Research Article ISSN 2689-1085

Journal of Pediatrics & Neonatology

Plasma Levels of Peptide YY in Obese Adolescents Throughout A Year of

Treatment for Weight Loss
Simone Pereira Fernandes1,2, Janine Alessi1,2, Mirian Benites Machado2, Zilda Elisabeth de
Albuquerque Santos1,2, Carlos Alberto Nogueira-de-Almeida3 and Elza Daniel de Mello1,2
1
Hospital de Clínicas de Porto Alegre; Porto Alegre, Rio Grande
do Sul, Brasil. *
Correspondence:
Simone Pereira Fernandes, Av nonoai 1458 m211, CEP
Universidade Federal do Rio Grande do Sul; Porto Alegre, Rio
2 91720000, Bairro Nonoai, Porto Alegre, Rio Grande do Sul,
Grande do Sul, Brasil. Brasil, Tel: (051) 92126133.

Universidade Federal de São Carlos, São Carlos, São Paulo,

3
Received: 05 July 2021; Accepted: 29 August 2021
Brasil.

Citation: Fernandes SP, Alessi J Machado MB, et al. Plasma Levels of Peptide YY in Obese Adolescents Throughout A Year of
Treatment for Weight Loss. J Pediatr Neonatal. 2021; 3(3): 1-6.

ABSTRACT
Objective: To evaluate serum PYY levels in obese adolescents treated in an outpatient obesity treatment program
at a public hospital in southern Brazil.

Methods: Fifty-one adolescents with obesity were included and followed up for 12 months. They attended 12
consultations with weight loss recommendations based on quantitative and qualitative food goals and reduction
of sedentary behavior. Fasting serum levels of PYY, total cholesterol, HDL-cholesterol, triglycerides (TG), LDL-
cholesterol (LDL-C), insulin and glycemia were collected in T0 (before the first consultation), T1 (after 24 weeks)
and T2 (after 48 weeks). Besides blood samples, abdominal circumference (AC) was measured, and the homeostasis
model assessment (HOMA-IR) was calculated. By electrical bioimpedance analysis, fat mass and basal metabolic
rate were measured.

Results: Between T0 and T2, there was weight loss with a significant reduction of body mass index (BMI) Z-scores
(p<0.001). There were also a significat reduction of PYY (p=0.026), TRIG (p=0.016), LDL-C (p=0.016), HOMA-
IR (p=0.004), AC (p<0.001) and BMI (p=0.002). In T2, there was a reduction in the baseline weight and in the
proportion of severe obesity, and there was an increase in PYY levels (r=-0.421; p=0.002).

Conclusion: Obese adolescents who changed their sedentary behavior and adopted a balanced diet showed weight
loss and increse in PYY levels.

Keywords 4.7 to 27.2% among boys and from 9.7 to 22.0% among girls [2].
Adolescent, Peptide YY, Lifestyle interventions, Obesity, Weight It is an important public health problem, as it not only impairs a
loss. person’s quality of life but also considerably increases the national
health budget. That is why it is one of the major public health
Introduction challenges of the 21st century.
Obesity is the cause of many comorbidities and is currently the
most common chronic disease among children and adolescents, Obesity results from an imbalance between energy intake and
affecting 20 to 25% of children under 19 years of age in Latin expenditure and appears to be associated with changes in the
America [1]. In the southern region of Brazil, the evolution of concentrations of peptide hormones derived from the intestine,
overweight in the last 6 years among adolescents increased from such as peptide YY (PYY), involved in decreased satiety and

