Intervenção combinando exercício físico e educação alimentar e nutricional modula o microbioma intestinal e melhora a inflamação e a função autonômica cardíaca na obesidade infantil: uma abordagem translacional

Abstract

Children with obesity are more likely to develop cardiovascular and metabolic alterations in adulthood. Physical exercise and food and nutrition education are important strategies for preventing and/or treating obesity and associated disorders. However, the effectiveness of these strategies in promoting weight loss, modulating the gut microbiome, and improving metabolic and cardiovascular parameters in children with obesity is not fully understood. This study aimed to evaluate the effectiveness of an intervention consisting of physical exercise and food and nutrition education in improving body composition, metabolic and inflammatory parameters, and cardiovascular health in schoolchildren with obesity. Children aged 7 to 10 were recruited from schools in João Pessoa, Paraíba, for the study. Before the intervention, students with normal-weight and obesity were assessed for cross-sectional analyses. After the intervention, the students with obesity were reassessed for body composition, inflammatory profile, blood pressure, heart rate variability (HRV), metabolomics, and gut microbiota. Additionally, an experimental protocol involving physical exercise in rats was developed to better understand the biomolecular mechanisms involved in the observed physiological effects. Cross-sectional analyses revealed that obese children exhibit cardiac autonomic dysfunction and a proinflammatory profile compared to normal-weight children. Heart rate was found to be a reliable indicator of cardiac autonomic dysfunction in schoolchildren. Small intestinal bacterial overgrowth was also found to be related to the consumption of large quantities of ultra-processed foods. However, the systematic review found that the most effective type of physical exercise for improving HRV in children with obesity remains unclear, though all analyzed types demonstrated beneficial effects on some indices. The intervention study found a reduction in the body mass index z-score for age, body fat percentage, systolic and diastolic blood pressure, and improvements in HRV, inflammatory and metabolic profiles, as well as the composition of the gut microbiome in children with obesity. In rats, the results showed that physical exercise improved gut microbiota, cardiac autonomic function, and the expression of genes related to autonomic function and inflammation in the colon and brainstem of rats fed a high-fat diet. The results indicate that this strategy is fundamental in combating childhood obesity and its associated complications, elucidating the physiological and biomolecular mechanisms involved in this process. The evidence obtained in this study could support the implementation of public policies that ensure regular physical exercise combined with food and nutrition education in schools.