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Gostoli S, Raimondi G, Popa AP, Giovannini M, Benasi G, Rafanelli C. Behavioral Lifestyle Interventions for Weight Loss in Overweight or Obese Patients with Type 2 Diabetes: A Systematic Review of the Literature. Curr Obes Rep 2024; 13:224-241. [PMID: 38436787 PMCID: PMC11150315 DOI: 10.1007/s13679-024-00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE OF REVIEW Around 80-90% of patients with type 2 diabetes mellitus (T2DM) are overweight or obese, presenting a greater risk for serious health complications and mortality. Thus, weight loss represents a main goal for T2DM management. Although behavioral lifestyle interventions (BLIs) could help promoting weight loss in T2DM patients with overweight or obesity, their effectiveness is still controversial. This systematic review offers an updated and comprehensive picture of BLIs according to Michie's classification in T2DM patients with overweight or obesity and identifies possible factors (related to both patients and interventions) associated with weight loss. The PRISMA guidelines were followed. The literature search till March 2023 indicated 31 studies involving 42 different BLIs. RECENT FINDINGS Our findings suggest that structured BLIs, characterized by frequent feedback and support, can lead to a clinically meaningful 5% weight loss, regardless of specific behavioral, diet, and physical activity components. Further research should address methodological issues and heterogeneity of interventions, also considering the effect of pharmacological therapies on weight reduction. Lastly, more attention should be paid to the long-term effectiveness of behavioral lifestyle interventions and to the relationship between weight loss and diabetes.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Giulia Raimondi
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Alexandra Paula Popa
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Micaela Giovannini
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Giada Benasi
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168th Street, 10032, New York, NY, United States
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
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Kounatidis D, Vallianou NG, Geladari E, Panoilia MP, Daskou A, Stratigou T, Karampela I, Tsilingiris D, Dalamaga M. NAFLD in the 21st Century: Current Knowledge Regarding Its Pathogenesis, Diagnosis and Therapeutics. Biomedicines 2024; 12:826. [PMID: 38672181 PMCID: PMC11048710 DOI: 10.3390/biomedicines12040826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a major public health issue worldwide. It is the most common liver disease in Western countries, andits global prevalence is estimated to be up to 35%. However, its diagnosis may be elusive, because liver biopsy is relatively rarely performed and usually only in advanced stages of the disease. Therefore, several non-invasive scores may be applied to more easily diagnose and monitor NAFLD. In this review, we discuss the various biomarkers and imaging scores that could be useful in diagnosing and managing NAFLD. Despite the fact that general measures, such as abstinence from alcohol and modulation of other cardiovascular disease risk factors, should be applied, the mainstay of prevention and management is weight loss. Bariatric surgery may be suggested as a means to confront NAFLD. In addition, pharmacological treatment with GLP-1 analogues or the GIP agonist tirzepatide may be advisable. In this review, we focus on the utility of GLP-1 analogues and GIP agonists in lowering body weight, their pharmaceutical potential, and their safety profile, as already evidenced inanimal and human studies. We also elaborate on other options, such as the use of vitamin E, probiotics, especially next-generation probiotics, and prebiotics in this context. Finally, we explore future perspectives regarding the administration of GLP-1 analogues, GIP agonists, and probiotics/prebiotics as a means to prevent and combat NAFLD. The newest drugs pegozafermin and resmetiron, which seem to be very promising, arealso discussed.
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Affiliation(s)
- Dimitris Kounatidis
- Department of Internal Medicine, Hippokration General Hospital, 114 Vassilissis Sofias str, 11527 Athens, Greece;
| | - Natalia G. Vallianou
- First Department of Internal Medicine, Sismanogleio General Hospital, 1 Sismanogliou str, 15126 Athens, Greece
| | - Eleni Geladari
- Department of Internal Medicine, Evangelismos General Hospital, 45–47Ipsilantou str, 10676 Athens, Greece
| | - Maria Paraskevi Panoilia
- First Department of Internal Medicine, Sismanogleio General Hospital, 1 Sismanogliou str, 15126 Athens, Greece
| | - Anna Daskou
- First Department of Internal Medicine, Sismanogleio General Hospital, 1 Sismanogliou str, 15126 Athens, Greece
| | - Theodora Stratigou
- Department of Endocrinology and Metabolism, Evangelismos General Hospital, 45–47Ipsilantou str, 10676 Athens, Greece
| | - Irene Karampela
- 2nd Department of Critical Care, Medical School, Attikon General University Hospital, University of Athens, 1 Rimini str., 12461 Athens, Greece
| | - Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Demokritus University of Thrace, 68100 Alexandroupoli, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str., 11527 Athens, Greece;
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Takahashi M, Tamura Y, Tsurumi T, Terashima M, Takahashi H, Tamiya H, Furuya T, Nakatani Y, Otani N, Yasu T. Skeletal Muscle Quality Assessment in Patients With Cardiac Disease Associated With Type 2 Diabetes Mellitus: A Pilot Study. Cureus 2024; 16:e51897. [PMID: 38333459 PMCID: PMC10849938 DOI: 10.7759/cureus.51897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is associated with changes in skeletal muscle quantity and quality, such as increased ectopic fat. Cardiac rehabilitation (CR) aims to improve the exercise capacity and muscle strength. This study aimed to determine the relationship between qualitative changes in the skeletal muscles and exercise function in patients with and without diabetes mellitus. Methods The study included patients with cardiovascular diseases who entered CR. Of 72 CR patients (68.1±9.0 years) who underwent a cardiopulmonary exercise test and skeletal muscle assessment at discharge, 15 patients with T2DM and 15 without DM were selected using propensity score matching by age and gender. Results No significant differences in the skeletal muscle echo intensity (EI) (T2DM: 58.4, Non-DM: 53.4, p=0.32), skeletal muscle index (T2DM: 7.5 kg/m2, Non-DM: 7.2 kg/m2, p=0.36), or the weight-bearing index (WBI)(T2DM: 0.44, Non-DM: 0.50, p=0.35) existed between the two groups. The phase angle (PhA) (T2DM: 3.67°, Non-DM: 4.49°, p<0.05) and peak oxygen uptake (T2DM: 12.3 mL/kg/min, Non-DM: 14.8 mL/kg/min, p<0.05) were significantly lower in the T2DM group. PhA values showed a significant correlation with the WBI, a parameter of lower limb muscle strength (r=0.50, p<0.05). Conclusion The coexistence of cardiovascular disease and T2DM resulted in a decrease in the PhA, indicating a qualitative decrease in skeletal muscle mass. The PhA is also associated with lower limb muscle strength.
