Background: Reviews of primary research in developed countries and policy in the UK demonstrate there is a lack of evidence from well conducted RCTs on lifestyle interventions for childhood obesity (NICE 2006, SIGN 2003, Oude Luttikhuis et al. 2009). Objectives: To develop, implement and evaluate the Y W8? family focused childhood obesity treatment programme using a randomized controlled trial. Methods: The programme was developed using Bartholomew’s Intervention Mapping framework. Using this stepped process a needs analysis was undertaken, a steering group formed, focus groups were completed in local schools and interviews took place with parents of obese children. The determinants identified by these processes were combined with relevant theories and information gathered through a literature review to develop the programme. Y W8? is a 12 week course for families with children aged 8–13 years designed to assist with weight management. The RCT was designed as an individually randomised parallel-group trial with a waiting-list control group. Children in the intervention group (n=59) had their height, weight, self-reported physical activity levels, self-reported fruit and vegetable consumption and a measure of self-esteem recorded at pre- and post-assessment, whilst only height and weight was collected from the children in the control group (n=55). Results: Twelve week (post course) results showed a significant difference in change in BMI z-score between the control and intervention group, mean difference = -0.12 (95% CI: 0.09 to 0.16, F (1, 98) = 54.04, p < 0.0005), with the control group increasing and the intervention group decreasing their BMI z-score. Analysis showed this positive effect on weight status did not adversely affect linear growth. For the intervention group 81% of children completed the programme. Implications: This RCT offers evidence to support the use of family-based treatment programmes in the treatment of childhood obesity and displays positive results in the short-term, at a lower cost than similar interventions. The thesis also demonstrates how a public health programme can be implemented and sustained in routine NHS practice.

Made available in DSpace on 2016-06-02T20:19:04Z (GMT). No. of bitstreams: 1 DissNTF.pdf: 922511 bytes, checksum: aa3fd5e4f734104cb6412bdf0bc56152 (MD5) Previous issue date: 2007-02-02 / Financiadora de Estudos e Projetos / The purpose of this study was to assess the effects of a weight reduction program on the plantar pressure behavior during standing and walking of obese children. Thirty children, divided into three groups (obese experimental group, obese control group and non obese group), both genders, aged between nine and eleven years old volunteered to this study. The data were collected before and after a weight reduction program with duration of three months. The evaluations included static footprints and plantar pressure variables under six areas of the foot during standing and walking using the Pedar System (Novel GMBh). The results revealed that there was a decrease in the pressures under the midfoot area for the experimental group after the training program, but plantar pressure changes were not observed under other foot areas. An increase in the pressure-time integral was observed after training for the same obese group. In addition, the obese children presented greater contact areas and pressures when compared to non-obese, which can indicate increased risk of injuries due to the excessive load supported by the lower limbs of the obese children. However, the body weight was only poorly related to the plantar pressures, indicating that others factors may interfere on pressure distribution patterns. The correlations between the variables in the midfoot area indicated that it is not possible to assess the dynamic function of the feet from static measures, mainly in obese children, since the excess of adipose tissue in the feet and the medial arch changes may not allow the appropriate interpretation of these measures. Because the plantar pressures measured in this study were not sensitive enough to the training program of three months and, therefore were less influenced by it, the planning of weight reduction programs of longer durations and applied as early as possible is recommended, in order to promote important changes in the plantar pressure behavior and, consequently, to prevent structural and functional disorders in the children s feet. / O objetivo deste estudo foi verificar os efeitos de um programa para redução da massa corporal em crianças obesas sobre o comportamento das pressões plantares e caracterizar os efeitos da obesidade. Foram avaliadas 30 crianças, divididas em três grupos (grupo de obesos experimental, grupo de obesos controle e grupo de eutróficos), de ambos os sexos, com idades entre nove e onze anos. As avaliações foram realizadas antes e depois do programa de intervenção, que teve duração de três meses e incluíram medidas de impressões plantares estáticas e de distribuição de pressão plantar, na postura ereta e na marcha por meio do sistema Pedar (Novel GMBh). A partir dos resultados obtidos constatou-se que o grupo de obesos experimental apresentou diminuição das pressões na região do médio-pé após a intervenção, mas não foram observadas variações das pressões em outras regiões do pé. Um aumento na variável integral pressão-tempo foi observado após a intervenção para o mesmo grupo. As crianças obesas mostraram maiores áreas de contato, pressões e integral pressãotempo quando comparadas às eutróficas, o que pode indicar risco aumentado de lesões, devido à sobrecarga excessiva suportada pelas extremidades inferiores de crianças obesas. Porém, a massa corporal mostrou-se pobremente relacionada com as pressões plantares, indicando que outros fatores podem interferir nos padrões de distribuição de pressão. As correlações entre as variáveis na região do médio-pé indicaram que se deve ter cautela ao inferir a função dinâmica do pé a partir de medidas estáticas, principalmente em crianças obesas, já que o acúmulo de tecido adiposo nos pés e as modificações do arco medial podem dificultar a interpretação dessas medidas. Em virtude da pequena influência do programa de intervenção sobre as variáveis de pressão plantar, recomenda-se o planejamento de programas, com maior tempo de duração e aplicados o mais precocemente possível, a fim de que estes sejam capazes de promover modificações importantes no comportamento das pressões plantares e, dessa forma, prevenir mudanças estruturais e funcionais nos pés de crianças, além de evitar a progressão de outros problemas relacionados à obesidade e melhorar a qualidade de vida dessas crianças.

