The Effect Of Exercise On Endothelial Function And Inflammatory Factors Such As Acute-phase Serum Amyloid A In Obese Children And Adolescents

Objective: Data shows that obesity incidence is rising year by year in China, which seriously damaged their physical and mental health. As we all know, obesity often accompanies with insulin resistance, lipid metabolic abnormalities, chronic inflammation and endothelial dysfunction, and endothelial dysfunction has some relations with the diseases above. Therefore, this study observed obese children and adolescents'blood lipid metabolism, inflammatory factors, vascular endothelial function before and after 4 weeks'aerobic exercise, explored the correlation between endothelial function and other indicators, discussed the changes of proinflammatory A-SAA after weight loss and the relationship between proinflammatory such as A-SAA and endothelial function, in order to further explore the role of proinflammatory factor A-SAA in endothelial function damage and the possible mechanisms of weight loss to endothelial function.Methods: 37 obese children and adolescents were selected from the fully closed weight camp as subjects. Before starting the exercise programme, subjects underwent a graded treadmill stress test to determine the appropriate individual level of exercise intensity. On the basis of the results, the subjects were provided with an appropriate training heart rate and given an individualized weight loss programme. The subjects were intervened with methods of health knowledge education, reasonable diet, aerobic exercise and behavior intervention. Before and after 4 weeks intervention, body morphology index (mainly includes: height, weight, waist circumference, hip circumference, chest circumference and skin-fold), body function index (including the blood pressure and heart rate, vital capacity) were measured. The blood lipid (HDL-C?LDL-C?TC?TG?ApoA?ApoB), fasting blood-glucose(FBG), fasting insulin(FINS), glycated hemoglobin, plasma endothelin-1, serum nitric oxide, serum vWF, serum soluble intercellular adhesion molecule-1, serum PAI-1, Adipocytokines(serum adiponectin, blood leptin, serum tumor necrosis factor alpha, serum IL-6, A-SAA) were also measured before and after the weight loss programme.The changes of vascular endothelial vasomotion, clotting, adhesion, fibrinolytic functions were analyzed after 4 weeks. Before and after weight loss, proinflammatory factors were analyzed, and the correlations between A-SAA and blood sugar, blood lipid and inflammatory factors were discussed. The results: (1) After weight loss intervention, the subjects'body weight dropped 6.57 kilogrammes, dropped 8.7% (P < 0.01); BMI dropped from 29.09 Kg/m2 to 26.43Kg/m~2, dropped 9.1%(P<0.01); the sum of upper arm and shoulder Angle skin-fold dropped 12.47 mm, dropped 22%(P<0.01); Body fat percentage dropped 16.5% (P < 0.01), Waist circumference declined 12.8 cm, declined 14% (P < 0.01), Hip circumference declined 9.36 cm, dropped 9.38% (P < 0.01), Waist-hip ratio dropped from 0.91 to 0.87, dropped 4.4% (P < 0.01). After the weight loss programme, neck circumference, upper arm tension circumference, upper arm relax circumference all dropped significantly.(2) After weight loss programme, obese subjects'systolic blood pressure and diastolic blood pressure declined very significally, vessel elasticity index rised and had statistical significance, pulse pressure dropped but had no statistical significance, resting heart rate dropped and had very significant statistical significance, vital capacity increased and had significant statistical significance.(3) After weight loss programme, subjects'fasting glucose and fasting insulin levels decreased significantly, insulin resistance index declined obviously, glycated hemoglobin levels also declined, but there were no significant statistical significance, total cholesterol, triglyceride and low density lipoprotein cholesterol, apolipoprotein B decreased significantly; Apolipoprotein A and high-density lipoprotein cholesterol decreased significantly, but HDL and LDL ratio increased very significantly (P < 0.01), Atherosclerosis index dropped significantly (P < 0.01). Among 37 subjects, there were 9 subjects whose total cholesterol and triglyceride beyond the normal range, 5 subjects whose triglyceride and 5 subjects whose cholesterol beyond the normal range. After weight loss programme, blood lipid returned to the normal range.