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Affiliation(s)
- Momo Takahashi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Yuma Tamura
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Tomoki Tsurumi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Masato Terashima
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Harunori Takahashi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Hajime Tamiya
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, JPN
| | - Tomoki Furuya
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Yuki Nakatani
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Naoyuki Otani
- Department of Cardiology, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
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Frączek B, Pięta A. Does the Paleo diet affect an athlete's health and sport performance? Biol Sport 2023; 40:1125-1139. [PMID: 37867746 PMCID: PMC10588572 DOI: 10.5114/biolsport.2023.123325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/24/2022] [Accepted: 12/16/2022] [Indexed: 10/24/2023] Open
Abstract
The aim of the study was to assess the impact of an eight-week Paleo diet on the health status (body composition, haematology and biochemistry of blood and urine) and the level of physical capacity (aerobic and anaerobic) of professional handball players. Fifteen athletes were assigned to two groups: 9 in the experimental group (PD) and 6 in the control group (CD). Significant decreases in body mass (BM), body mass index (BMI), and fat mass (FM) as well as an increase in the fat-free mass (FFM) (%) in both groups were observed. There were no significant differences between groups in particular series during the experiment in all haematological and biochemical indicators of blood and urine. Only HDL-C was significantly higher in the last series in the PD compared to the CD (1.63 mmol/l vs. 1.23 mmol/l). In the Wingate test, there were only single intragroup changes, consisting of a significant decrease in the Wt, MAP and Pmean in the experimental group. There were no significant differences between the groups in individual series or intragroup differences during the experiment, determined by the VO2max, VEmax, VE ∙ VCO2 -1, RER, and the time of the test with a gradually increasing load on a treadmill, except for a significant decrease of maximum tidal volume (TVmax) in the PD. No adverse effect of the Paleo diet on the health status was found. The use of the Paleo diet slightly adversely affects anaerobic capacity and does not affect the level of aerobic capacity.
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Affiliation(s)
- Barbara Frączek
- Department of Sports Medicine and Human Nutrition, Institute of Biomedical Sciences, University School of Physical Education in Kraków, Poland
| | - Aleksandra Pięta
- Department of Sports Medicine and Human Nutrition, Institute of Biomedical Sciences, University School of Physical Education in Kraków, Poland
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Konner M, Eaton SB. Hunter-gatherer diets and activity as a model for health promotion: Challenges, responses, and confirmations. Evol Anthropol 2023; 32:206-222. [PMID: 37417918 DOI: 10.1002/evan.21987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 07/27/2022] [Accepted: 04/17/2023] [Indexed: 07/08/2023]
Abstract
Beginning in 1985, we and others presented estimates of hunter-gatherer (and ultimately ancestral) diet and physical activity, hoping to provide a model for health promotion. The Hunter-Gatherer Model was designed to offset the apparent mismatch between our genes and the current Western-type lifestyle, a mismatch that arguably affects prevalence of many chronic degenerative diseases. The effort has always been controversial and subject to both scientific and popular critiques. The present article (1) addresses eight such challenges, presenting for each how the model has been modified in response, or how the criticism can be rebutted; (2) reviews new epidemiological and experimental evidence (including especially randomized controlled clinical trials); and (3) shows how official recommendations put forth by governments and health authorities have converged toward the model. Such convergence suggests that evolutionary anthropology can make significant contributions to human health.
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Affiliation(s)
- Melvin Konner
- Department of Anthropology, Program in Anthropology and Human Biology, Emory University, Atlanta, Georgia, USA
| | - S Boyd Eaton
- Department of Radiology, Emory University School of Medicine (Emeritus), Adjunct Lecturer, Department of Anthropology, Emory University, Atlanta, Georgia, USA
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Rebello CJ, Zhang D, Kirwan JP, Lowe AC, Emerson CJ, Kracht CL, Steib LC, Greenway FL, Johnson WD, Brown JC. Effect of exercise training on insulin-stimulated glucose disposal: a systematic review and meta-analysis of randomized controlled trials. Int J Obes (Lond) 2023; 47:348-357. [PMID: 36828899 PMCID: PMC10148910 DOI: 10.1038/s41366-023-01283-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND OBJECTIVE The effect of exercise training on whole-body insulin sensitivity has not been systematically summarized. We aimed to summarize the data from randomized controlled trials evaluating the effect of exercise training on insulin action, in adults. SUBJECTS MEDLINE, EMBASE, and CENTRAL databases were searched until January 2021. Randomized controlled trials lasting ≥4 weeks, including adults, and evaluating the effect of exercise on insulin-stimulated glucose disposal measured using the hyperinsulinemic euglycemic clamp, were included. METHODS Three reviewers extracted summary data from published trials. The primary outcome was insulin-stimulated glucose disposal. Standardized weighted mean differences (SMD) in glucose disposal between intervention and control were compared. The PEDro scale was used to assess risk of bias. RESULTS We included 25 trials (36 interventions, N = 851). Exercise increased insulin-stimulated glucose disposal relative to control, SMD = 0.52 (95% confidence interval [CI]: 0.39, 0.65; p < 0.001; I2 = 47%) without significantly suppressing hepatic glucose production. In trials without isotopic tracers, exercise increased glucose disposal (SMD = 0.63; 95% CI: 0.48, 0.77; p < 0.001, I2 = 55%). In trials with isotopic tracers, exercise increased glucose disposal only when tracers were added to the exogenous glucose used for clamping (SMD = 0.34; 95% CI: 0.03, 0.66, p = 0.034. I2 = 0%). In a meta-regression model including aerobic exercise, weight change, and tracer technique, only percent weight change explained between trial heterogeneity (β = 0.069; 95% CI: 0.005, 0.013). The PEDro rating indicated relatively low risk of bias (5.8 ± 0.22). CONCLUSIONS Exercise training for at least four weeks significantly increases insulin-stimulated glucose disposal. Weight loss maximizes the effect and may be needed to improve hepatic insulin sensitivity. Differences in tracer methodology contribute to divergent outcomes and should be considered when assessing conclusions from research examining the effect of exercise on insulin action. REGISTRATION PROSPERO (CRD42019124381).
