Impacto de los polimorfismos genéticos en la efectividad de intervenciones nutricionales frente a tratamientos farmacológicos en niños y adolescentes con obesidad

Abstract

Childhood and adolescent obesity constitutes a major public health challenge, not only because of its high prevalence but also due to the associated metabolic, cardiovascular, and psychosocial complications. In addition to environmental and behavioral determinants, the influence of genetic polymorphisms is increasingly recognized, as they may affect susceptibility to excess weight and modulate responses to different interventions. In this context, analyzing the impact of these polymorphisms is relevant to better understand their role in the effectiveness of nutritional and pharmacological strategies and to move toward a more personalized approach to pediatric obesity. To this end, a rapid systematic review was conducted following PRISMA guidelines and the Cochrane Handbook. The review included 19 clinical trials involving participants aged 8 to 16 years from multiple regions, mainly Europe, Japan, the United States, and Latin America. Sample sizes ranged from 75 to more than 500 participants. The most frequently studied genes were FTO, MC4R, ADRB3, LEPR, TMEM18, and IL6. Overall, the studies suggest that these polymorphisms are associated with variability in the effects of diet- and exercise based interventions and, in some cases, pharmacological treatments. Differences were observed in body mass index reduction, body composition, and metabolic markers such as lipid profile and insulin sensitivity. The findings showed considerable heterogeneity across studies, attributable to methodological differences, sample characteristics, and the tools used. While some studies reported significant associations between certain alleles and therapeutic response, others did not confirm these results. Nevertheless, there is growing consensus on the importance of integrating genomics into pediatric clinical care, promoting personalized, multidimensional, and cost-effective prevention and treatment strategies aimed at optimizing the quality of life of children and adolescents living with obesity.