1
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Gijbels A, Jardon KM, Trouwborst I, Manusama KC, Goossens GH, Blaak EE, Feskens EJ, Afman LA. Fasting and postprandial plasma metabolite responses to a 12-wk dietary intervention in tissue-specific insulin resistance: a secondary analysis of the PERSonalized glucose Optimization through Nutritional intervention (PERSON) randomized trial. Am J Clin Nutr 2024; 120:347-359. [PMID: 38851634 DOI: 10.1016/j.ajcnut.2024.05.027] [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: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND We previously showed that dietary intervention effects on cardiometabolic health were driven by tissue-specific insulin resistance (IR) phenotype: individuals with predominant muscle IR (MIR) benefited more from a low-fat, high-protein, and high-fiber (LFHP) diet, whereas individuals with predominant liver insulin resistance (LIR) benefited more from a high-monounsaturated fatty acid (HMUFA) diet. OBJECTIVES To further characterize the effects of LFHP and HMUFA diets and their interaction with tissue-specific IR, we investigated dietary intervention effects on fasting and postprandial plasma metabolite profile. METHODS Adults with MIR or LIR (40-75 y, BMI 25-40 kg/m2) were randomly assigned to a 12-wk HMUFA or LFHP diet (n = 242). After the exclusion of statin use, 214 participants were included in this prespecified secondary analysis. Plasma samples were collected before (T = 0) and after (T = 30, 60, 120, and 240 min) a high-fat mixed meal for quantification of 247 metabolite measures using nuclear magnetic resonance spectroscopy. RESULTS A larger reduction in fasting VLDL-triacylglycerol (TAG) and VLDL particle size was observed in individuals with MIR following the LFHP diet and those with LIR following the HMUFA diet, although no longer statistically significant after false discovery rate (FDR) adjustment. No IR phenotype-by-diet interactions were found for postprandial plasma metabolites assessed as total area under the curve (tAUC). Irrespective of IR phenotype, the LFHP diet induced greater reductions in postprandial plasma tAUC of the larger VLDL particles and small HDL particles, and TAG content in most VLDL subclasses and the smaller LDL and HDL subclasses (for example, VLDL-TAG tAUC standardized mean change [95% CI] LFHP = -0.29 [-0.43, -0.16] compared with HMUFA = -0.04 [-0.16, 0.09]; FDR-adjusted P for diet × time = 0.041). CONCLUSIONS Diet effects on plasma metabolite profiles were more pronounced than phenotype-by-diet interactions. An LFHP diet may be more effective than an HMUFA diet for reducing cardiometabolic risk in individuals with tissue-specific IR, irrespective of IR phenotype. Am J Clin Nutr 20xx;x:xx. This trial was registered at the clinicaltrials.gov registration (https://clinicaltrials.gov/study/NCT03708419?term=NCT03708419&rank=1) as NCT03708419 and CCMO registration (https://www.toetsingonline.nl/to/ccmo_search.nsf/fABRpop?readform&unids=3969AABCD9BA27FEC12587F1001BCC65) as NL63768.068.17.
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Affiliation(s)
- Anouk Gijbels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands; Top Institute Food and Nutrition (TiFN), Wageningen, The Netherlands.
| | - Kelly M Jardon
- Top Institute Food and Nutrition (TiFN), Wageningen, The Netherlands; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Inez Trouwborst
- Top Institute Food and Nutrition (TiFN), Wageningen, The Netherlands; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Koen Cm Manusama
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Gijs H Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ellen E Blaak
- Top Institute Food and Nutrition (TiFN), Wageningen, The Netherlands; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith Jm Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Lydia A Afman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Costabile G, Salamone D, Della Pepa G, Vitale M, Testa R, Cipriano P, Scidà G, Rivellese AA, Annuzzi G, Bozzetto L. Differential Effects of Two Isocaloric Healthy Diets on Postprandial Lipid Responses in Individuals with Type 2 Diabetes. Nutrients 2024; 16:333. [PMID: 38337618 PMCID: PMC10857261 DOI: 10.3390/nu16030333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND High blood concentrations of triglycerides (TG) in the postprandial period have been shown to be more closely associated with the risk of cardiovascular disease (CVD) than fasting values in individuals with type 2 diabetes (T2D). Dietary changes are the primary determinants of postprandial lipid responses. METHODS We investigated the effects of an isocaloric multifactorial diet, rich in n-3 PUFA, MUFA, fiber, polyphenols, and vitamins, compared to an isocaloric diet, containing the same amount of MUFA, on the postprandial lipid response in T2D individuals. Following a randomized, controlled, parallel group design, 43 (25 male/18 female) T2D individuals were assigned to an isocaloric multifactorial (n = 21) or a MUFA-rich diet (n = 22). At the beginning and after the 8 weeks of dietary intervention, the concentrations of plasma triglycerides, total cholesterol, HDL cholesterol, and non-HDL cholesterol were detected at fasting and over a 4-h test meal with the same composition as the prescribed diet. RESULTS The concentrations of fasting plasma triglycerides, total cholesterol, HDL cholesterol, and non-HDL cholesterol did not change after both diets. Compared with the MUFA diet, the 8-week multifactorial diet significantly lowered the postprandial response, which was evaluated as the incremental area under the curve (iAUC), of triglycerides by 33% (64 ± 68 vs. 96 ± 50 mmol/L·240 min, mean ± SD, respectively, p = 0.018), total cholesterol by 105% (-51 ± 33 vs. -25 ± 29, p = 0.013), and non-HDL cholesterol by 206% (-39 ± 33 vs. -13 ± 23, p = 0.013). CONCLUSIONS In T2D individuals, a multifactorial diet, characterized by several beneficial components, improved the postprandial lipid response compared to a MUFA diet, generally considered a healthy diet being reduced in saturated fat, and probably contributed to the reduction of cardiovascular risk.