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Affiliation(s)
- Candida J Rebello
- Nutrition and Chronic Disease, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Dachuan Zhang
- Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - John P Kirwan
- Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Adam C Lowe
- Interventional Resources, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Carlante J Emerson
- Interventional Resources, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Chelsea L Kracht
- Clinical Science, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Lori C Steib
- Library and Information Center, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Frank L Greenway
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - William D Johnson
- Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Justin C Brown
- Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, USA
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What do we know about nutrient-based strategies targeting molecular mechanisms associated with obesity-related fatty liver disease? Ann Hepatol 2023; 28:100874. [PMID: 36371078 DOI: 10.1016/j.aohep.2022.100874] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Obesity is a risk factor for developing nonalcoholic fatty liver disease (NAFLD), and the associated molecular mechanisms could be targeted with nutrient-based strategies. Therefore, it is necessary to review the current mechanisms to propose further treatments. Obesity facilitates the onset of insulin resistance, lipidic abnormalities, hepatic fat accumulation, lipid peroxidation, mitochondrial dysfunction, excessive reactive oxygen species (ROS) production, and inflammation, all related to further steatosis progression and fibrosis. Microbiota alterations can also influence liver disease by the translocation of pathogenic bacteria, energy extraction from short chain fatty acids (SCFAs), intestinal suppression of the expression of fasting-induced adipose factor (FIAF), reduction of bile acids, and altered choline metabolism. There are also genetic polymorphisms in metabolic proteins that predispose to a higher risk of liver diseases, such as those found in the patatin-like phospholipase domain-containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), membrane-bound O-acyltransferase domain-containing 7 (MBOAT7) or also known as lysophosphatidylinositol acyltransferase 1 (LPIAT1), transmembrane channel-like 4 genes (TMC4), fat mass and obesity-associated protein (FTO), the b Klotho (KLB) and carboxylesterase (CES1). No clear dietary guidelines target all mechanisms related to NAFLD development and progression. However, energy and carbohydrate intake restriction, regular physical exercise, supplementation of antioxidants, and restoration of gut microbiota seem to have beneficial effects on the new proposed features of NAFLD.
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Katsiki N, Stoian AP, Rizzo M. Dietary patterns in non-alcoholic fatty liver disease (NAFLD): Stay on the straight and narrow path! CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34 Suppl 1:S24-S31. [PMID: 35131122 DOI: 10.1016/j.arteri.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most frequent hepatic disease globally. NAFLD patients are at an increased risk of both liver and cardiovascular morbidity and mortality, as well as all-cause death. NAFLD prevalence is rapidly increasing worldwide and, thus, there is an urgent need for health policies to tackle its development and complications. Currently, since there is no drug therapy officially indicated for this disease, lifestyle interventions remain the first-line therapeutic option. In the present narrative review, we discuss the effects of certain dietary patterns on NAFLD incidence and progression. The Mediterranean diet is regarded as the diet of choice for the prevention/treatment of NAFLD and its complications, based on the available evidence. Other plant-based dietary patterns (poor in saturated fat, refined carbohydrates, red and processed meats) are also beneficial [i.e., Dietary Approaches to Stop Hypertension (DASH) and vegetarian/vegan diets], whereas more data are needed to establish the role of ketogenic, intermittent fasting and paleo diets in NAFLD. Nevertheless, there is no "one-size-fits-all" dietary intervention for NAFLD management. Clinicians should discuss with their patients and define the diet that each individual prefers and is able to implement in his/her daily life.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece.
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of South Carolina, Columbia, SC, USA
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9
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Khalafi M, Azali Alamdari K, Symonds ME, Rohani H, Sakhaei MH. A comparison of the impact of exercise training with dietary intervention versus dietary intervention alone on insulin resistance and glucose regulation in individual with overweight or obesity: a systemic review and meta-analysis. Crit Rev Food Sci Nutr 2022; 63:9349-9363. [PMID: 35442133 DOI: 10.1080/10408398.2022.2064424] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Obesity is associated with the development of insulin resistance (IR) and type 2 diabetes for which exercise training (Ex) and dietary interventions (DI) are effective interventions that can improve IR. We therefore performed a systematic meta-analysis to compare the effect of Ex + DI compared with DI on IR and glucose homeostasis. METHODS PubMed and Cochrane Library were conducted up to May 2021. Meta-analyses were conducted to compare the effect of Ex + DI compared with DI on fasting glucose and insulin, IR and body weight. Standardized mean differences (SMDs), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were computed using random or fixed effect models. RESULTS Fifty studies involving 2864 participants with overweight or obesity were included in the meta-analysis. Ex + DI caused a larger decrease in fasting glucose (p = 0.001, 62 trials) and IR (p = 0.01, 29 trials) when compared with DI alone. There was no significant evidence, however, for a greater effect of Ex + DI on fasting insulin (p = 0.07, 48 trials) and body weight (p = 0.12, 58 trials), compared with DI alone. CONCLUSION Our results suggest that a combination of Ex and DI may be more effective than DI alone at improving IR and fasting glucose in individuals with overweight and obesity.