(4) Before weight loss programme, there were no significant differences in the levels of leptin, adiponectin, A-SAA, tumor necrosis factor alpha, LNSTNFR2, IL-6, WBC between female and male subjects. After weight intervention, the level of leptin and WBC declined very significantly, adiponectin increased very significantly in male and female subjects (P<0.01). Serum A-SAA and IL-6 reduced significantly in male subjects (P<0.05), while very significantly in female subjects (P<0.01). Before weight loss,mild-to-moderate obesity group and group compared , adiponectin of severe obese group was lower 27.13% (P<0.05) than that of mild-to-moderate obesity group, WBC and A-SAA levels were higher 14.66% and 23.87% respectively(P<0.05). After weight loss intervention, leptin, IL-6 levels declined very significantly (P<0.01), leukocyte declined 28.85% (P<0.01), adiponectin levels increased 16.28% (P<0.01), A-SAA dropped 21.89% (P<0.05) in mild-to-moderate obesity group; leptin, A-SAA, WBC declined very significantly, A-SAA dropped 28.20% (P<0.01), adiponectin increased 36.17% in severely obese group (P<0.01). It showed that inflammation level decreased after weight loss. Serum adiponectin was correlated with waist circumference, body mass index (BMI), AI, INS, HOMA-IR negatively, correlated with ISI, HDL, ApoA positively, which shows that adiponectin had some relations with abdominal obesity and reduced with obesity. The drop of adiponectin levels would cause atherosclerosis index increasing and insulin resistance level aggravating, which would increase the risk of atherosclerosis. We also found that Leptin level was positively correlated with the fat mass. It told us that more fat mass, higher leptin, which might be the body feedback adjustment performance.(5) After 4 weeks' weight loss programme, in mild-to-moderate and severely obese group, serum levels of nitric oxide increased significantly (P<0.01), elevated 70.75% and 101.1% respectively compared with the level before weight loss; Plasma endothelin levels droped significantly, which showed that after weight loss the vasomotion vascular endothelial function improved. Before weight loss, plasma vWF, serum SICAM-1, serum PAI-1, platelet count of mild-to-moderate and severe obese participants exited no significant differences. Severe obese participants' HCT were higher 5.22% than that of mild-to-moderate obesity group (P<0.05). After weight loss, plasma vWF dropped 55.85% (P<0.01) and 48.94% (P<0.01)respectively, Serum SICAM-1 dropped 17.51%(P<0.01) and 17.15% (P<0.01) respectively, Serum PAI-1 dropped 21.81% (P<0.01) and 26.69% (P<0.01) respectively, HCT dropped 5.78%(P<0.01) and 4.96%(P<0.01) respectively, Platelet count dropped 22.84% (P<0.05) and 24.95% (P<0.01) respectively in the two groups. Datas above showed that after weight loss, endothelial clotting, adhesion, fibrinolytic function significantly improved. Correlation analysis showed that, ET-1 positively correlated with TNF alpha, IL-6. Serum levels of nitric oxide correlated negatively with diastolic blood pressure, skin-fold. Plasma vWF positively correlated with triglyceride, lNGLU; SICAM-1 correlated positively with LEP, PAI-1 correlated with WBC and TNF alpha, IL-6, ET-1 significantly.Conclusion: (1) Aerobic exercise significantly improved obese subjects'body shape, glucolipid metabolism disorders and insulin sensitivity. (2) Aerobic exercise significantly enhanced the level of adiponectin, reduced the level of serum leptin and inflammatory factors of the obesity in fully closed weight camp.It told us that aerobic exercise played an important role in reducing inflammatory factors'level, preventing occurrence and development of atherosclerosis. (3) Vascular endothelial dysfunction has close relationship with inflammation. Aerobic exercise improved obese subjects'vascular endothelial vasomotion, clotting, adhesion and fibrinolytic function, which showed that aerobic exercise was an effective means in reducing inflammation level and recovering endothelial dysfunction to prevent from diseases such atherosclerosis and metabolic syndrome.