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Affiliation(s)
- Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Dominic Salamone
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Roberta Testa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Paola Cipriano
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Giuseppe Scidà
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (G.C.); (D.S.); (M.V.); (R.T.); (P.C.); (G.S.); (A.A.R.); (G.A.); (L.B.)
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3
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Engeroff T, Groneberg DA, Wilke J. After Dinner Rest a While, After Supper Walk a Mile? A Systematic Review with Meta-analysis on the Acute Postprandial Glycemic Response to Exercise Before and After Meal Ingestion in Healthy Subjects and Patients with Impaired Glucose Tolerance. Sports Med 2023; 53:849-869. [PMID: 36715875 PMCID: PMC10036272 DOI: 10.1007/s40279-022-01808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The most effective way to cope with high blood sugar spikes is to engage in physical activity in temporal proximity to food intake. However, so far, it is unclear as to whether there is an optimal time for physical activity around food intake. OBJECTIVES We aimed to identify the impact of pre- and post-meal exercise on postprandial glucose excursions in humans with and without type 2 diabetes mellitus. METHODS We conducted a systematic review with meta-analysis, PROSPERO registration number: CRD42022324070. We screened MEDLINE/PubMed, Cochrane/CINAHL/EMBASE, and Web of Knowledge until 1 May, 2022. We used the risk of bias rating with the crossover extension of the Cochrane risk of bias assessment tool II. Standardized mean differences (SMDs, Hedges' g) with 95% confidence intervals (CIs) were calculated as pooled effect estimates of a random-effects meta-analysis. Eligibility criteria included three-armed randomized controlled trials comparing the acute effects of pre- and post-meal exercise to a no-exercise control in humans. RESULTS Eight randomized controlled trials (crossover trials, high risk of bias) with 30 interventions in 116 participants (47 diagnosed with type 2 diabetes, 69 without type 2 diabetes) were eligible. Exercise after meal ingestion (real food or meal replacement drinks) led to a reduction in postprandial glucose excursions compared with exercise before eating (15 effect sizes; SMD = 0.47 [95% CI 0.23, 0.70]) and an inactive control condition (15 effect sizes; SMD = 0.55 [95% CI 0.34, 0.75]. Pre-meal exercise did not lead to significantly lower postprandial glucose compared to an inactive control (15 effect sizes; SMD = - 0.13 [95% CI - 0.42, 0.17]). The time between meal and exercise (estimate = - 0.0151; standard error = 0.00473; Z = - 3.19; p = 0.001; 95% CI - 0.024, - 0.006) had a moderating influence on postprandial glucose excursions. CONCLUSIONS Exercise, i.e., walking, has a greater acute beneficial impact on postprandial hyperglycemia when undertaken as soon as possible after a meal rather than after a longer interval or before eating. CLINICAL TRIAL REGISTRATION The review was pre-registered in the PROSPERO database (CRD42022324070). The date of submission was 07.04.2022, with the registration on 08.05.2022.
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Affiliation(s)
- Tobias Engeroff
- Division Health and Performance, Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, Building 9B, 60590, Frankfurt am Main, Germany.
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jan Wilke
- Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt, Frankfurt, Germany
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Petridou A, Mougios V. Exercise to lower postprandial lipemia: why, when, what and how. Int J Sports Med 2022; 43:1013-1022. [PMID: 35345016 DOI: 10.1055/a-1810-5118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We review recent findings on the ability of exercise to lower postprandial lipemia (PPL). Specifically, we answer why exercise is important in lowering PPL, when it is most effective to exercise to achieve this, what the preferred exercise is and how exercise reduces PPL. Most findings confirm the power of exercise to lower PPL, which is an independent risk factor for cardiovascular disease. Exercise is most effective when performed on the day preceding a high- or moderate-fat meal. This effect lasts up to approximately two days; therefore, one should exercise frequently to maintain this benefit. However, the time of exercise relative to a meal is not that important in real-life conditions, since one consumes several meals during the day; thus, an exercise bout will inevitably exert its lowering effect on PPL in one or more of the subsequent meals. Although moderate-intensity continuous exercise, high-intensity intermittent exercise (HIIE), resistance exercise and accumulation of short bouts of exercise throughout the day are all effective in lowering PPL, submaximal, high-volume interval exercise seems to be superior, provided it is tolerable. Finally, exercise reduces PPL by both lowering the rate of appearance and increasing the clearance of triacylglycerol-rich lipoproteins from the circulation.
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Affiliation(s)
- Anatoli Petridou
- School of Physical Education and Sport Science at Thessaloniki, Laboratory of Evaluation of Human Biological Performance, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Mougios
- School of Physical Education and Sport Science at Thessaloniki, Laboratory of Evaluation of Human Biological Performance, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Cardiovascular disease is the leading cause of death globally The past few decades have shown that especially low- and middle-income countries have undergone rapid industrialization, urbanization, economic development and market globalization. Although these developments led to many positive changes in health outcomes and increased life expectancies, they all also caused inappropriate dietary patterns, physical inactivity and obesity. Evidence shows that a large proportion of the cardiovascular disease burden can be explained by behavioural factors such as low physical activity, unhealthy diet and smoking. Controlling these risk factors from early ages is important for maintaining cardiovascular health. Even in patients with genetic susceptibility to cardiovascular disease, risk factor modification is beneficial.Despite the tremendous advances in the medical treatment of cardiovascular risk factors to reduce overall cardiovascular risk, the modern lifestyle which has led to greater sedentary time, lower participation in active transport and time spent in leisure or purposeful physical activity, unhealthy diets and increased exposure to stress, noise and pollution have diminished the beneficial effects of contemporary medical cardiovascular prevention strategies. Therefore attenuating or eliminating these health risk behaviours and risk factors is imperative in the prevention of cardiovascular diseases.