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increased energy intake [3,4]. One of the ways to measure satiety is and PYY3-36. Besides those data, an electrical impedance test
by measuring the production of PYY after a particular food intake. (BioDynamics450) was carried out in order to evaluate the
PYY is a hormone produced in the walls of the distal portion of percentage of fat mass (%FM) and basal metabolic rate (BMR).
the ileum, colon and rectum, and secreted when ingested nutrients HOMA-IR was calculated using blood glucose and insulin results.
begin to reach this location [3]. Its best known physiological PYY3-36 was determined by Elisa (Enzyme-Linked Immunosorbent
function is to signal to the central nervous system that food intake Assay), through commercial kits of Phoenix.
occurred, causing the sensation of satiety [3]. The administration
of PYY to human volunteers demonstrated a relevant ability to The outcomes evaluated were: the evolution of BMI Z-score and
reduce food intake regardless of nutritional status [5,37]. Current abdominal circumference, body composition, basal metabolic rate,
data indicate that PYY influences energy homeostasis through laboratory markers and PYY. To compare the three time points
different mechanisms, but resistance to PYY action in obese (T0, T1, T2), variance analysis (ANOVA) tests were applied for
individuals has never been demonstrated [6]. In the short term it repeated measures, complemented by Bonferroni, or Friedman test,
has been suggested its association with lower dietary intake and in conjunction with Wilcoxon's test. The associations between the
reduction of body weight [7]; in the long term, there is association variables were evaluated by the Pearson or Spearman correlation
with increased thermogenesis and lipolysis [8]. coefficients. The statistical analysis was performed in the SPSS
program V21.0, and the level of significance considered was of p
The objective of this study was to evaluate the evolution of serum <0.05. All the study procedures were evaluated and approved by
PYY levels in obese adolescents treated at an outpatient clinic the ethics committee of the Hospital de Clínicas of Porto Alegre,
for the management of childhood and juvenile obesity in a public under protocol 130190.
hospital in southern Brazil.
Results
Methods The mean age of the 51 adolescents involved in the study was
An intervention study with clinical follow-up was carried out 12.02 ± 0.9, of which 29 (56.9%) were female; 50.5% had at
over a year with adolescents ages 10 to 19 years with evaluation least 1 obese parent, with a prevalence of maternal and paternal
of Tanner pubertal staging [9] above 2, BMI percentile ≥ 97 and obesity of 33.3% and 37.2%, respectively. Of these adolescents,
BMI Z-score ≥ +2 at baseline at an outpatient clinic for obesity at a 21 (41.2%) were obese and 58.8% were severely obese. Table 1
university hospital in Porto Alegre, Brazil. Those taking continuous presents the biochemical, anthropometric, %FM and BMR results,
medication were excluded. Obesity was defined as z-score of BMI in the three time points that were evaluated. We observe that PYY
greater than or equal to +2 and severe obesity greater than +3 for
significantly increased over time (p = 0.026). The other parameters
sex and age [10].
evaluated did not present significantly statistic changes.
All participants had monthly consultations that each consisted of:
The intervention provided a significant improvement in BMI
anthropometric evaluation (weight, height, waist circumference),
Z-score and AC. Table 2 shows that there was a significant
nutritional guidance and food anamnesis. All information was
discussed in an interdisciplinary team and a plan of action was reduction in the number of patients who started the study with
defined, with nutritional recommendations and stimulus to the severe obesity and, over the course of 12 months, this number
reduction of sedentary behaviors, as suggested by Barlow [11], dropped to 15 (p <0.001).
Beghetto et al. [12], Fernandes et al. [13], de Mello et al. [14]
and by Ministry of Health of Brazil [15]. The following are In relation to PYY, a negative and significant variation was
the nutritional recommendations provided to the participants: observed with BMI Z-score (Table 3).
reduction and / or withdrawal of sugary drinks (artificial juices
and soft drinks) and unhealthy foods (cookies, savory snacks, Discussion
pastries and chocolates); intake of 3 units of fruit / day; ingestion During childhood and adolescence, a number of factors including
of dairy products (milk or yogurt or 2 slices of cheese) at least age, puberty, gender, and body composition may contribute to
once a day; reduction of the portion size of the usually consumed differences in satiety, food intake, and appetite-related peptide
foods; ingestion of breakfast; eating at the table; chewing the food levels [16]. Other authors examined the effect of weight loss on
thoroughly; and setting time for each meal. As a stimulus to the PYY release in obese children and found a significant increase in
reduction of sedentary behavior, the adolescents were advised to: fasting hormone after weight reduction [17]. The present study
limit screen time (television, tablet, telephone, computer) to two showed that the increase in plasma concentrations of PYY and the
hours a day and to practice physical activity (volleyball, soccer, reduction of BMI occurred after 12 months of intervention. Weight
handball, dancing, walking, playing with friends). reduction resulted in changes in the adiposity status represented by
the decrease in AC and the reduction of the following biochemical
After 8-hours fasting, blood samples were collected at T0 values: insulin, LDL-C, TC and TRIG. Considering that the plasma
(baseline), T1 (24 weeks) and T2 (48 weeks) in order to evaluate: concentration of PYY does not change within the age group [18],
total cholesterol; (c-HDL), (c-LDL), TG, insulin, blood glucose the changes observed are due to the proposed interventions.