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Affiliation(s)
- Mousa Khalafi
- Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran
| | | | - Michael E Symonds
- The Early Life Research Unit, Division of Child Health, Obstetrics and Gynaecology, and Nottingham Digestive Disease Centre and Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Hadi Rohani
- Department of Exercise Physiology, Sport Sciences Research Institute, Tehran, Iran
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Chorell E, Otten J, Stomby A, Ryberg M, Waling M, Hauksson J, Svensson M, Olsson T. Improved Peripheral and Hepatic Insulin Sensitivity after Lifestyle Interventions in Type 2 Diabetes Is Associated with Specific Metabolomic and Lipidomic Signatures in Skeletal Muscle and Plasma. Metabolites 2021; 11:metabo11120834. [PMID: 34940592 PMCID: PMC8708788 DOI: 10.3390/metabo11120834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 01/15/2023] Open
Abstract
Lifestyle interventions with weight loss can improve insulin sensitivity in type 2 diabetes (T2D), but mechanisms are unclear. We explored circulating and skeletal muscle metabolite signatures of altered peripheral (pIS) and hepatic insulin sensitivity (hIS) in overweight and obese T2D individuals that were randomly assigned a 12-week Paleolithic-type diet with (diet-ex, n = 13) or without (diet, n = 13) supervised exercise. Baseline and post-intervention measures included: mass spectrometry-based metabolomics and lipidomics of skeletal muscle and plasma; pIS and hIS; ectopic lipid deposits in the liver and skeletal muscle; and skeletal muscle fat oxidation rate. Both groups lowered BMI and total % fat mass and increased their pIS. Only the diet-group improved hIS and reduced ectopic lipids in the liver and muscle. The combined improvement in pIS and hIS in the diet-group were associated with decreases in muscle and circulating branched-chain amino acid (BCAA) metabolites, specifically valine. Improved pIS with diet-ex was instead linked to increased diacylglycerol (34:2) and triacylglycerol (56:0) and decreased phosphatidylcholine (34:3) in muscle coupled with improved muscle fat oxidation rate. This suggests a tissue crosstalk involving BCAA-metabolites after diet intervention with improved pIS and hIS, reflecting reduced lipid influx. Increased skeletal muscle lipid utilization with exercise may prevent specific lipid accumulation at sites that perturb insulin signaling.
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Affiliation(s)
- Elin Chorell
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden; (J.O.); (A.S.); (M.R.); (T.O.)
- Correspondence: ; Tel.: +46-(0)90-785-1326
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden; (J.O.); (A.S.); (M.R.); (T.O.)
| | - Andreas Stomby
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden; (J.O.); (A.S.); (M.R.); (T.O.)
| | - Mats Ryberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden; (J.O.); (A.S.); (M.R.); (T.O.)
| | - Maria Waling
- Department of Food, Nutrition and Culinary Science, Umeå University, 901 87 Umeå, Sweden;
| | - Jon Hauksson
- Department of Radiation Sciences, Umeå University, 901 87 Umeå, Sweden;
| | - Michael Svensson
- Department of Community Medicine and Rehabilitation, Section of Sports Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden; (J.O.); (A.S.); (M.R.); (T.O.)
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11
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Shemirani F, Djafarian K, Fotouhi A, Azadbakht L, Rezaei N, Chamari M, Shabani S, Mahmoudi M. Effect of Paleolithic-based low-carbohydrate vs. moderate-carbohydrate diets with portion-control and calorie-counting on CTRP6, asprosin and metabolic markers in adults with metabolic syndrome: A randomized clinical trial. Clin Nutr ESPEN 2021; 48:87-98. [DOI: 10.1016/j.clnesp.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/29/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023]
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12
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Otten J, Stomby A, Waling M, Chorell E, Ryberg M, Svensson M, Holst JJ, Olsson T. The liver-alpha-cell axis after a mixed meal and during weight loss in type 2 diabetes. Endocr Connect 2021; 10:1101-1110. [PMID: 34382579 PMCID: PMC8494406 DOI: 10.1530/ec-21-0171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Glucagon and amino acids may be regulated in a feedback loop called the liver-alpha-cell axis with alanine or glutamine as suggested signal molecules. We assessed this concept in individuals with type 2 diabetes in the fasting state, after ingestion of a protein-rich meal, and during weight loss. Moreover, we investigated if postprandial glucagon secretion and hepatic insulin sensitivity were related. METHODS This is a secondary analysis of a 12-week weight-loss trial (Paleolithic diet ± exercise) in 29 individuals with type 2 diabetes. Before and after the intervention, plasma glucagon and amino acids were measured in the fasting state and during 180 min after a protein-rich mixed meal. Hepatic insulin sensitivity was measured using the hyperinsulinemic-euglycemic clamp with [6,6-2H2]glucose as a tracer. RESULTS The postprandial increase of plasma glucagon was associated with the postprandial increase of alanine and several other amino acids but not glutamine. In the fasted state and after the meal, glucagon levels were negatively correlated with hepatic insulin sensitivity (rS = -0.51/r = -0.58, respectively; both P < 0.05). Improved hepatic insulin sensitivity with weight loss was correlated with decreased postprandial glucagon response (r = -0.78; P < 0.001). CONCLUSIONS Several amino acids, notably alanine, but not glutamine could be key signals to the alpha cell to increase glucagon secretion. Amino acids may be part of a feedback mechanism as glucagon increases endogenous glucose production and ureagenesis in the liver. Moreover, postprandial glucagon secretion seems to be tightly related to hepatic insulin sensitivity.