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Affiliation(s)
- Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Vedat Hekimsoy
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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6
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Bozzetto L, Polito R, Nigro E, Prinster A, Della Pepa G, Costabile G, Vetrani C, Vitale M, Daniele A, Rivellese AA, Annuzzi G. Dietary influence on adiponectin in patients with type 2 diabetes. Eur J Clin Invest 2021; 51:e13548. [PMID: 33797089 DOI: 10.1111/eci.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Here, we evaluate the effects of a diet rich in low-glycaemic index carbohydrates and fibre (CHO/Fibre diet) or monounsaturated fatty acids (MUFA diet), on fasting and postprandial adiponectin concentrations and their relationship with the beneficial effects of the experimental diets on postprandial glucose metabolism and liver fat in type 2 diabetes (T2D). METHODS Fasting and postprandial adiponectin plasma concentrations were measured before and after dietary interventions in the participants to a randomized controlled trial (NCT01025856), wherein 37 men and 8 women with T2D, aged 35-70 years, followed a CHO/Fibre diet or a MUFA diet for an 8-week period. Hepatic fat content by 1 H NMR and fasting and postprandial plasma glucose and insulin measurements were also available. RESULTS Fasting adiponectin plasma levels did not change after both diets. Postprandial adiponectin significantly increased after the CHO/fibre diet (9.9 ± 1.6 μg/mL vs. 10.8 ± 2.3 μg/mL; P = .033) but not after the MUFA diet (10.6 ± 1.8 μg/mL vs. 10.6 ± 1.6 μg/mL; P = .935) with a significant difference between changes (P = .035). In the combined CHO/Fibre and MUFA groups, fasting and postprandial adiponectin significantly and inversely correlated with postprandial insulin iAUC at baseline and after intervention, and with liver fat content after intervention. CONCLUSIONS A diet rich in CHO/Fibre increased postprandial plasma adiponectin significantly more than a MUFA diet in patients with T2D. Independently of diet, adiponectin levels associated with postprandial insulin concentrations. The dietary interventions modulated the relationship between adiponectin and liver fat.
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Affiliation(s)
- Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rita Polito
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - Ersilia Nigro
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Scienze e Tecnologie Ambientali, Biologiche, Farmaceutiche, Università della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Anna Prinster
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Aurora Daniele
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Scienze e Tecnologie Ambientali, Biologiche, Farmaceutiche, Università della Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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7
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Rosqvist F, Rydell A, Iggman D. The Effects of Foods on Blood Lipids in Non-alcoholic Fatty Liver Disease (NAFLD)-A Systematic Review and Meta-Analysis. Front Nutr 2021; 7:613221. [PMID: 33392241 PMCID: PMC7772219 DOI: 10.3389/fnut.2020.613221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is associated with dyslipidemia and increased cardiovascular disease risk. Dietary choices may produce profound effects on blood lipids. Thus, the purpose of this study was to investigate which foods modify blood lipids in NAFLD. Methods: Systematic review of published systematic reviews and randomized controlled trials (RCTs). Searches were performed in PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from inception through March 2020. Studies in populations with NAFLD, which provided data on foods or dietary patterns and blood lipids were included, but not weight loss diets, supplements, nor individual nutrients. The strength of evidence was evaluated using The Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: No relevant systematic reviews were identified. Eleven RCTs were included in the qualitative synthesis. Two RCTs were included in meta-analyses, regarding the comparison between Mediterranean and Low-fat diets, in which there were no clear effects on either high-density lipoprotein cholesterol or triglycerides, with Low evidence. From single RCTs, there was Moderate evidence for reduced triglycerides by a healthy dietary pattern, compared with usual care; and for reduced total cholesterol by a probiotic yogurt, enriched with Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12, compared with conventional yogurt. For all other comparisons, the evidence was considered as Low or Very low. Conclusion: Few studies were identified which reported effects of foods on blood lipids in subjects with NAFLD. The possible beneficial effect of probiotics warrants further study. PROSPERO identifier: CRD42020178927.
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Affiliation(s)
- Fredrik Rosqvist
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Rydell
- Norslund-Svärdsjö Academic Health Care Center, Center for Clinical Research Dalarna, Falun, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden
| | - David Iggman
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Norslund-Svärdsjö Academic Health Care Center, Center for Clinical Research Dalarna, Falun, Sweden
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8
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Bozzetto L, Della Pepa G, Vetrani C, Rivellese AA. Dietary Impact on Postprandial Lipemia. Front Endocrinol (Lausanne) 2020; 11:337. [PMID: 32733374 PMCID: PMC7358426 DOI: 10.3389/fendo.2020.00337] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
Abnormalities in postprandial lipemia (PPL), particularly those related to triglyceride-rich lipoproteins, are considered an independent cardiovascular risk factor. As diet is known to be one of the main modulators of PPL, the aim of this review was to summarize and discuss current knowledge on the impact of diet and its components on PPL in humans; specifically, the impact of weight loss, different nutrients (quantity and quality of dietary fats, carbohydrates, and proteins), alcohol and other bioactive dietary components (i.e., polyphenols), as well as the effect of different dietary patterns. The possible mechanisms behind the metabolic effects of each dietary component were also discussed.