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Table 1: Results of the biochemical parameters, anthropometric measurements, body fat percentage and basal metabolic rate in the three time points
evaluated.
Variables T0 T1 T2 p
PYY (Pg/mL) 55.9 ± 17.4a 58.2 ± 16.6ab 61.2 ± 17.7b 0.026
*Insulin (mg/dL) 19.3 (15.2 – 27.9) 18.7 (14.1 – 26.3) 17.3 (12.9 – 24.3) 0.052
Glucose (mg/dL) 90,84 ± 7.78 88.76 ± 5.44 87.98 ± 6.87 0.071
TC (mg/dL) 163.6 ± 29.4b 156.9 ± 24.4ab 151.0 ± 22.5a 0.003
LDLc (mg/dL) 100.04 ± 22.02 96.34 ± 19.95 93.30 ± 18.28 0.058
TG (mg/dL) 99.7 ± 46.1ab 101.9 ± 43.5b 88.6 ± 32.8a 0.022
HDLc (mg/dL) 42.12 ± 9.22 41.04 ± 8.17 41.90 ± 7.49 0.533
BMI (kg/m2) 29.6 ± 4.4b 28.8 ± 4.5ab 28.6 ± 5.3a 0.002
BMI Z-score 3.4 ± 0.9c 3.0 ± 0.8b 2.8 ± 0.9a <0.001
AC (cm) 93.0 ± 11.3b 90.8 ± 10.4a 90.2 ± 12.1a 0.003
Body fat percentage (%) 32.9 ± 6.0 31.9 ± 5.9 32.3 ± 6.2 0.340
BMR (Kcal/day) 1382 ± 388 1430 ± 333 1447 ± 334 0.110
Variables described as mean ± SD or * median (percentiles 25-75)
a,b
Equivalent letters do not differ by the Bonferroni test at 5% significance
Lable: peptide tyrosine tyrosine (PYY), Total Cholesterol (TC), HDLcholesterol (HDLc), triglycerides (TG), LDLcholesterol (LDLc), abdominal
circumference (AC), percentage (%), basal metabolic rate (BMR), body mass index (BMI), body mass index Z score (BMI Z-score), low density
lipoprotein (LDL), high density lipoprotein (HDL).

Table 2: Number of individuals, with undesired biochemical results, in the three time points evaluated.
T0 T2 T2
Variables p
n=51 n=51 n=51
HOMA IR >3,6 40 40 34 0,105
Glucose > 100 mg/dL 4 2 2 0,368
Total Cholesterol > 170 mg/dL 19 18 15 0,234
LDLc> 130 mg/dL 6 2 1 0,016
TG > 130 mg/dL 8 10 4 0,016
HDLc < 45mg/dL 34 36 37 0,494
Lable: Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), LDL cholesterol (LDLc), triglycerides (TG), HDL cholesterol (HDLc), low
density lipoprotein (LDL), high density lipoprotein (HDL).

Table 3: Association of PYY levels with other variables through the Pearson (r) or Spearman (rs) correlation coefficients.
PYY T0 T1 T2 Time variation 0 -2 (∆)
vs variables correlation coefficients correlation coefficients correlation coefficients correlation coefficients
BMR (Kcal/day) 0.006 0.072 -0.011 0.002
% FM -0.087 -0.104 -0.042 0.139
Lean mass 0.105 0.165 0.010 -0.182
BMI (Kg/m2) 0.041 0.129 0.018 -0.421
HDL c 0.137 -0.068 0.226 -0.185
BMI Z-score 0.105 0.144 -0.037 -0.340*
TG -0.094 -0.272 -0.082 -0.107
TC 0.129 -0.050 0.065 0.041
LDLc -0.070 0.051 -0.128 -0.079
Glucose 0.176 0.086 0.308* 0.165
Insulin -0.116 -0.120 -0.077 0.109
AC 0.011 0.102 0.030 -0.186
** p<0,01 - significant inverse association: the lower the BMI, the higher the levels of the PYY hormone.
*p<0,05- significant inverse association: the lower the z-score BMI, the higher the levels of the PYY hormone.
Lable: percentage (%), body mass index (BMI), body mass index Z score (BMI Z-score), HDL cholesterol (HDLc), Total Cholesterol (TC), triglycerides
(TG), LDL cholesterol (LDLc), abdominal circumference (AC), basal metabolic rate (BMR), low density lipoprotein (LDL), high density lipoprotein
(HDL), T0 (baseline), T1 (24 weeks) and T2 (48 weeks).