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Affiliation(s)
- Julia Otten
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Correspondence should be addressed to J Otten:
| | - Andreas Stomby
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Region Jönköping County, Jönköping, Sweden
| | - Maria Waling
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
| | - Elin Chorell
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mats Ryberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michael Svensson
- Department of Community Medicine and Rehabilitation, Section for Sports Medicine, Umeå University, Umeå Sweden
| | - Jens Juul Holst
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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13
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Frączek B, Pięta A, Burda A, Mazur-Kurach P, Tyrała F. Paleolithic Diet-Effect on the Health Status and Performance of Athletes? Nutrients 2021; 13:1019. [PMID: 33801152 PMCID: PMC8004139 DOI: 10.3390/nu13031019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/18/2023] Open
Abstract
The aim of this meta-analysis was to review the impact of a Paleolithic diet (PD) on selected health indicators (body composition, lipid profile, blood pressure, and carbohydrate metabolism) in the short and long term of nutrition intervention in healthy and unhealthy adults. A systematic review of randomized controlled trials of 21 full-text original human studies was conducted. Both the PD and a variety of healthy diets (control diets (CDs)) caused reduction in anthropometric parameters, both in the short and long term. For many indicators, such as weight (body mass (BM)), body mass index (BMI), and waist circumference (WC), impact was stronger and especially found in the short term. All diets caused a decrease in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), albeit the impact of PD was stronger. Among long-term studies, only PD cased a decline in TC and LDL-C. Impact on blood pressure was observed mainly in the short term. PD caused a decrease in fasting plasma (fP) glucose, fP insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) and glycated hemoglobin (HbA1c) in the short run, contrary to CD. In the long term, only PD caused a decrease in fP glucose and fP insulin. Lower positive impact of PD on performance was observed in the group without exercise. Positive effects of the PD on health and the lack of experiments among professional athletes require longer-term interventions to determine the effect of the Paleo diet on athletic performance.
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Affiliation(s)
- Barbara Frączek
- Department of Sports Medicine and Human Nutrition, Institute of Biomedical Sciences, University School of Physical Education in Krakow, Jana Pawla II 78, 31-571 Cracow, Poland; (A.P.); (P.M.-K.)
| | - Aleksandra Pięta
- Department of Sports Medicine and Human Nutrition, Institute of Biomedical Sciences, University School of Physical Education in Krakow, Jana Pawla II 78, 31-571 Cracow, Poland; (A.P.); (P.M.-K.)
| | - Adrian Burda
- Department of Econometrics and Operational Research, Cracow University of Economics, 31-510 Cracow, Poland;
| | - Paulina Mazur-Kurach
- Department of Sports Medicine and Human Nutrition, Institute of Biomedical Sciences, University School of Physical Education in Krakow, Jana Pawla II 78, 31-571 Cracow, Poland; (A.P.); (P.M.-K.)
| | - Florentyna Tyrała
- Department of Sports Dietetics, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
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14
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Ramírez-Vélez R, Ezzatvar Y, Izquierdo M, García-Hermoso A. Effect of exercise on myosteatosis in adults: a systematic review and meta-analysis. J Appl Physiol (1985) 2020; 130:245-255. [PMID: 33180646 DOI: 10.1152/japplphysiol.00738.2020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Muscle tissue typically contains only small amounts of adipose tissue, and the excess deposition of adiposity is considered a pathological phenomenon termed myosteatosis. Several studies have assessed the effects of exercise alone on the severity of myosteatosis, and some studies have reported promising results. We performed a systematic review and meta-analysis to investigate the effects of exercise interventions on myosteatosis (i.e., lipid infiltration and muscle radiation attenuation). Studies were identified through a systematic search of three databases and limited to randomized controlled trials (RCTs) focused on evaluating the effect of exercise interventions on lipid infiltration and/or muscle attenuation in adults. Thirteen studies met the inclusion criteria, and 12 were included in the meta-analysis (n = 465, 84.7% women). The volume of lipid infiltration was decreased in the exercise group compared with the control group [Hedges' g = -0.45, 95% confidence interval (CI), -0.74 to -0.16; P = 0.008, I2 = 0%], and the degree of muscle radiation attenuation was increased (Hedges' g = 0.67, 95% CI, 0.22 to 1.13; P = 0.009, I2 = 59.3%). Based on meta-regression analyses, there were no significant effects of mean age at baseline (lipid infiltration, β = -0.008, 95% CI, -0.035 to 0.019; P = 0.495; muscle radiation attenuation, β = -0.013, 95% CI, -0.036 to 0.011; P = 0.248) and intervention duration (lipid infiltration, β = -0.008, 95% CI, -0.028 to 0.010; P = 0.311; muscle radiation attenuation, β = -0.018, 95% CI, -0.050 to 0.014; P = 0.230) on the effect size estimates. Overall, our findings indicate that exercise can significantly improve muscle quality in populations at risk of developing obesity and sarcopenia-related disability.NEW & NOTEWORTHY Muscle tissue typically contains only small amounts of adipose tissue, and the excess deposition of adiposity is considered a pathological phenomenon termed myosteatosis. The volume of lipid infiltration tissue was decreased in the exercise group compared with the control group, and muscle attenuation coefficient was increased. Based on the meta-regression analyses, the mean age at baseline and intervention duration did not affect the effect size estimates for lipid infiltration tissue and muscle radiation attenuation.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Navarrabiomed, Universidad Pública de Navarra-Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Yasmin Ezzatvar
- Exercise Intervention for Health Research Group, Department of Physiotherapy, Universitat de València, Valencia, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Universidad Pública de Navarra-Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Universidad Pública de Navarra-Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
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15
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Moore MP, Cunningham RP, Dashek RJ, Mucinski JM, Rector RS. A Fad too Far? Dietary Strategies for the Prevention and Treatment of NAFLD. Obesity (Silver Spring) 2020; 28:1843-1852. [PMID: 32893456 PMCID: PMC7511422 DOI: 10.1002/oby.22964] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a major health problem, and its prevalence has increased in recent years, concurrent with rising rates of obesity and other metabolic diseases. Currently, there are no FDA-approved pharmacological therapies for NAFLD, and lifestyle interventions, including weight loss and exercise, remain the cornerstones for treatment. Manipulating diet composition and eating patterns may be a sustainable approach to NAFLD treatment. Dietary strategies including Paleolithic, ketogenic, Mediterranean, high-protein, plant-based, low-carbohydrate, and intermittent fasting diets have become increasingly popular because of their purported benefits on metabolic disease. This review highlights what is currently known about these popular dietary approaches in the management of NAFLD in clinical populations with mechanistic insight from animal studies. It also identifies key knowledge gaps to better inform future preclinical and clinical studies aimed at the treatment of NAFLD.
