New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT

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Term Occurence Count Dictionary
glucose intolerance 3 endocrinologydiseases
obesity 30 endocrinologydiseases
type 2 diabetes mellitus 3 endocrinologydiseases
Insulin 13 endocrinologydiseasesdrugs
hyperglycemia 7 endocrinologydiseases
hyperinsulinemia 2 endocrinologydiseases
metabolic syndrome 14 endocrinologydiseases
metformin 13 endocrinologydiseasesdrugs
diabetes mellitus 5 endocrinologydiseases

Graph of close proximity drug and disease terms (within 200 characters).

Note: If this graph is empty, then there are no terms that meet the proximity constraint.

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Having read the paper, please pick a pair of statements from the paper to indicate that a drug and disease are related.

Select Drug Character Offset Drug Term Instance
Insulin 2719 mellitus: DM): serious medical condition in which body cannot control the amount of sugar in your blood. Insulin resistance: is a pathology in which cells fail to respond normally to the hormone insulin. Insulin controls
Insulin 2818 blood.Insulin resistance: is a pathology in which cells fail to respond normally to the hormone insulin. Insulin controls the concentrations of glucose in blood and it is produced by the pancreas when glucose starts
Insulin 5828 Metabolic Syndrome (MS): Concept and Prevalence (Table 1 and Table 2) Metabolic syndrome, also known as “ Insulin Resistance Syndrome”, can be defined as a series of physiological, biochemical and metabolic factors
Insulin 31692 (years)12–196–9 [[21]]10–15 [[21]]10–16 [[23]]>15 [[21]]≥16 [[24]]NDNDEssential criteriaNDNDNDND Insulin resistance [[23]]None [[23]]Waist circumferenceWC ≥ 90th percentile for age, sex and race/ethnicityWC
Insulin 33421 mmol/L (≥100 mg/dL) [[23]]Fasting glucose ≥5.6 mmol/L (≥100 mg/dL) [[24]] or known T2DM [[21]] Insulin resistance or diabetes [[23]]Fasting glucose ≥ 6.1 mmol/L (≥110 mg/dL) or ≥80/90th percentile
Insulin 33704 [[23]] Fasting glucose ≥5.6 or 6.1 mmol/L (≥100 or 110 mg/dL) or 2 h glucose ≥140 mg/dL [[22]] Insulin NDNDNDNDInsulin resistance [[23]]NDAHA: American Heart Association; BMI: body mass index; cm: centimeters;
Insulin 33719 glucose ≥5.6 or 6.1 mmol/L (≥100 or 110 mg/dL) or 2 h glucose ≥140 mg/dL [[22]]InsulinNDNDNDND Insulin resistance [[23]]NDAHA: American Heart Association; BMI: body mass index; cm: centimeters; DBP: diastolic
Insulin 42653 = 86IG1: 47IG2: 39Girls: 58%Age: 11–19 years oldPopulation: South America (Argentina)Obesity and Insulin Resistance, source of diagnostic criteria: 95th Percentile /NE4Dietary interventionWithin groups:IG1
Insulin 43295 [[58]]n = 42IG1: 23IG2: 19Girls: 66%Age: 10–16 years oldPopulation: Europe (The Netherlands)Obesity and Insulin Resistance, source of diagnostic criteria: NE/NE18Physical exercise intervention, pharmacologyWithin
Insulin 44008 56Girls: 61%Age: 10–17 years oldPopulation: Oceania (Australia)Overweight and Obesity/Prediabetes and/or Insulin Resistance, source of diagnostic criteria: International Obesity Task Force/ADA/NE6Dietary and physical
Insulin 45787 2011 [[61]]n = 100IG1: 53IG2: 47Girls: 60%Age: 6–12 years oldPopulation: North America (USA)Obesity/ Insulin resistance, source of diagnostic criteria: ≥ 95th Percentile /NE6Dietary and physical exercise intervention,
Insulin 46617 [[62]]n = 25IG1: 11IG2: 14Boys: 56%Age: 10–16 years oldPopulation: North America (Canada)Obesity/ Insulin Resistance, source of diagnostic criteria: >95th Percentile /NE6Physical exercise intervention, dietary
Insulin 47493 2008 [[64]]n = 64IG1: 48IG2: 16Girls: 71%Age: 12–19 years oldPopulation: North America (USA)Obesity/ Insulin Resistance, source of diagnostic criteria: >95th Percentile /NE6Dietary and physical exercise intervention,
metformin 10829 Endocrine Society recommend that pediatricians abstain from prescribing pharmacotherapy, including metformin [[48]]. However, there are other bibliographic sources that recommend its use [[30],[49]]. The American
metformin 10987 sources that recommend its use [[30],[49]]. The American Diabetes Association recognizes insulin and metformin as treatment for T2DM [[50]].1.7. Theoretical Framework and Purpose of the ReviewThe interest and novelty
metformin 18826 statistical study of the percentage changes of BW, obtaining a change of 5.86% in the group treated with metformin (with a range of 2.0–19%). This trial was treated as a multidisciplinary intervention based on the
metformin 19041 of a balanced diet, a normocaloric diet, the inclusion of moderate physical exercise and the use of metformin [[60]]. None of the trials perform a study on the percent changes of other parameters.The Van der Aa.
