{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T17:58:19Z","timestamp":1789235899142,"version":"build-2803163510"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Excess abdominal fat is a major determinant in the development of insulin resistance and other metabolic disorders. Increased visceral adipose tissue (VAT) seems to precede the development of insulin resistance and is therefore a prime target of childhood lifestyle interventions aimed at preventing diabetes.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To examine the effect of added exercise to a family-based lifestyle intervention program designed to reduce VAT plus subcutaneous (ASAT), intermuscular (IMAAT), and pancreatic (PAT) adipose tissue in children with overweight or obesity and to explore the effect of changes in VAT on insulin resistance.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This 2-group, parallel-design clinical trial was conducted in Vitoria-Gasteiz, Spain. A total of 116 children with overweight or obesity participated and were assigned to a 22-week family-based lifestyle program (control group [n\u2009=\u200957]) or the same program plus an exercise intervention (exercise group [n\u2009=\u200959]). Data were collected between September 1, 2014, and June 30, 2017, and imaging processing for fat depot assessments and data analysis were performed between May 1, 2019, and February 12, 2021.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n The compared interventions consisted of a family-based lifestyle and psychoeducation program (two 90-minute sessions per month) and the same program plus supervised exercise (three 90-minute sessions per week).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome of this study was the change in VAT between baseline and 22 weeks as estimated by magnetic resonance imaging. The secondary outcomes were changes in ASAT, IMAAT, and PAT. The effect of changes in VAT area on insulin resistance was also recorded.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The 116 participants included in the analysis (62 girls [53.4%]) had a mean (SD) age of 10.6 (1.1) years, and 67 (57.8%) presented with obesity. Significantly greater reductions were recorded for the exercise group in terms of reduction in VAT (\u221218.1% vs \u22128.5% for the control group;\n P<\/jats:italic>\n \u2009=\u2009.004), ASAT (\u22129.9% vs \u22123.0%;\n P<\/jats:italic>\n \u2009=\u2009.001), and IMAAT (\u22126.0% vs \u22122.6%;\n P<\/jats:italic>\n \u2009=\u2009.02) fat fractions compared with the control group. Changes in VAT explained 87.6% of the improvement seen in insulin resistance (\u03b2 = \u22120.102 [95% CI, \u22120.230 to \u22120.002]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n These findings suggest that the addition of exercise to a lifestyle intervention program substantially enhanced the positive effects on abdominal fat depots in children with overweight or obesity. In addition, the reduction in VAT seemed to largely mediate the improvement of insulin sensitivity. These results highlight the importance of including exercise as part of lifestyle therapies aimed at treating childhood obesity and preventing the development of type 2 diabetes.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02258126<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.43864","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T11:33:48Z","timestamp":1669635228000},"page":"e2243864","source":"Crossref","is-referenced-by-count":23,"title":["Effects of a Family-Based Lifestyle Intervention Plus Supervised Exercise Training on Abdominal Fat Depots in Children With Overweight or Obesity"],"prefix":"10.1001","volume":"5","author":[{"given":"Cristina","family":"Cadenas-Sanchez","sequence":"first","affiliation":[{"name":"Institute for Sustainability & Food Chain Innovation, Department of Health Sciences, Public University of Navarre, Pamplona, 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Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco B.","family":"Ortega","sequence":"additional","affiliation":[{"name":"PROFITH (Promoting Fitness and Health Through Physical Activity) Research Group, Sport and Health University Research Institute, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y Nutrici\u00f3n (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Faculty of Sport and Health Sciences, University of Jyv\u00e4skyl\u00e4, Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonatan R.","family":"Ruiz","sequence":"additional","affiliation":[{"name":"PROFITH (Promoting Fitness and Health Through Physical Activity) Research Group, Sport and Health University Research Institute, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y Nutrici\u00f3n (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria, ibs.Granada, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idoia","family":"Labayen","sequence":"additional","affiliation":[{"name":"Institute for Sustainability & Food Chain Innovation, Department of Health Sciences, Public University of Navarre, Pamplona, Spain"},{"name":"Navarra Institute for Health Research, Pamplona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y Nutrici\u00f3n (CIBERobn), Instituto de Salud Carlos III, Madrid, 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