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Assessment of Adiponectin and Leptin as Biomarkers of Positive Metabolic Outcomes after Lifestyle Intervention in Overweight and Obese Children

Endocrinology and Metabolism (V.M.C., M.I., M.P., E.C., S.M., M.G.B.), Division of Oncology (R.S.), Department of Medical Sciences, University of Cagliari, 09042 Cagliari, Italy; Pediatric Endocrine Unit (M.C.M., V.M., S.L.), Regional Hospital for Microcitaemia, 09124 Cagliari, Italy; and Departments of Clinical and Medical Therapy (M.G.C.) and Clinical Sciences (V.M.C.), University "La Sapienza" of Rome, 00161 Rome Italy

Address all correspondence and requests for reprints to: M. G. Baroni, M.D. Ph.D., Department of Medical Sciences, Endocrinology and Metabolism, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Polo di Monserrato, 09042 Monserrato (CA), Italy. E-mail: marcobaroni{at}pacs.unica.it.

Background: A number of metabolic changes are caused by childhood obesity, including insulin resistance, diabetes, and dyslipidemia. To counteract them, lifestyle modification with changes in dietary habits and physical activity is the primary intervention. Anthropometric parameters may not identify all positive changes associated with lifestyle modifications, whereas circulating adipokines may represent an alternative as biomarkers. The aim of this study was to evaluate adiponectin and leptin levels as markers of positive metabolic outcomes in childhood obesity.

Methods: Changes in clinical, anthropometric, and metabolic parameters, including adiponectin and leptin, were assessed in 104 overweight and obese children before and after 1 yr of lifestyle intervention. Obesity and overweight were defined according to the Italian body mass index reference tables for age and sex. Fifty-four normal-weight children were evaluated as controls. Forty-eight of the children (47.5%) returned for follow-up at 1 yr.

Results: Compared with normal-weight children, overweight and obese subjects differed significantly at baseline for glycemia, insulinemia, homeostasis model assessment for insulin resistance, adiponectinemia (5.8 vs. 18.2 µg/ml in controls), low-density lipoprotein-cholesterol, and triglycerides. These parameters were all higher in the overweight/obese children. At follow-up, most parameters improved in overweight/obese children. The most significant changes were observed in adiponectin concentration, which increased by 245% (P < 0.0001), reaching the levels observed in normal-weight children. Leptin levels showed changes unrelated to positive metabolic outcomes, remaining high at 1 yr of follow-up in overweight/obese children. Regardless of changes in weight status, children with lifestyle intervention reported changes in homeostasis model assessment for insulin resistance and in adiponectin that were associated with loss of fat mass.

Conclusions: After lifestyle intervention, adiponectin increased regardless of changes in weight, whereas no consistent changes was observed in serum leptin. Therefore, circulating adiponectin may represent a good biomarker to evaluate the efficacy of lifestyle intervention in overweight/obese children.