metformin 19490 of a physical therapist, and with training courses. It is the second intervention group to not use metformin [[58]]. The median range of growth was 4.5 kg with an interquartile range from 1.3 to 11.6 kg in the
metformin 19624 of growth was 4.5 kg with an interquartile range from 1.3 to 11.6 kg in the group that did not use metformin , versus the group that did. In response to the secondary objective of this review, the multidisciplinary
metformin 22066 them are studies where the difference between the two intervention groups lies on the use or nonuse of metformin . However, it should be noted that they present a high degree of heterogeneity (I2 = 70.46%).4. Discussion4.1.
metformin 43416 source of diagnostic criteria: NE/NE18Physical exercise intervention, pharmacologyWithin groups:IG1 ( metformin )IG2 (placebo)Between groupsYES (kg)NENENEYES (kg and % of BW)NENEp < 0.05/NSYESNENEp < 0.05NOYES (kg/m2)NENEp
metformin 44597 diagnostic criteria: ADA3Dietary intervention, physical exercise education, pharmacologyWithin groups:IG1 ( metformin )IG2 (placebo)Between groupsYES (kg) /YESp < 0.05p < 0.05NS/ p < 0.05NONONOYES (kg/m2)p < 0.05p < 0.05NSYESp
metformin 45937 ≥ 95th Percentile /NE6Dietary and physical exercise intervention, pharmacologyWithin groups:IG1 ( metformin )IG2 (placebo)Between groupsYES (kg)NSp < 0.05p < 0.001YES (kg)NSp < 0.05 (1)NS (2)p < 0.05NONOYES (kg/m2
metformin 46771 >95th Percentile /NE6Physical exercise intervention, dietary education, pharmacologyWithin groups:IG1 ( metformin )IG2 (lifestyle alone)Between groupsNONONONOYES (kg/m2)p < 0.05NSp < 0.05YESNSNSNSBMI:IG1: −1.8 ±
metformin 47194 criteria: >95th Percentile /NE6Dietary and physical exercise intervention pharmacologyWithin groups:IG1 ( metformin )IG2 (placebo)Between groupsYES (kg)p < 0.001NSNENONONOYES (kg/m2)p < 0.001NSp < 0.01NOBW:IG1: −3.4
metformin 47640 criteria: >95th Percentile /NE6Dietary and physical exercise intervention, pharmacologyWithin groups:IG1 ( metformin )IG2 (placebo)Between groupsYES (kg)NENENSNONONOYES (kg/m2)NENENSNOBW:IG1 and IG2: NE (kg)BMI:IG1: −0.16
Select Disease Character Offset Disease Term Instance
diabetes mellitus 3767 related and the show overlapping aspects.Prediabetes (or “Pre-diabetic state): precursor stage before diabetes mellitus in which blood sugar is abnormally high. This stage is not a disease itself. Prediabetes is associated
diabetes mellitus 4435 associated with insulin resistance and increased risk of cardiovascular pathology. IGT may precede type 2 diabetes mellitus by many yearsIsolated impaired fasting glucose (IFG): pre-diabetic state in which the concentrations
diabetes mellitus 4687 are consistently above the normal range, but below the diagnostic cut-off for a formal diagnosis of diabetes mellitus . Together with impaired glucose tolerance, it is a sign of insulin resistance. In this manner, it is
diabetes mellitus 34179 Education Program’s Adult Treatment Panel; ND: not declared; SBP: systolic blood pressure; T2DM: type 2 diabetes mellitus (type of glycerol that belongs to the family of lipids, in mammals it is transported throughout the
diabetes mellitus 34533 Organization.nutrients-10-00878-t002_Table 2Table 2Diagnostic criteria for prediabetes, impaired glucose tolerance and type 2 diabetes mellitus in children and adolescents.WHO CriteriaADA CriteriaPrediabetes [[25]]GlucoseFasting plasma glucose110–125
glucose intolerance 4258 forms of prediabetes that are similar in clinical definition but are physiologically distinct. Impaired glucose intolerance (IGT): pre-diabetic state of hyperglycemia that is associated with insulin resistance and increased
glucose intolerance 6067 cardiovascular disease and type 2 diabetes (T2DM). These factors include insulin resistance, T2DM or glucose intolerance , hypertension and central obesity [[3],[4],[5],[6],[7],[8],[9],[10],[11],[12]].The concept of MS in
glucose intolerance 12618 high blood pressure, insulin resistance, hyperinsulinemia, hyperinsulinism, hyperglycemia, dislipemia, glucose intolerance and/or prediabetes) (Table 1 and Table 2); intervention programs including diet, physical exercise and/or