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9
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Kolovou GD, Watts GF, Mikhailidis DP, Pérez-Martínez P, Mora S, Bilianou H, Panotopoulos G, Katsiki N, Ooi TC, Lopez-Miranda J, Tybjærg-Hansen A, Tentolouris N, Nordestgaard BG. Postprandial Hypertriglyceridaemia Revisited in the Era of Non-Fasting Lipid Profile Testing: A 2019 Expert Panel Statement, Narrative Review. Curr Vasc Pharmacol 2019; 17:515-537. [DOI: 10.2174/1570161117666190503123911] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/01/2019] [Accepted: 04/11/2019] [Indexed: 12/17/2022]
Abstract
Postprandial hypertriglyceridaemia, defined as an increase in plasma triglyceride-containing
lipoproteins following a fat meal, is a potential risk predictor of atherosclerotic cardiovascular disease
and other chronic diseases. Several non-modifiable factors (genetics, age, sex and menopausal status)
and lifestyle factors (diet, physical activity, smoking status, obesity, alcohol and medication use) may
influence postprandial hypertriglyceridaemia. This narrative review considers the studies published over
the last decade that evaluated postprandial hypertriglyceridaemia. Additionally, the genetic determinants
of postprandial plasma triglyceride levels, the types of meals for studying postprandial triglyceride response,
and underlying conditions (e.g. familial dyslipidaemias, diabetes mellitus, metabolic syndrome,
non-alcoholic fatty liver and chronic kidney disease) that are associated with postprandial hypertriglyceridaemia
are reviewed; therapeutic aspects are also considered.
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Affiliation(s)
- Genovefa D. Kolovou
- Cardiology Department and LDL-Apheresis Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Gerald F. Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Australia
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - Pablo Pérez-Martínez
- Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Helen Bilianou
- Department of Cardiology, Tzanio Hospital, Piraeus, Greece
| | | | - Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology-Metabolism, Diabetes Center, AHEPA University Hospital, Thessaloniki, Greece
| | - Teik C. Ooi
- Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - José Lopez-Miranda
- Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Desmarchelier C, Borel P, Lairon D, Maraninchi M, Valéro R. Effect of Nutrient and Micronutrient Intake on Chylomicron Production and Postprandial Lipemia. Nutrients 2019; 11:E1299. [PMID: 31181761 PMCID: PMC6627366 DOI: 10.3390/nu11061299] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 01/02/2023] Open
Abstract
Postprandial lipemia, which is one of the main characteristics of the atherogenic dyslipidemia with fasting plasma hypertriglyceridemia, low high-density lipoprotein cholesterol and an increase of small and dense low-density lipoproteins is now considered a causal risk factor for atherosclerotic cardiovascular disease and all-cause mortality. Postprandial lipemia, which is mainly related to the increase in chylomicron production, is frequently elevated in individuals at high cardiovascular risk such as obese or overweight patients, type 2 diabetic patients and subjects with a metabolic syndrome who share an insulin resistant state. It is now well known that chylomicron production and thus postprandial lipemia is highly regulated by many factors such as endogenous factors: circulating factors such as hormones or free fatty acids, genetic variants, circadian rhythms, or exogenous factors: food components, dietary supplements and prescription drugs. In this review, we focused on the effect of nutrients, micronutrients and phytochemicals but also on food structure on chylomicron production and postprandial lipemia.
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Affiliation(s)
- Charles Desmarchelier
- Faculty of Medicine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, C2VN (Center for Cardiovascular and Nutrition Research), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INSERM, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INRA, 27 Boulevard Jean Moulin, 13385 Marseille, France.
| | - Patrick Borel
- Faculty of Medicine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, C2VN (Center for Cardiovascular and Nutrition Research), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INSERM, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INRA, 27 Boulevard Jean Moulin, 13385 Marseille, France.
| | - Denis Lairon
- Faculty of Medicine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, C2VN (Center for Cardiovascular and Nutrition Research), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INSERM, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INRA, 27 Boulevard Jean Moulin, 13385 Marseille, France.
| | - Marie Maraninchi
- Faculty of Medicine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, C2VN (Center for Cardiovascular and Nutrition Research), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INSERM, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INRA, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- CHU Conception, APHM (Assistance Publique-Hôpitaux de Marseille), 147 Boulevard Baille, 13005 Marseille, France.
| | - René Valéro
- Faculty of Medicine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, C2VN (Center for Cardiovascular and Nutrition Research), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INSERM, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Faculty of Medicine, INRA, 27 Boulevard Jean Moulin, 13385 Marseille, France.
- CHU Conception, APHM (Assistance Publique-Hôpitaux de Marseille), 147 Boulevard Baille, 13005 Marseille, France.