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Insulin concentrations change physiologically during puberty the findings of Murphy et al. [32] which showed that the increase in
[19] and the reasons for these changes are not well understood, PYY secretion was positively correlated with the caloric content of
which makes it difficult to interpret them in adolescents [20]. meals. One of the agreed tasks of nutritional recommendations was
However, it is agreed upon that central obesity is the main aspect the increased intake of complex carbohydrates and the reduction in
related to insulin resistance [21,22] and that the changes refer to the amount of saturated fats stimulating the polyunsaturated fats.
the physiological insulin resistance of adolescence, which is a Troke et al. [33] showed that a diet rich in carbohydrates and low
mechanism used by the body to make the necessary anabolism to in fat is associated with higher levels of PYY in humans. Ludwig
the adolescent's rapid growth. [23,24]. The findings presented here [34] has shown in a clinical trial evidence of the benefit of a diet
showed that individuals with higher BMI and AC had the highest focused on food quality instead of fat restriction as a strategy for
levels of insulin, glycemia and HOMA-IR at the beginning of the altering energy balance.
study, which is in agreement with other recent studies [25,26].
Taking into account the effect of puberty, longitudinal studies In prepubertal adolescents who are obese, balanced macronutrient
report that insulin resistance increases more during puberty in diets have been proposed as a more adequate dietary strategy in
obese children than in children with healthy weight [27,28]. weight loss [11]. Considering the potential adverse effects of low-
calorie diets in individuals who did not complete their pubertal
It is currently unknown if the relationships between glucose and / growth, the recommendations did not include food exclusion
or insulin affect PYY. In the present study there was no association / restriction in the nutritional management of pubescent obese
between PYY and insulin, HOMA-IR or fasting glucose. King et adolescents according to Figueroa-Colon et al. [35]. In the Center
al. [7] suggest that signs of anorectic hormones, such as PYY, may where the present study was conducted, a multidisciplinary
have a likely mediation in insulin sensitivity (HOMA-IR) due to approach was used and the results corroborate with other clinical
central nervous system activity and muscle metabolism. Data from programs of childhood and juvenile obesity that are based on
the present study show that TG and TC levels showed a significant simple dietary changes and modifications of lifestyle to improve
reduction after 48 weeks of follow-up. According to Chagas et al. the body composition of obese children and adolescents [15,36].
[29], high TG values in adolescents may be due to obesity and Overall, PYY levels in obesity are low, but it is unclear whether
insulin resistance and it has been shown that the degree of obesity these low levels of PYY determine the development of obesity
is directly proportional to the increase in TG [26]. Bell et al. [30] or whether fasting PYY levels are reduced because of obesity.
showed that lifestyle intervention results in an improvement Thus, it is unclear whether the positive effects of the findings
in plasma lipid concentrations and insulin sensitivity in obese were attributable to the increase in PYY and subsequent to weight
children, even in the absence of weight loss and changes in body reduction or if weight reduction caused PYY levels to rise.
composition. Ho et al. [18] showed that lifestyle interventions
resulted in better levels of TC and TG up to 2 years from baseline Although more studies are needed, the present study suggests that
and, of insulin and HOMA-IR within 1 year, but found no lifestyle interventions based on quantitative food changes such
association with weight loss or body fat reduction. as reducing the current portion size and / or withdrawing sugary
drinks, cookies, salted foods, chocolates; qualitative changes in
The present study also showed no association between BMI diet such as ingestion of 3 units of fruit / day, intake of dairy at
reduction and the evaluated metabolic indexes. The weight loss least once a day, thoroughly chewing of foods, setting the time
and change of some variables obtained in this study are consistent for each meal, reducing sedentary behavior by limiting screen
with interventions based on lifestyle changes in adolescents, as time to up to 2 hours per day and practicing physical activity
found in the review of Oude Luttikhuis et al. [31]. A meta-analysis may be a therapeutic strategy for increasing PYY levels in obese
of 18 studies by Ho et al. indicated that lifestyle interventions that adolescents. By analyzing the number of individuals who are no
incorporated dietary modifications lead to significant weight loss longer severely obese and improving the undesirable biochemical
when compared to no treatment and that weight loss is greater values from baseline to the end of the study, the results were
when the duration of treatment is longer than 6 months. relevant and provide important information on the underlying
mechanism of this effect. The data suggest some components
The results in the improvement of some biochemical and for future interventions in weight management of children
anthropometric patterns and the reduction of the number of and adolescents. More comprehensive investigations of serum
individuals with undesired biochemical results may reflect the regulation of hormone-derived gut signals with behavioral and
adherence to weight loss recommendations, which included clinical outcomes are needed to understand the consequences on
dietary goals and stimulus to reduce sedentary behavior. The appetite deregulation in obese adolescents.
standardized technique in the service was an approach that aimed at
changing eating habits and lifestyle gradually, focusing first on the Acknowledgements
quantitative changes in food and, later, on qualitative changes in The authors thank the Child obesity clinic (AMO) of the Hospital
food, without the traditional prescription of restrictive diets. Thus, de Clínicas de Porto Alegre (HCPA) and the study investigators,
it was postulated that, along the nutritional recommendation, this participants, and personnel. All authors interpreted results,
sample modified the caloric content of the meals, corroborating with critically revised the manuscript, and approved the final version.

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