hyperglycemia 4307 definition but are physiologically distinct. Impaired glucose intolerance (IGT): pre-diabetic state of hyperglycemia that is associated with insulin resistance and increased risk of cardiovascular pathology. IGT may precede
hyperglycemia 12591 diagnostic criteria (T2DM, high blood pressure, insulin resistance, hyperinsulinemia, hyperinsulinism, hyperglycemia , dislipemia, glucose intolerance and/or prediabetes) (Table 1 and Table 2); intervention programs including
hyperglycemia 35486 maximum of 75 g; Random plasma glucose: In patients with hyperglycemic crises or classic symptoms of hyperglycemia (e.g., polyuria, polydipsia); diabetes: In the absence of unequivocal hyperglycemia, diagnosis is confirmed
hyperglycemia 35570 classic symptoms of hyperglycemia (e.g., polyuria, polydipsia); diabetes: In the absence of unequivocal hyperglycemia , diagnosis is confirmed if two different tests are above threshold or a single test is above threshold
hyperglycemia 40423 II diabetes” OR “insulin resistance” OR “hyperinsulinism” OR “hyperinsulinaemia” OR “ hyperglycemia ” OR “dyslipidemia” OR “prediabetes” AND “children” OR “teens” OR “pediatrics”
hyperglycemia 40750 II diabetes” OR “insulin resistance” OR “hyperinsulinism” OR “hyperinsulinaemia” OR “ hyperglycemia ” OR “dyslipidemia” OR “prediabetes” AND “children” OR “teens” OR “pediatrics”
hyperglycemia 41118 II diabetes” OR “insulin resistance” OR “hyperinsulinism” OR “hyperinsulinaemia” OR “ hyperglycemia ” OR “dyslipidemia” OR “prediabetes” AND “children” OR “teens” OR “pediatrics”
hyperinsulinemia 12556 been diagnosed using at least two diagnostic criteria (T2DM, high blood pressure, insulin resistance, hyperinsulinemia , hyperinsulinism, hyperglycemia, dislipemia, glucose intolerance and/or prediabetes) (Table 1 and Table
hyperinsulinemia 31495 the 5 must be presentCentral obesity and 2 of 4 other components must be present [[21]]At least 3 or hyperinsulinemia and at least 2 must be present [[22]]At least 3 must be present [[23]]Age (years)12–196–9 [[21]]10–15
metabolic syndrome 1236 interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). Method: search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method
metabolic syndrome 3600 insulin, thereby causing an increase in the level of blood sugar. The insulin resistance syndrome ( metabolic syndrome or syndrome X), and prediabetes are closely related and the show overlapping aspects.Prediabetes (or
metabolic syndrome 9223 Composition Andmetabolic AbnormalitiesAt present the metabolic changes are being considered as a cardio metabolic syndrome , which is a set of various risk factors such as abdominal obesity, hypertension or hypertension, dyslipidemia,
metabolic syndrome 13476 EBSCOhost, ProQuest and Web of Science in articles of original clinical trials. The key words were: metabolic syndrome , children, teens, pediatrics, diet and exercise; the database “MeSH” (Medical Subject Headings)
metabolic syndrome 31237 difference in BMI (kg/m2) between intervention groups.nutrients-10-00878-t001_Table 1Table 1Diagnosis of metabolic syndrome in children and adolescents.AHA Criteria [[21]]IDF CriteriaWHO CriteriaNCEP ATP III CriteriaNecessary
metabolic syndrome 34018 cholesterol from the tissues of the body to the liver); IDF: International Diabetes Federation; MS: metabolic syndrome ; NCEP ATP III: National Cholesterol Education Program’s Adult Treatment Panel; ND: not declared; SBP:
metabolic syndrome 39349 television time, to less than 2 h per day [[27]]Evidence grade D: expert opinions and evidence from metabolic syndrome and obesity studies. Prevalence of benefits over the harms.T1DM: Diabetes mellitus type 1; PSMF: high
metabolic syndrome 39733 strategyEBSCOhostIdentified/IncludedProQuestIdentified/IncludedPubMedIdentified/IncludedWeb of ScienceIdentified/Included“ metabolic syndrome ” AND “children” OR “teens” OR “pediatrics” AND “diet” OR “dietary treatment” OR
metabolic syndrome 39956 “feeding” AND “nutrition” OR “nutritional counseling” OR “lifestyle”12/025/03/032/1“ metabolic syndrome ” AND “children” OR “teens” OR “pediatrics” AND “exercise” OR “physical activity”
metabolic syndrome 40134 AND “exercise” OR “physical activity” OR “sport” OR “weightlifting”54/090/013/044/2“ metabolic syndrome ” AND “children” OR “teens” OR “pediatrics” AND “weight loss” OR “weight reduction”