Ces dernières années, la compréhension de la relation entre l'alimentation et la santé métabolique, en particulier dans le contexte du diabète de type 2 (T2D), est devenue de plus en plus importante. Les régimes riches en graisses (HFD) sont connus pour exacerber les conditions diabétiques, menant à des complications telles que l'obésité, un métabolisme déséquilibré, des problèmes cardiovasculaires et un dysfonctionnement rénal. À l'inverse, les régimes cétogènes (KD) et la supplémentation en cétones (KP), connus pour augmenter le taux de corps cétoniques dans le sang, ont attiré l'attention pour leur potentiel dans la gestion du poids, l'amélioration du contrôle de la glycémie et l'atténuation des complications associées au diabète de type 2. L'étude a pour but d'évaluer l'efficacité du KD et de KP dans la gestion de la pathogenèse du T2D et la réduction de la progression de la maladie rénale diabétique dans un modèle de souris, en se concentrant sur les changements dans les indicateurs métaboliques et de santé rénale. Cette étude a examiné les effets de diverses interventions diététiques (HFD, KD, KP) sur une série de paramètres de santé rénale dans un modèle murin de T2D. Sur une période de 15 semaines, le T2D a été induit chez les souris, suivi d'une exposition de six semaines à différents régimes. La recherche s'est concentrée sur l'évaluation des changements dans le poids corporel, la prise alimentaire, la glycémie et les niveaux de cétone, la tolérance à l'insuline et au glucose, et les fonctions cardiovasculaires et rénales. L'évaluation des fonctions rénales comprenait le rapport albumine/créatinine, l'azote uréique du sang (BUN), les niveaux de cystatine C et l'histopathologie. En outre, l'étude a examiné l'impact de ces régimes sur l'accumulation de lipides dans les tissus rénaux et les niveaux de triglycérides plasmatiques, afin de comprendre les implications métaboliques plus larges des choix alimentaires dans la gestion du T2D. Les résultats ont indiqué que les souris suivant un régime KD présentaient des améliorations significatives dans plusieurs paramètres par rapport à celles suivant un régime HFD. Cela incluait une réduction du poids corporel, une meilleure maîtrise glycémique, une sensibilité accrue à l'insuline et une meilleure santé cardiovasculaire et rénale. En revanche, la supplémentation en KP n'a pas montré d'effet aussi prononcé dans plusieurs aspects, y compris l'amélioration du contrôle glycémique et de la fonction rénale. Intéressant, bien que le régime KD ait été efficace pour réduire les niveaux de triglycérides plasmatiques, il a paradoxalement conduit à une augmentation de l'accumulation de lipides dans les tissus rénaux. En conclusion, l'étude souligne l'efficacité du régime cétogène dans la gestion du poids, l'amélioration des marqueurs métaboliques et la réduction des complications liées au diabète dans un modèle de souris de T2D. Elle met également en évidence la complexité des réponses métaboliques aux interventions diététiques, en particulier en ce qui concerne la santé rénale et le métabolisme des lipides. Les résultats suggèrent que, bien que le régime KD puisse offrir de nombreux avantages pour la santé dans le contexte du diabète, il pourrait également induire des adaptations métaboliques spécifiques à certains organes. / In recent years, understanding the relationship between diet and metabolic health, particularly in the context of type 2 diabetes (T2D), has become increasingly important. High-fat diets (HFD) are known to exacerbate diabetic conditions, leading to complications such as obesity, dysregulated metabolism, cardiovascular issues, and renal dysfunction. Conversely, ketogenic diets (KD) and ketone supplementation (KP) known to elevate ketone bodies in the blood, have been gaining attention for their potential in managing weight, improving glycemic control, and mitigating complications associated with T2D. The study aims to evaluate the effectiveness of KD and KP in managing T2D pathogenesis and reducing the progression of diabetic kidney disease in a mouse model, focusing on changes in metabolic and renal health indicators. This study investigated the effects of various dietary interventions (HFD, KD, KP) on a range of kidney health parameters in a mouse model of T2D. Over 15 weeks, T2D was induced in mice, followed by a six-week exposure to different diets. The research focused on evaluating changes in body weight, food intake, blood glucose and ketone levels, insulin and glucose tolerance, and cardiovascular and renal function. Renal assessment included albumin-to-creatinine ratio, Blood urea nitrogen (BUN), Cystatin C levels, and histopathology. Additionally, the study examined the impact of these diets on lipid accumulation in renal tissues and plasma triglyceride levels, aiming to understand the broader metabolic implications of dietary choices in T2D management. Results indicated that mice on a KD exhibited significant improvements in several parameters compared to those on an HFD. These included reductions in body weight, enhanced glycemic control, improved insulin sensitivity, and better cardiovascular and renal health. In contrast, the KP supplementation group did not show as pronounced an effect in several aspects, including glycemic control and renal function improvement. Interestingly, while KD was effective in reducing plasma triglyceride levels, it paradoxically led to increased lipid accumulation in renal tissues. In conclusion, the study underscores the effectiveness of a ketogenic diet in managing weight, improving metabolic markers, and mitigating diabetes-related complications in a mouse model of T2D. It also highlights the complexity of metabolic responses to dietary interventions, especially concerning renal health and lipid metabolism. The results suggest that, while the KD diet may offer many health benefits in the context of diabetes, it may also induce organ-specific metabolic adaptations.