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11
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Bozzetto L, Alderisio A, Clemente G, Giorgini M, Barone F, Griffo E, Costabile G, Vetrani C, Cipriano P, Giacco A, Riccardi G, Rivellese AA, Annuzzi G. Gastrointestinal effects of extra-virgin olive oil associated with lower postprandial glycemia in type 1 diabetes. Clin Nutr 2018; 38:2645-2651. [PMID: 30567626 DOI: 10.1016/j.clnu.2018.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/21/2018] [Accepted: 11/25/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the possible mechanisms behind the lower glycemic response observed when extra-virgin olive oil (EVOO) is added to a high-glycemic index meal in patients with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS According to a randomized cross-over design, eleven T1D patients (6 women, 5 men) on insulin pump consumed in the metabolic ward, one week apart, three high-glycemic index meals differing only for amount and quality of fat: high-monounsaturated fat (EVOO), high-saturated fat (Butter), and low-fat (LF). Before and after the meals, blood glucose (continuous glucose monitoring), gastric emptying rate (ultrasound technique), and plasma concentrations of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide GIP (ELISA), glucagon (RIA), and lipids (colorimetric assays) were evaluated. RESULTS Blood glucose iAUC (mmol/lx360 min) was lower after the EVOO (690 ± 431) than after the Butter (1320 ± 600) and LF meals (1007 ± 990) (M ± SD, p = 0.041 by repeated measures ANOVA). Gastric antrum volume was significantly larger in the early (60-90 min) postprandial phase (106 ± 21 vs. 90 ± 16 ml, p = 0.048) and significantly smaller in the late phase (330-360 min) (46 ± 10 vs. 57 ± 22 ml, p = 0.045) after the EVOO than after Butter meal. EVOO significantly increased postprandial GLP-1 iAUC (261 ± 311) compared to Butter (189 ± 349) (pmol/Lx180 min, p = 0.009). Postprandial GIP and glucagon responses were not significantly different between EVOO and Butter. Postprandial triglyceride iAUC was significantly higher after EVOO (100 ± 53) than after Butter (65 ± 60) (mmol/l × 360 min, p = 0.048). CONCLUSIONS Changes in gastric emptying and GLP-1 secretion and reduced glucose absorption through glucose-lipid competition may contribute to lower glycemia after a high-glycemic index meal with EVOO in T1D patients. CLINICAL TRIALS NUMBER NCT02330939.
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Affiliation(s)
- Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Alderisio
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gennaro Clemente
- Institute for Research on Population and Social Policies (IRPPS), National Research Council, Fisciano, SA, Italy
| | - Marisa Giorgini
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesca Barone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ettore Griffo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paola Cipriano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Angela Giacco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
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12
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Hornstrup T, Løwenstein FT, Larsen MA, Helge EW, Póvoas S, Helge JW, Nielsen JJ, Fristrup B, Andersen JL, Gliemann L, Nybo L, Krustrup P. Cardiovascular, muscular, and skeletal adaptations to recreational team handball training: a randomized controlled trial with young adult untrained men. Eur J Appl Physiol 2018; 119:561-573. [PMID: 30474740 DOI: 10.1007/s00421-018-4034-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/07/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE The prevalence of lifestyle diseases has escalated, and effective exercise training programmes are warranted. This study tested the hypothesis that regular participation in small-sided team handball training could provide beneficial health effects on cardiovascular, skeletal, and muscular parameters in young adult untrained men. METHOD Twenty-six untrained 20-30-year-old men were randomly allocated to either a team handball training group (HG; n = 14), which completed 1.9 ± 0.3 training sessions per week over 12 weeks, or an inactive control group (CG; n = 12). Physiological training adaptations were assessed pre- and post interventions by DXA scans, blood samples, muscle biopsies, and physical tests. RESULTS The average heart rate during training was equivalent to 84 ± 4% of maximal heart rate. Compared to CG, HG displayed significant increases in VO2max (11 ± 6%), proximal femur bone mineral density (2 ± 1%), whole-body bone mineral content (2 ± 1%), intermittent endurance performance (32 ± 16%), incremental treadmill test performance (16 ± 7%) and muscle citrate synthase activity (22 ± 28%) as well as decreases in total fat mass (7 ± 7%) and total fat percentage (6 ± 7%) (all p < 0.05). There were no significant changes in muscle mass, blood pressure, resting heart rate, muscle hydroxyl-acyl-dehydrogenase activity, or blood lipids (all p > 0.05). CONCLUSION Participation in regular recreational team handball training was associated with positive cardiovascular, skeletal, and muscular adaptations, including increased maximal oxygen uptake, increased muscle enzymatic activity, and improved bone mineralization as well as lower fat percentage. These findings suggest that recreational team handball training may be an effective health-promoting activity for young adult men.
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Affiliation(s)
- Therese Hornstrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark.
| | - F T Løwenstein
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - M A Larsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - E W Helge
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - S Póvoas
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, 4475-690, Maia, Portugal
| | - J W Helge
- Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - J J Nielsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - B Fristrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - J L Andersen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, 2400, Copenhagen NV, Denmark
| | - L Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - L Nybo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - P Krustrup
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, 5230, Odense, Denmark
- Sport and Health Sciences, Faculty of Life and Environmental Sciences, University of Exeter, Exeter, EX1 2LU, UK
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13
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Bozzetto L, Costabile G, Della Pepa G, Ciciola P, Vetrani C, Vitale M, Rivellese AA, Annuzzi G. Dietary Fibre as a Unifying Remedy for the Whole Spectrum of Obesity-Associated Cardiovascular Risk. Nutrients 2018; 10:E943. [PMID: 30037123 PMCID: PMC6073249 DOI: 10.3390/nu10070943] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 02/07/2023] Open
Abstract
Obesity is a pandemic carrying the heavy burden of multiple and serious co-morbidities including metabolic syndrome, type 2 diabetes and cardiovascular diseases. The pathophysiological processes leading to the accumulation of body fat slowly evolve to fat accumulation in other body compartments than subcutaneous tissue. This abnormal fat deposition determines insulin resistance which in turn causes blood glucose and lipid metabolism derangement, non-alcoholic fatty liver disease, hypertension, and metabolic syndrome. All these conditions contribute to increase the cardiovascular risk of obese people. Several randomized clinical trials demonstrated that moderate weight loss (5⁻10%) in obese patients improves obesity-related metabolic risk factors and coexisting disorders. Therefore, nutritional strategies able to facilitate weight management, and in the meantime positively influence obesity-associated cardiovascular risk factors, should be implemented. To this aim, a suitable option could be dietary fibres that may also act independently of weight loss. The present narrative review summarizes the current evidence about the effects of dietary fibres on weight management in obese people. Moreover, all of the different cardiovascular risk factors are individually considered and evidence on cardiovascular outcomes is summarized. We also describe the plausible mechanisms by which different dietary fibres could modulate cardio-metabolic risk factors. Overall, despite both epidemiological and intervention studies on weight loss that show statistically significant but negligible clinical effects, dietary fibres seem to have a beneficial impact on main pathophysiological pathways involved in cardiovascular risk (i.e., insulin resistance, renin-angiotensin, and sympathetic nervous systems). Although the evidence is not conclusive, this suggests that fibre would be a suitable option to counteract obesity-related cardio-metabolic diseases also independently of weight loss. However, evidence is not consistent for the different risk factors, with clear beneficial effects shown on blood glucose metabolism and Low Density Lipoprotein (LDL) cholesterol while there is fewer, and less consistent data shown on plasma triglyceride and blood pressure. Ascribing the beneficial effect of some foods (i.e., fruits and vegetables) solely to their fibre content requires more investigation on the pathophysiological role of other dietary components, such as polyphenols.