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Affiliation(s)
- Mary P. Moore
- Research Service, Harry S Truman Memorial Veterans Medical Center, Columbia, MO, 65211
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211
| | - Rory P. Cunningham
- Research Service, Harry S Truman Memorial Veterans Medical Center, Columbia, MO, 65211
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211
| | - Ryan J. Dashek
- Research Service, Harry S Truman Memorial Veterans Medical Center, Columbia, MO, 65211
- Comparative Medicine Program, University of Missouri, Columbia, MO 65211
| | - Justine M. Mucinski
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211
| | - R. Scott Rector
- Research Service, Harry S Truman Memorial Veterans Medical Center, Columbia, MO, 65211
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211
- Medicine-Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65211
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16
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Rutledge GA, Phang HJ, Le MN, Bui L, Rose MR, Mueller LD, Jafari M. Diet and Botanical Supplementation: Combination Therapy for Healthspan Improvement? Rejuvenation Res 2020; 24:331-344. [PMID: 32924860 DOI: 10.1089/rej.2020.2361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Healthspan science aims to add healthy, functional years to human life. Many different methods of improving healthspan have been investigated, chiefly focusing on just one aspect of an organism's health such as survival. Studies in Drosophila melanogaster have demonstrated that a reversal to a long-abandoned ancestral diet results in improved functional health, particularly at later ages. Meanwhile, pharmaceutical studies have demonstrated that botanical extracts have potent antiaging properties, capable of extending the mean lifespan of D. melanogaster by up to 25%, without a decrease in early fecundity. In this study, we combine these two different approaches to healthspan extension to examine whether a combination of such treatments results in a synergistic or antagonistic effect on Drosophila healthspan. One botanical extract, derived from Rhodiola rosea, mimicked the effects of the ancestral apple diet with better performance at later ages compared with the control. Another extract, derived from Rosa damascena, decreased age-specific survivorship when combined with the apple diet providing support for the "Poisoned Chalice" hypothesis that combinations of various supplements or diets can elicit adverse physiological responses. More experiments in model organisms should be completed researching the effects of combining healthspan-extending substances in various diet backgrounds.
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Affiliation(s)
- Grant A Rutledge
- Department of Ecology and Evolutionary Biology, School of Biological Sciences, University of California, Irvine, Irvine, California, USA.,Neuroscience and Aging Lab, USDA-ARS Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Howard J Phang
- Department of Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
| | - Michael N Le
- Department of Ecology and Evolutionary Biology, School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Linsey Bui
- Department of Ecology and Evolutionary Biology, School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Michael R Rose
- Department of Ecology and Evolutionary Biology, School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Laurence D Mueller
- Department of Ecology and Evolutionary Biology, School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Mahtab Jafari
- Department of Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
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17
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Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 8:CD011737. [PMID: 32827219 PMCID: PMC8092457 DOI: 10.1002/14651858.cd011737.pub3] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS We included 15 randomised controlled trials (RCTs) (16 comparisons, 56,675 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | - Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Christian Kirk
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eve Foster
- Norwich Medical School, University of East Anglia, Norwich, UK
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18
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Abstract
The Paleolithic diet (PaleoDiet) is an allegedly healthy dietary pattern inspired by the consumption of wild foods and animals assumed to be consumed in the Paleolithic era. Despite gaining popularity in the media, different operational definitions of this Paleolithic nutritional intake have been used in research. Our hypothesis is that specific components used to define the PaleoDiet may modulate the association of this diet with several health outcomes. We comprehensively reviewed currently applied PaleoDiet scores and suggested a new score based on the food composition of current PaleoDiet definitions and the theoretical food content of a staple dietary pattern in the Paleolithic age. In a PubMed search up to December 2019, fourteen different PaleoDiet definitions were found. We observed some common components of the PaleoDiet among these definitions although we also found high heterogeneity in the list of specific foods that should be encouraged or banned within the PaleoDiet. Most studies suggest that the PaleoDiet may have beneficial effects in the prevention of cardiometabolic diseases (type 2 diabetes, overweight/obesity, CVD and hyperlipidaemias) but the level of evidence is still weak because of the limited number of studies with a large sample size, hard outcomes instead of surrogate outcomes and long-term follow-up. Finally, we propose a new PaleoDiet score composed of eleven food items, based on a high consumption of fruits, nuts, vegetables, fish, eggs and unprocessed meats (lean meats); and a minimum content of dairy products, grains and cereals, and legumes and practical absence of processed (or ultra-processed) foods or culinary ingredients.
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19
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Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 5:CD011737. [PMID: 32428300 PMCID: PMC7388853 DOI: 10.1002/14651858.cd011737.pub2] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | - Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Christian Kirk
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eve Foster
- Norwich Medical School, University of East Anglia, Norwich, UK
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20
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Stomby A, Otten J, Ryberg M, Andrew R, Walker BR, Olsson T. Diet-induced weight loss alters hepatic glucocorticoid metabolism in type 2 diabetes mellitus. Eur J Endocrinol 2020; 182:447-457. [PMID: 32069218 PMCID: PMC7087495 DOI: 10.1530/eje-19-0901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 11/08/2022]
Abstract
CONTEXT Altered tissue-specific glucocorticoid metabolism has been described in uncomplicated obesity and type 2 diabetes. We hypothesized that weight loss induced by diet and exercise, which has previously been shown to reverse abnormal cortisol metabolism in uncomplicated obesity, also normalizes cortisol metabolism in patients with type 2 diabetes. OBJECTIVE Test the effects of a diet intervention with added exercise on glucocorticoid metabolism. DESIGN Two groups followed a Paleolithic diet (PD) for 12 weeks with added 180 min of structured aerobic and resistance exercise per week in one randomized group (PDEX). SETTING Umeå University Hospital. PARTICIPANTS Men and women with type 2 diabetes treated with lifestyle modification ± metformin were included. Twenty-eight participants (PD, n = 15; PDEX, n = 13) completed measurements of glucocorticoid metabolism. MAIN OUTCOME MEASURES Changes in glucocorticoid metabolite levels in 24-h urine samples, expression of HSD11B1 mRNA in s.c. adipose tissue and conversion of orally administered cortisone to cortisol measured in plasma. Body composition and insulin sensitivity were measured using a hyperinsulinemic-euglycemic clamp, and liver fat was measured by magnetic resonance spectroscopy. RESULTS Both groups lost weight and improved insulin sensitivity. Conversion of orally taken cortisone to plasma cortisol and the ratio of 5α-THF + 5β-THF/THE in urine increased in both groups. CONCLUSIONS These interventions caused weight loss and improved insulin sensitivity with concomitant increases in the conversion of cortisone to cortisol, which is an estimate of hepatic HSD11B1 activity. This suggests that dysregulation of liver glucocorticoid metabolism in these patients is a consequence rather than a cause of metabolic dysfunction.
