of Sport ScienceUniversity of GrazGrazAustria
  3. 3.Federal University of Paraiba, Health Science CentreJoão PessoaBrazil
  4. 4.Research Center on Physical Activity, Health and Leisure, Faculty of SportUniversity of PortoPortoPortugal
  5. 5.Faculty of Education, Arts and SportWestern Norway University of Applied SciencesSogndalNorway
  6. 6.Research Center on Physical Activity, Health and LeisureFederal University of ParaibaJoão PessoaBrazil

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