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Affiliation(s)
- Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Paola Ciciola
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
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14
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Hornstrup T, Wikman JM, Fristrup B, Póvoas S, Helge EW, Nielsen SH, Helge JW, Andersen JL, Nybo L, Krustrup P. Fitness and health benefits of team handball training for young untrained women-A cross-disciplinary RCT on physiological adaptations and motivational aspects. JOURNAL OF SPORT AND HEALTH SCIENCE 2018; 7:139-148. [PMID: 30356492 PMCID: PMC6180563 DOI: 10.1016/j.jshs.2017.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/07/2017] [Accepted: 08/19/2017] [Indexed: 05/22/2023]
Abstract
PURPOSE The present study evaluated the effects of regular participation in small-sided team handball training on body composition, osteogenic response, physical performance, and cardiovascular risk factors, as well as well-being and motivation, in young untrained women. METHODS Twenty-eight untrained 20- to 30-year-old women were randomized to a handball training group (HG; n = 14, height 170 ± 5 cm, weight 73 ± 11 kg, VO2peak 37.7 ± 4.1 mL/min/kg) that trained 1.7 ± 0.3 times per week over 12 weeks (70 min 4 v 4 handball sessions) or an inactive control group (CG; n = 14, 169 ± 5 cm, 71 ± 12 kg, 38.1 ± 3.7 mL/min/kg). Physiological and psychological and motivational training adaptations were assessed pre- and post-intervention by dual-energy X-ray Absorptiometry (DXA) scans, blood sampling, physical tests, and questionnaires. RESULTS The average heart rate (HR) over all training sessions was equal to 85% ± 6% HRmax. Between-group intervention effects were observed in favor of HG for muscle mass (2.1%, p = 0.024), proximal femur bone mineral density (0.8%, p = 0.041), Yo-Yo IE1 intermittent endurance test level 1 (IE1) performance (35%, p < 0.001), and incremental treadmill test performance (11.5%, p = 0.003), but not total fat mass (p = 0.176), mean arterial blood pressure (p = 0.328), resting HR (p = 0.219), or blood lipids (p = 0.298-0.854). In CG, no changes were observed in any of the measured physiological variables after the training period. Compared to CG, HG had an increase in intrinsic motivation (p < 0.001) and in the well-being subscale "energy" (p = 0.010). CONCLUSION Participation in regular recreational team handball training organized as small-sided games has marked beneficial effects on physical performance, musculoskeletal fitness, well-being, and motivation in untrained young women.
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Affiliation(s)
- Therese Hornstrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Johan M. Wikman
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Bjørn Fristrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Susana Póvoas
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Maia 4475-690, Portugal
| | - Eva W. Helge
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Signe H. Nielsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Jørn W. Helge
- Center of Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Jesper L. Andersen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen NV 2400, Denmark
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense 3450, Denmark
- Sport and Health Sciences, University of Exeter, Exeter, EX1 2LU, UK
- Corresponding author.
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15
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Cunha AP, Ribeiro AC, Ricardo NM, Oliveira AC, Dávila LS, Cardoso JH, Rodrigues DC, Azeredo HM, Silva LM, Brito ES, Mendes Filho J, Rocha TM, Leal LK, Ricardo NM. Polysaccharides from Caesalpinia ferrea seeds – Chemical characterization and anti-diabetic effects in Wistar rats. Food Hydrocoll 2017. [DOI: 10.1016/j.foodhyd.2016.10.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jung CH, Choi KM. Impact of High-Carbohydrate Diet on Metabolic Parameters in Patients with Type 2 Diabetes. Nutrients 2017; 9:nu9040322. [PMID: 28338608 PMCID: PMC5409661 DOI: 10.3390/nu9040322] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/04/2017] [Accepted: 03/22/2017] [Indexed: 12/19/2022] Open
Abstract
In patients with type 2 diabetes mellitus (T2DM), whether dietary carbohydrates have beneficial or detrimental effects on cardiometabolic risk factors has drawn attention. Although a high-carbohydrate (HC) diet and a low-carbohydrate (LC) diet have gained popularity for several decades, there is scarce review focusing on the effects of HC diet on glucose, lipids and body weight in patients with T2DM. In this review, we examined recently-published literature on the effects of HC diets on metabolic parameters in T2DM. HC diets are at least as effective as LC diets, leading to significant weight loss and a reduction in plasma glucose, HbA1c and low density lipoprotein-cholesterol (LDL-C) levels. The major concern is that HC diets may raise serum triglyceride levels and reduce high density lipoprotein-cholesterol (HDL-C) levels, increasing the risk of cardiovascular disease. However, these untoward effects were not a persistent consequence and may be ameliorated with the consumption of a low glycemic index (GI)/low glycemic load (GL) and high fiber. Carbohydrate intake should be individualized, and low caloric intake remains a crucial factor to improve insulin sensitivity and reduce body weight; however, an HC diet, rich in fiber and with a low GI/GL, may be recommendable in patients with T2DM.
