Changes in Metabolic, Inflammatory, and Vascular Markers During a 4-Week Residential Exercise and Dietary Intervention in Adolescents With Obesity: An Exploratory Pre-Post Study

Abstract Objective To investigate the effects of a 4-week intensive lifestyle intervention on anthropometric measures, glucose and lipid metabolism, and vasomotor homeostasis in adolescents with obesity. We also examined heterogeneity in metabolic responses and mechanisms of endothelial adaptation according to the baseline leptin-to-adiponectin ratio (L/A ratio). Methods Forty adolescents with obesity completed a 4-week residential exercise and dietary intervention comprising regular aerobic exercise and dietary control. Anthropometric measures, glucose and lipid metabolism, serum inflammatory factors, and vascular endothelial markers were assessed before and after the intervention. Participants were stratified into high- and low-risk groups according to baseline L/A ratio. Partial correlation analyses controlled for confounders and examined associations between endocrine remodeling and endothelial repair. Results (1) After 4 weeks, body weight, body mass index (BMI), body fat percentage, and measures of central adiposity decreased significantly. Circulating nitric oxide (NO) increased significantly, endothelin-1 (ET-1) decreased, and the nitric oxide/endothelin-1 ratio (NO/ET-1 ratio) increased markedly. (2) Despite comparable reductions in body composition, metabolic improvement was significantly greater in the high-risk group than in the low-risk group. Specifically, the high-risk group showed greater improvement in the homeostatic model assessment for insulin resistance (HOMA-IR), greater triglyceride clearance, and a larger reduction in tumor necrosis factor alpha (TNF-α). (3) After adjustment for age, sex, and baseline BMI, changes in the L/A ratio remained positively correlated with changes in TNF-α. Changes in high-sensitivity C-reactive protein (hs-CRP) were negatively correlated with changes in von Willebrand factor (vWF). The biochemical clearance of hs-CRP appeared to precede the mechanical remodeling of the vascular endothelium reflected by vWF, indicating a temporal lag in short-term adaptation. Conclusion The L/A ratio can serve as a biomarker for cardiometabolic risk stratification in adolescents with obesity. Beyond broadly improving anthropometric outcomes, the intensive lifestyle intervention may preferentially promote deeper metabolic remodeling and recovery of endothelial function in high-risk individuals. Trial registration: The study was approved by the Scientific Research Ethics Committee of Shanghai University of Sport (Approval No. 102772024RT158)