Feasibility, safety, and efficacy of dietary or lifestyle interventions for hypothalamic obesity: A systematic review

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2024-08, Vol.43 (8), p.1798-1811
• Main Authors: Van Roessel, I.M.A.A., Van Den Brink, M., Dekker, J., Ruitenburg-van Essen, B.G., Tissing, W.J.E., van Santen, H.M.
• Format: Article
• Language: English
• Subjects: Adolescent; animals; Caloric restriction; Child; Child, Preschool; childhood; clinical nutrition; Diet - methods; energy expenditure; Exercise; Feasibility Studies; Female; Humans; hyperinsulinemia; Hypothalamic Diseases - therapy; Hypothalamic obesity; hypothalamus; Life Style; lifestyle; low calorie diet; Male; neoplasms; nutritional intervention; obesity; overeating; patients; Pediatric; Pediatric Obesity - diet therapy; Pediatric Obesity - therapy; risk; satiety; systematic review; Treatment Outcome
• ISSN: 0261-5614; 1532-1983; 1532-1983
• DOI: 10.1016/j.clnu.2024.05.028

A dysfunctional hypothalamus may result in decreased feelings of satiety (hyperphagia), decreased energy expenditure, and increased fat storage as a consequence of hyperinsulinemia. Hypothalamic dysfunction may thus lead to morbid obesity and can be encountered in childhood as a consequence of congenital, genetic, or acquired disorders. There is currently no effective treatment for hypothalamic obesity (HO). However, comparable to alimentary obesity, dietary and lifestyle interventions may be considered the cornerstones of obesity treatment. We questioned the effect of dietary or lifestyle interventions for HO and systematically searched the literature for evidence on feasibility, safety, or efficacy of dietary or lifestyle interventions for childhood hypothalamic overweight or obesity. A systematic search was conducted in MEDLINE (including Cochrane Library), EMBASE, and CINAHL (May 2023). Studies assessing feasibility, safety, or efficacy of any dietary or lifestyle intervention in children with hypothalamic overweight or obesity, were included. Animal studies, studies on non-diet interventions, and studies with no full text available were excluded. Because the number of studies to be included was low, the search was repeated for adults with hypothalamic overweight or obesity. Risk of bias was assessed with an adapted Cochrane Risk of Bias Tool. Level of evidence was assessed using the GRADE system. Descriptive data were described, as pooled-data analysis was not possible due to heterogeneity of included studies. In total, twelve studies were included, with a total number of 118 patients (age 1–19 years) of whom one with craniopharyngioma, one with ROHHAD-NET syndrome, 50 with monogenic obesity, and 66 with Prader–Willi syndrome (PWS). Four studies reported a dietary intervention as feasible. However, parents did experience difficulties with children still stealing food, and especially lowering carbohydrates was considered to be challenging. Seven studies reported on efficacy of a dietary intervention: a well-balanced restrictive caloric diet (30% fat, 45% carbohydrates, and 25% protein) and various hypocaloric diets (8–10 kcal/cm/day) were considered effective in terms of weight stabilization or decrease. No negative effect on linear growth was reported. Four studies reported on specific lifestyle interventions, of which three also included a dietary intervention. Combined dietary and lifestyle intervention resulted in decreased BMI, although BMI return