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Affiliation(s)
- Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon Hospital, 170 Jomaru-Ro, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do 420-767, Korea.
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-050, Korea.
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17
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Bozzetto L, Costabile G, Luongo D, Naviglio D, Cicala V, Piantadosi C, Patti L, Cipriano P, Annuzzi G, Rivellese AA. Reduction in liver fat by dietary MUFA in type 2 diabetes is helped by enhanced hepatic fat oxidation. Diabetologia 2016; 59:2697-2701. [PMID: 27650287 DOI: 10.1007/s00125-016-4110-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate hepatic lipid metabolic processes possibly involved in the reduction of liver fat content (LF) observed in patients with type 2 diabetes after an isoenergetic diet enriched in monounsaturated fatty acids (MUFAs). METHODS This is an ancillary analysis of a published study. In a parallel-group design, 30 men and eight women, aged 35-70 years, with type 2 diabetes and whose blood glucose was controlled satisfactorily (HbA1c < 7.5% [58 mmol/mol]) by diet or diet plus metformin, were randomised by MINIM software to follow either a high-carbohydrate/high-fibre/low-glycaemic index diet (CHO/fibre diet, n = 20) or a high-MUFA diet (MUFA diet, n = 18) for 8 weeks. The assigned diets were known for the participants and blinded for people doing measurements. Before and after intervention, LF was measured by 1H-MRS (primary outcome) and indirect indices of de novo lipogenesis (DNL) (serum triacylglycerol palmitic:linoleic acid ratio), stearoyl-CoA desaturase activity (SCD-1) (serum triacylglycerol palmitoleic:palmitic acid ratio) and hepatic β-oxidation of fatty acids (β-hydroxybutyrate plasma concentrations) were measured. RESULTS LF was reduced by 30% after the MUFA diet, as already reported. Postprandial β-hydroxybutyrate incremental AUC (iAUC) was significantly less suppressed after the MUFA diet (n = 16) (-2504 ± 4488 μmol/l × 360 min vs baseline -9021 ± 6489 μmol/l × 360 min) while it was unchanged after the CHO/fibre diet (n = 17) (-8168 ± 9827 μmol/l × 360 min vs baseline -7206 ± 10,005 μmol/l × 360 min, p = 0.962) (mean ± SD, p = 0.043). In the participants assigned to the MUFA diet, the change in postprandial β-hydroxybutyrate iAUC was inversely associated with the change in LF (r = -0.642, p = 0.010). DNL and SCD-1 indirect indices did not change significantly after either of the dietary interventions. CONCLUSIONS/INTERPRETATION Postprandial hepatic oxidation of fatty acids is a metabolic process possibly involved in the reduction of LF by a MUFA-rich diet in patients with type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT01025856 FUNDING : The study was funded by Ministero Istruzione Università e Ricerca and Italian Minister of Health.
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Affiliation(s)
- Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Delia Luongo
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Daniele Naviglio
- Department of Chemical Science, Federico II University, Naples, Italy
| | - Valentina Cicala
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Chiara Piantadosi
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Lidia Patti
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Paola Cipriano
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy
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18
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Karimi G, Azadbakht L, Haghighatdoost F, Esmaillzadeh A. Low energy density diet, weight loss maintenance, and risk of cardiovascular disease following a recent weight reduction program: A randomized control trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:32. [PMID: 27904578 PMCID: PMC5122107 DOI: 10.4103/1735-1995.181992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/13/2015] [Accepted: 03/08/2016] [Indexed: 02/07/2023]
Abstract
Background: Little is known about the effects of a low energy dense diet on weight maintenance and cardiovascular risks following a recent weight reduction. Therefore, we assessed if weight maintenance, lipid profiles, and glycemic control differ between low energy density (LED) diet and usual diet consumers following a recent weight reduction. Materials and Methods: In this randomized controlled clinical trial study in a parallel design, we recruited 70 patients with the history of weight reduction in the recent 1 year. LED diet contained 30% fat, 15% protein, and 55% carbohydrate was administered to the test group, and a usual diet including 35% fat, 15% protein, and 50% carbohydrate was prescribed to the control group for 7 months. Dietary intake was assessed by using 3 days food records. Biochemical markers and anthropometric measures were done according to the standard protocol. Results: Weight reduced in LED diet consumers compared to usual diet consumers (−0.3 ± 0.2 vs. 1.3 ± 0.4%, P = 0.002). The results was the same regarding waist circumference (−0.4 ± 0.2 vs. 0.3 ± 0.1%, P = 0.004). Fasting blood sugar also decreased in LED diet group (−9.5 ± 0.8 vs. 0.4 ± 1.0%, P = 0.0001). LED diet group had a drop in percent change of their total cholesterol (−0.4 ± 0.5 vs. 2.05 ± 0.4%, P = 0.04) and low-density lipoprotein-cholesterol (4.8 ± 0.9 vs. −0.3 ± 0.9%, P = 0.002). Conclusion: Our findings confirmed beneficial effects of LED diet on attenuating weight regain in subjects with history of recent weight reduction. It might be derived from higher consumption of fruits, vegetables, and fiber among LED diet than usual diet consumers.