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Affiliation(s)
- Andreas Stomby
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Region Jönköping County, Jönköping, Sweden
- Correspondence should be addressed to A Stomby;
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mats Ryberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ruth Andrew
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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21
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Parry SA, Hodson L. Managing NAFLD in Type 2 Diabetes: The Effect of Lifestyle Interventions, a Narrative Review. Adv Ther 2020; 37:1381-1406. [PMID: 32146704 PMCID: PMC7140753 DOI: 10.1007/s12325-020-01281-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 02/07/2023]
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) is increasing. As a strong association between these two diseases exist, it is unsurprising that the number of patients with coexisting NAFLD and T2D is also increasing. These patients display a deleterious metabolic profile (e.g. hypertriglyceridemia), and increased mortality rates relative to those with only NAFLD or T2D in isolation; therefore, effective treatment strategies are required. Here we review the available intervention studies that have investigated the effects of changes in lifestyle (diet and exercise/physical activity) on NAFLD in patients with both NAFLD and T2D. On the basis of the available evidence, it appears that the addition of any kind of exercise (i.e. resistance, aerobic, or high-intensity intermittent exercise) is beneficial for patients with both NAFLD and T2D. These effects appear to occur independently of changes in body weight. Hypocaloric diets leading to weight loss are also effective in improving metabolic parameters in patients with both NAFLD and T2D, with data indicating that ~ 7–10% weight loss is required in order to observe beneficial effects. It is unclear if multidisciplinary interventions incorporating changes in both diet and physical activity levels are a more effective treatment strategy in this population than diet or exercise interventions in isolation. In conclusion, it is clear that lifestyle interventions are an effective treatment strategy in patients with both NAFLD and T2D, although further research is required to optimise these interventions and determine their scalability.
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Affiliation(s)
- Siôn A Parry
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK.
| | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital Trusts, Oxford, UK
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22
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Metabolic profiling of tissue-specific insulin resistance in human obesity: results from the Diogenes study and the Maastricht Study. Int J Obes (Lond) 2020; 44:1376-1386. [PMID: 32203114 DOI: 10.1038/s41366-020-0565-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent evidence indicates that insulin resistance (IR) in obesity may develop independently in different organs, representing different etiologies toward type 2 diabetes and other cardiometabolic diseases. The aim of this study was to investigate whether IR in the liver and IR in skeletal muscle are associated with distinct metabolic profiles. METHODS This study includes baseline data from 634 adults with overweight or obesity (BMI ≥ 27 kg/m2) (≤65 years; 63% women) without diabetes of the European Diogenes Study. Hepatic insulin resistance index (HIRI) and muscle insulin sensitivity index (MISI), were derived from a five-point OGTT. At baseline 17 serum metabolites were identified and quantified by nuclear-magnetic-resonance spectroscopy. Linear mixed model analyses (adjusting for center, sex, body mass index (BMI), waist-to-hip ratio) were used to associate HIRI and MISI with these metabolites. In an independent sample of 540 participants without diabetes (BMI ≥ 27 kg/m2; 40-65 years; 46% women) of the Maastricht Study, an observational prospective population-based cohort study, 11 plasma metabolites and a seven-point OGTT were available for validation. RESULTS Both HIRI and MISI were associated with higher levels of valine, isoleucine, oxo-isovaleric acid, alanine, lactate, and triglycerides, and lower levels of glycine (all p < 0.05). HIRI was also associated with higher levels of leucine, hydroxyisobutyrate, tyrosine, proline, creatine, and n-acetyl and lower levels of acetoacetate and 3-OH-butyrate (all p < 0.05). Except for valine, these results were replicated for all available metabolites in the Maastricht Study. CONCLUSIONS In persons with obesity without diabetes, both liver and muscle IR show a circulating metabolic profile of elevated (branched-chain) amino acids, lactate, and triglycerides, and lower glycine levels, but only liver IR associates with lower ketone body levels and elevated ketogenic amino acids in circulation, suggestive of decreased ketogenesis. This knowledge might enhance developments of more targeted tissue-specific interventions to prevent progression to more severe disease stages.
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23
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Mendham AE, Larsen S, George C, Adams K, Hauksson J, Olsson T, Fortuin-de Smidt MC, Nono Nankam PA, Hakim O, Goff LM, Pheiffer C, Goedecke JH. Exercise training results in depot-specific adaptations to adipose tissue mitochondrial function. Sci Rep 2020; 10:3785. [PMID: 32123205 PMCID: PMC7052157 DOI: 10.1038/s41598-020-60286-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/03/2020] [Indexed: 11/09/2022] Open
Abstract
We assessed differences in mitochondrial function in gluteal (gSAT) and abdominal subcutaneous adipose tissue (aSAT) at baseline and in response to 12-weeks of exercise training; and examined depot-specific associations with body fat distribution and insulin sensitivity (SI). Obese, black South African women (n = 45) were randomized into exercise (n = 23) or control (n = 22) groups. Exercise group completed 12-weeks of aerobic and resistance training (n = 20), while the control group (n = 15) continued usual behaviours. Mitochondrial function (high-resolution respirometry and fluorometry) in gSAT and aSAT, SI (frequently sampled intravenous glucose tolerance test), body composition (dual-energy X-ray absorptiometry), and ectopic fat (MRI) were assessed pre- and post-intervention. At baseline, gSAT had higher mitochondrial respiratory capacity and hydrogen peroxide (H2O2) production than aSAT (p < 0.05). Higher gSAT respiration was associated with higher gynoid fat (p < 0.05). Higher gSAT H2O2 production and lower aSAT mitochondrial respiration were independently associated with lower SI (p < 0.05). In response to training, SI improved and gynoid fat decreased (p < 0.05), while H2O2 production reduced in both depots, and mtDNA decreased in gSAT (p < 0.05). Mitochondrial respiration increased in aSAT and correlated with a decrease in body fat and an increase in soleus and hepatic fat content (p < 0.05). This study highlights the importance of understanding the differences in mitochondrial function in multiple SAT depots when investigating the pathophysiology of insulin resistance and associated risk factors such as body fat distribution and ectopic lipid deposition. Furthermore, we highlight the benefits of exercise training in stimulating positive adaptations in mitochondrial function in gluteal and abdominal SAT depots.
