Multicomponent intervention effect on cardiometabolic risk factors among overweight/obese Brazilian children: a mediation analysis



To verify whether percentage of body fat, physical fitness, physical activity and calorie intake mediates the multicomponent intervention effect on cardiometabolic risk factors in overweight/obese children, and present the relative contribution of each mediator.


This is an intervention study, developed with 35 overweight/obese school-aged children (control group = 17 and intervention group = 18), aged between 7 and 13 years (9.05 ± 1.90). A 12-week multicomponent intervention was performed, consisting of physical exercise, nutritional education sessions and parental support. The following variables were evaluated at baseline and post-intervention: anthropometric measures and percentage of body fat, physical fitness, physical activity assessed by accelerometer, total calorie intake and biochemical assays. For statistical analysis, generalized linear models were used.


The intervention effect on glucose was mediated by percentage of body fat (24%), muscular fitness (22%) and total calorie intake (40%). The same was observed for alanine aminotransferase (ALT), with a mediation proportion of 26, 31 and 35%, respectively, as well as for HDL-C (percentage of body fat − 30%, muscular fitness − 30% and total calorie intake − 33%); while vigorous physical activity mediated the intervention effect on glucose (40%), HDL-C (39%) LDL-C (43%) and total cholesterol (37%).


Interventions strategies should focus on reducing percentage of body fat and calorie intake, and enhancing muscular fitness and vigorous physical activity to achieve effective changes on cardiometabolic risk factors.

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Fig. 1
Fig. 2



Nonalcoholic fatty liver disease


Upper-limb strength


Lower-limb strength


Total cholesterol


Low-density lipoprotein cholesterol


High-density lipoprotein cholesterol




Alanine aminotransferase


Aspartate aminotransferase


Homeostasis model assessment of insulin resistance


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This work was supported by the National Counsel of Technological and Scientific Development (CNPQ) (ID: 477893/2013-9), Coordination for the Improvement of Higher Education Personnel (CAPES) and Foundation for Science and Technology (FCT), Portugal: SFRH/BSAB/142983/2018 and UID/DTP/00617/201.

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Correspondence to Caroline Brand.

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There are no potential conflict of interest.

Ethical approval

The evaluation methods and procedures were approved by the Scientific Board of the Research Unit that leads the project and is registered at (Number: NCT02929472). Also, all the Helsinki Declarations’ ethical aspects were followed.

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The parents from those who agreed to participate signed the consent form, as well as the assent form was signed for children and adolescents.

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Brand, C., de Lucena Martins, C.M., Dias, A.F. et al. Multicomponent intervention effect on cardiometabolic risk factors among overweight/obese Brazilian children: a mediation analysis. Sport Sci Health (2020).

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  • Obesity
  • Physical exercise
  • Cardiometabolic health