metabolic syndrome 41337 “exercise” OR “physical activity” OR “sport” OR “weightlifting”114/0200/065/1135/6“ metabolic syndrome ” AND “hypertension” OR “high blood pressure” AND “children” OR “teens” OR “pediatrics”
metabolic syndrome 41569 “weight loss” OR “weight reduction” OR “fat loss” OR “fat reduction”3/06/00/045/0“ metabolic syndrome ” AND “hypertension” OR “high blood pressure” AND “children” OR “teens” OR “pediatrics”
metabolic syndrome 41843 “feeding” AND “nutrition” OR “nutritional counseling” OR “lifestyle”4/013/00/040/0“ metabolic syndrome ” AND “hypertension” OR “high blood pressure” AND “children” OR “teens” OR “pediatrics”
metabolic syndrome 47977 fat (BF); Fat-free mass (FFM); lean mass (LM); Body Mass Index (BMI); medical Subject Heading (MeSH); metabolic syndrome (MS); study of the analyzed anthropometric parameter (YES); The article does not include its study (NO);
obesity 3893 blood sugar is abnormally high. This stage is not a disease itself. Prediabetes is associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol,
obesity 3935 stage is not a disease itself. Prediabetes is associated with obesity (especially abdominal or visceral obesity ), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension. Thus, it is considered
obesity 5698 out: the reduction of widespread insufficient physical activity and the prevention of diabetes and obesity [[1],[2]].1.3. Metabolic Syndrome (MS): Concept and Prevalence (Table 1 and Table 2) Metabolic syndrome,
obesity 6113 (T2DM). These factors include insulin resistance, T2DM or glucose intolerance, hypertension and central obesity [[3],[4],[5],[6],[7],[8],[9],[10],[11],[12]].The concept of MS in the pediatric population is difficult
obesity 7175 and definition of MS in children and adolescents (Table 1 and Table 2) [[18],[19]].The diagnosis of obesity has evolved over time. The current definition of obesity based on weight and height cannot accurately
obesity 7232 and Table 2) [[18],[19]].The diagnosis of obesity has evolved over time. The current definition of obesity based on weight and height cannot accurately identify all causes obesity-related risk of CVD (cardiovascular
obesity 7305 The current definition of obesity based on weight and height cannot accurately identify all causes obesity -related risk of CVD (cardiovascular disease). People with a normal BMI (body mass index) and high content
obesity 7898 treatments of MS have not been detailed. Therefore, evaluation and intervention guidelines on overweight, obesity and T2DM are presented (Table 3 and Table 4). Guides and/or algorithms for the management of the treatment
obesity 8028 (Table 3 and Table 4). Guides and/or algorithms for the management of the treatment of overweight, obesity and diabetes are technical reports supported by evidence. They contain an outline of interventions,
obesity 9300 considered as a cardiometabolic syndrome, which is a set of various risk factors such as abdominal obesity , hypertension or hypertension, dyslipidemia, and prediabetes [[42],[43]]. In response to this syndrome
obesity 10014 [[40],[41]].Current evidence suggests that the intervention of physical exercise in adolescents with overweight and obesity improves body composition, changes body fat, and therefore could improve some cardio-metabolic factors
obesity 11430 greater changes in body composition in children and adolescents with MS, as described by the overweight, obesity and T2DM guidelines [[27],[29],[30]].The relationship between the changes in body composition and cardio-metabolic
obesity 22795 comparisons were made with the reviews and/or meta-analyses of children and adolescents with overweight, obesity , insulin-resistance or prediabetes.In this literary search, it has not been possible to find reviews
obesity 27675 [[82],[83]]. For example, in the maintenance and/or reduction of body composition in patients with overweight, obesity , T2DM and MS, the amount of time they can be seated in front of the television, must be limited and
obesity 28664 patients with MS. In addition, these recommendations may also be used for patients with overweight, obesity , pre-diabetes, insulin resistance and T2DM. 4.3. Limitations and Strength of the Systematic ReviewThe
