4. Discussion
obesity, T2D, inflammation, cardiometabolic disease, prediabetes, weight loss
OBESITY, INFLAMMATION, PREDIABETES, ADIPOSITY, INSULIN SENSITIVITY
Studies support a reduction in T2D risk factors following lifestyle intervention among high-risk youth [Similar to our findings, one other study supported a significant inverse association between MCP-1 and insulin sensitivity [Of interest is that HMW Adpn was not associated with insulin sensitivity nor β-cell function, which may have been due to low variability among the cohort. Unlike many other cytokines, adiponectin is almost exclusively produced by adipocytes and is an established marker associated with insulin sensitivity and reduced cardiometabolic disease risk among youth [In response to lifestyle intervention, our study demonstrated no notable treatment effects on the pro- and anti-inflammatory mediators of interest compared to usual care. Given that the proposed main source of inflammation in obesity is adipose tissue, it is possible that reductions in weight or adiposity, an effect that was not observed in the present study, are needed to induce significant changes in inflammatory mediators. Surgical weight loss studies among youth would support this notion, having demonstrated significant improvements in the pro- and anti-inflammatory milieus following substantial weight loss [There are data to suggest that there is a dose-dependent response of inflammatory markers to exercise. A randomized control trial among older adults showed that adiponectin, and leptin, an appetite-reducing hormone, are increased in response to a resistance training program in an intensity-dependent manner [Quasi-experimental lifestyle intervention studies have demonstrated significant increases in adiponectin [A strength of this present study is that it is the first to report on obesity-related pro- and anti-inflammatory mediators in response to a lifestyle intervention among youth with prediabetes. β-cell function is an understudied T2D risk factor in relation to obesity-related pro- and anti-inflammatory mediators, unlike insulin sensitivity, thereby representing another strength of this study. Furthermore, this study prioritizes a high-risk Latino youth population that is underrepresented in the field. We acknowledge that this study has some limitations. This analysis only included a sub-sample of a larger RCT and thus was not powered to detect significant changes in the outcomes of interest. The prioritization of Latino youth limits the generalizability of these findings to other youth populations. WBISI and oDI are not the gold standard approaches for measuring insulin sensitivity and β-cell function; however, they have been validated or compared against their respective gold standard in youth with obesity [