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Affiliation(s)
- Amy E Mendham
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
| | - Steen Larsen
- Center for Healthy Aging, Department of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Cindy George
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kevin Adams
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Jon Hauksson
- Department of Radiation Sciences, Radiation Physics and Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Melony C Fortuin-de Smidt
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Pamela A Nono Nankam
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Olah Hakim
- Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Louise M Goff
- Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Julia H Goedecke
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
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24
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Barone M, Turroni S, Rampelli S, Soverini M, D’Amico F, Biagi E, Brigidi P, Troiani E, Candela M. Gut microbiome response to a modern Paleolithic diet in a Western lifestyle context. PLoS One 2019; 14:e0220619. [PMID: 31393934 PMCID: PMC6687155 DOI: 10.1371/journal.pone.0220619] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/18/2019] [Indexed: 02/07/2023] Open
Abstract
The modern Paleolithic diet (MPD), featured by the consumption of vegetables, fruit, nuts, seeds, eggs, fish and lean meat, while excluding grains, dairy products, salt and refined sugar, has gained substantial public attention in recent years because of its potential multiple health benefits. However, to date little is known about the actual impact of this dietary pattern on the gut microbiome (GM) and its implications for human health. In the current scenario where Western diets, low in fiber while rich in industrialized and processed foods, are considered one of the leading causes of maladaptive GM changes along human evolution, likely contributing to the increasing incidence of chronic non-communicable diseases, we hypothesize that the MPD could modulate the Western GM towards a more “ancestral” configuration. In an attempt to shed light on this, here we profiled the GM structure of urban Italian subjects adhering to the MPD, and compared data with other urban Italians following a Mediterranean Diet (MD), as well as worldwide traditional hunter-gatherer populations from previous publications. Notwithstanding a strong geography effect on the GM structure, our results show an unexpectedly high degree of biodiversity in MPD subjects, which well approximates that of traditional populations. The GM of MPD individuals also shows some peculiarities, including a high relative abundance of bile-tolerant and fat-loving microorganisms. The consumption of plant-based foods–albeit with the exclusion of grains and pulses–along with the minimization of the intake of processed foods, both hallmarks of the MPD, could therefore contribute to partially rewild the GM but caution should be taken in adhering to this dietary pattern in the long term.
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Affiliation(s)
- Monica Barone
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Silvia Turroni
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
- * E-mail:
| | - Simone Rampelli
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Matteo Soverini
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Federica D’Amico
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Elena Biagi
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Brigidi
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Emidio Troiani
- Primary Care Unit and Territorial Health, Social Security Institute, Cailungo, Republic of San Marino
| | - Marco Candela
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
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25
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Sugimoto D, Tamura Y, Takeno K, Kaga H, Someya Y, Kakehi S, Funayama T, Furukawa Y, Suzuki R, Kadowaki S, Nishitani-Yokoyama M, Shimada K, Daida H, Aoki S, Kanazawa A, Kawamori R, Watada H. Clinical Features of Nonobese, Apparently Healthy, Japanese Men With Reduced Adipose Tissue Insulin Sensitivity. J Clin Endocrinol Metab 2019; 104:2325-2333. [PMID: 30689902 DOI: 10.1210/jc.2018-02190] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 12/23/2022]
Abstract
CONTEXT Adipose tissue insulin resistance has been observed in obese subjects and is considered an early metabolic defect that precedes insulin resistance in muscle and liver. Although Asians can readily develop metabolic disease without obesity, the clinical features of nonobese, apparently healthy, Asians with reduced adipose tissue insulin sensitivity (ATIS) have not been elucidated. OBJECTIVE To investigate the clinical parameters associated with reduced ATIS in nonobese, apparently healthy (body mass index <25 kg/m2), Japanese men. METHODS We studied 52 nonobese Japanese men without cardiometabolic risk factors. Using a two-step hyperinsulinemic euglycemic clamp with a glucose tracer, we evaluated the insulin sensitivity in muscle, liver, and adipose tissue. ATIS was calculated as the percentage of free fatty acid (FFA) suppression/insulin concentration during the first step of the glucose clamp. RESULTS Using the median ATIS value, the subjects were divided into low- and high-FFA suppression groups. The low-FFA suppression group had moderate fat accumulation in the abdominal subcutaneous adipose tissue and liver. Compared with the high-FFA group, they also had a lower fitness level, decreased insulin clearance, impaired insulin sensitivity in muscle, moderately elevated triglycerides, and lowered high-density lipoprotein cholesterol levels. All these factors correlated significantly with ATIS. Hepatic insulin sensitivity was comparable between the two groups. CONCLUSIONS In nonobese, apparently healthy, Japanese men, reduced ATIS was associated with moderate fat accumulation in subcutaneous fat and liver, lower insulin clearance, muscle insulin resistance, and moderate lipedema. These data suggest that reduced ATIS can occur early in the development of the metabolic syndrome, even in nonobese, apparently healthy, men.
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Affiliation(s)
- Daisuke Sugimoto
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Tamura
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kageumi Takeno
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideyoshi Kaga
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Someya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Saori Kakehi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Funayama
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Furukawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ruriko Suzuki
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Kadowaki
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Kazunori Shimada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryuzo Kawamori
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Center for Identification of Diabetic Therapeutic Targets, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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