obesity 29111 diagnostic criteria (Table 1 and Table 2). (2b) A synthesis of guides about the treatment of overweight, obesity , and T2DM (Table 3 and Table 4) together with the development of practical recommendations for the design
obesity 29524 by professionals versed in dietary intervention and physical exercise for patients with overweight, obesity , and T2DM [[38],[39],[74],[77],[90],[92],[93]].The limitations of this systematic review were previously
obesity 30750 children and adolescents. It is proposed to follow the guidelines proposed for patients with overweight, obesity and T2DM (Table 3 and Table 4) and extrapolate these strategies as recommendations to the future clinical
obesity 31423 CriteriaNCEP ATP III CriteriaNecessary components for the MS diagnosis3 of the 5 must be presentCentral obesity and 2 of 4 other components must be present [[21]]At least 3 or hyperinsulinemia and at least 2 must
obesity 35906 Organization.nutrients-10-00878-t003_Table 3Table 3Guidelines and consensus on the treatment of overweight and obesity : children and adolescents *.AuthorRecommendations in Dietary Intervention and ExerciseOverweight and
obesity 36015 children and adolescents *.AuthorRecommendations in Dietary Intervention and ExerciseOverweight and obesity AND[[27]]Intervention: divided into three levels: primary, secondary and tertiary preventionEvidence:
obesity 36682 lb or 0.91 kg wk−1Evidence: [[29]]T2DM[[30]]Dietary intervention:Interventions to reduce pediatric obesity should be multicomponent and include diet, physical activity, nutritional consulting and require participation
obesity 37037 pediatric weight control program.The dietary factors that can be associated with the greatest risk for obesity are increasing the total amount of fats in diet as well as increasing the intake of beverages.The dietary
obesity 37206 increasing the intake of beverages.The dietary factors that can be associated with the least risk for obesity is the increase of fruits and vegetables.The familiar dietary behaviors that are associated with the
obesity 37343 vegetables.The familiar dietary behaviors that are associated with the greatest risk for pediatric obesity are the parental restriction of healthy foods, the consumption of food outside the house (e.g., fast
obesity 37920 (lb).nutrients-10-00878-t004_Table 4Table 4Intervention strategies for the reduction of body composition in overweight, obesity and T2DM: children and adolescents.Dietary InterventionEnergy restrictionOverweight and obesity1000
obesity 38016 overweight, obesity and T2DM: children and adolescents.Dietary InterventionEnergy restrictionOverweight and obesity 1000 a 2000 Kcal day−1 [[27]]T2DM≥1200 Kcal day−1 in ages between 6 and 12 years old [[30]]VLCDOverweight
obesity 38139 day−1 [[27]]T2DM≥1200 Kcal day−1 in ages between 6 and 12 years old [[30]]VLCDOverweight and obesity ≤1.000 Kcal day−1 ó 600 a 800 Kcal day−1 (PSMF) [[27]]T2DM≥900 Kcal day−1 in ages between
obesity 38677 daily multivitamin supplements, balanced diet (for 10 weeks) [[27]]Physical exerciseOverweight and obesity ≤2 years old should not watch television, supervised free play is encouraged; 4 to 6 years old, up
obesity 39372 less than 2 h per day [[27]]Evidence grade D: expert opinions and evidence from metabolic syndrome and obesity studies. Prevalence of benefits over the harms.T1DM: Diabetes mellitus type 1; PSMF: high protein diet.nutrients-10-00878-t005_Table
type 2 diabetes mellitus 4428 associated with insulin resistance and increased risk of cardiovascular pathology. IGT may precede type 2 diabetes mellitus by many yearsIsolated impaired fasting glucose (IFG): pre-diabetic state in which the concentrations
type 2 diabetes mellitus 34172 Education Program’s Adult Treatment Panel; ND: not declared; SBP: systolic blood pressure; T2DM: type 2 diabetes mellitus (type of glycerol that belongs to the family of lipids, in mammals it is transported throughout the
type 2 diabetes mellitus 34526 Organization.nutrients-10-00878-t002_Table 2Table 2Diagnostic criteria for prediabetes, impaired glucose tolerance and type 2 diabetes mellitus in children and adolescents.WHO CriteriaADA CriteriaPrediabetes [[25]]GlucoseFasting plasma glucose110–125

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