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Affiliation(s)
- Golgis Karimi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangore, Malaysia
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition and Dietetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Nutrition and Dietetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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19
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Lopes LL, Peluzio MDCG, Hermsdorff HHM. Ingestão de ácidos graxos monoinsaturados e metabolismo lipídico. J Vasc Bras 2016. [DOI: 10.1590/1677-5449.008515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Resumo Esta revisão teve como objetivo apresentar e discutir os achados mais recentes do efeito dos ácidos graxos monoinsaturados (AGMI) sobre marcadores plasmáticos do metabolismo lipídico em estudos pós-prandiais e de intervenção clínica nutricional. Realizou-se busca em diferentes bases de dados entre 2010 e 2014, usando os seguintes termos de indexação: MUFA, Lipemia, Lipid Metabolism, Triglycerides e Postprandial. O consumo de refeição com alto conteúdo de AGMI tem demonstrado efeito benéfico na resposta lipidêmica pós-prandial, mas se essa resposta pode ser alterada em indivíduos com excesso de peso e/ou outras doenças crônicas após consumo de AGMI, ainda não está totalmente elucidado. De modo geral, após a intervenção com AGMI, os fatores de risco cardiovascular diminuíram, além de haver melhora no perfil lipídico. Em conclusão, os estudos recentes têm demonstrado um efeito benéfico do consumo de AGMI em curto e longo prazos, mediante aumento/manutenção das concentrações de HDL colesterol e diminuição do LDL colesterol.
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20
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Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, Chordiya P, Dhakal S, Hartling L, Nuspl M, Featherstone R, Dryden DM. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Ann Intern Med 2015; 163:848-60. [PMID: 26414227 DOI: 10.7326/m15-1400] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs. PURPOSE To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. DATA SOURCES 6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists. STUDY SELECTION Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs. DATA EXTRACTION One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias. DATA SYNTHESIS Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants). LIMITATIONS All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions. CONCLUSION Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).
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Affiliation(s)
- Jennifer Pillay
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Marni J. Armstrong
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Lois E. Donovan
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Ronald J. Sigal
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Ben Vandermeer
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Pritam Chordiya
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Sanjaya Dhakal
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Lisa Hartling
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Megan Nuspl
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Robin Featherstone
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Donna M. Dryden
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
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21
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Maraki MI, Sidossis LS. Physiology in Medicine: update on lifestyle determinants of postprandial triacylglycerolemia with emphasis on the Mediterranean lifestyle. Am J Physiol Endocrinol Metab 2015; 309:E440-9. [PMID: 26152767 DOI: 10.1152/ajpendo.00245.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
This review updates the effect of lifestyle on plasma triacylglycerols (TAG) in the postprandial state, commonly reported as postprandial lipemia (PPL), an independent risk factor for cardiovascular diseases (CVD). Numerous studies have shown that Mediterranean diet may reduce PPL. However, most of these studies were focused on the type of fat (i.e., monounsaturated fat from olive oil), and the other components of the Mediterranean lifestyle were neglected. Physical activity, an integral part of this lifestyle, is widely investigated on its own and shown to reduce PPL. In addition, preliminary results of studies examining other Mediterranean "ingredients", such as legumes, fish, and herbs, showed additional benefits; however, data on the long-term effects are limited. More studies are needed to confirm short-term results and investigate the effects of the whole Mediterranean lifestyle on PPL and whether these effects mediate its protective role on CVD. Moreover, investigation of the effects in nonhealthy populations and the underlying mechanisms would be clinically helpful in individualizing the appropriate intervention.
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Affiliation(s)
- Maria I Maraki
- Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; and
| | - Labros S Sidossis
- Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; and Metabolism Unit, Shriners Hospital for Children, Departments of Internal Medicine and Surgery, University of Texas Medical Branch at Galveston, Texas
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22
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de Sousa MV, Fukui R, Krustrup P, Pereira RMR, Silva PRS, Rodrigues AC, de Andrade JL, Hernandez AJ, da Silva MER. Positive effects of football on fitness, lipid profile, and insulin resistance in Brazilian patients with type 2 diabetes. Scand J Med Sci Sports 2015; 24 Suppl 1:57-65. [PMID: 24944132 DOI: 10.1111/sms.12258] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/19/2022]
Abstract
We evaluated the effects of recreational football training combined with calorie-restricted diet (football + diet) vs calorie-restricted diet alone (diet) on aerobic fitness, lipid profile, and insulin resistance indicators in type 2 diabetes (T2D) patients. Forty-four T2D patients aged 48-68 years (27 females, 17 males) were randomly allocated to the football + diet group (FDG; n = 22) or to the diet group (DG; n = 22), of whom 19 FDG and 15 DG subjects completed the study. The football training was performed for 3 × 40 min/week for 12 weeks. Dual-energy X-ray absorptiometry scanning, treadmill testing, and fasting blood samplings were performed pre and post-intervention. After 12 weeks, maximal oxygen uptake (VO₂max ) was elevated (P < 0.05) by 10 ± 4% in FDG but not in DG (-3 ± 4%, P < 0.05). After 12 weeks, reductions in blood triglycerides (0.4 ± 0.1 mmol/L), total cholesterol (0.6 ± 0.2 mmol/L), low-density lipoprotein, and very low-density lipoprotein levels were observed only in FDG. Fat mass decreased (P < 0.05) by 3.4 ± 0.4 kg in FDG and 3.7 ± 0.4 kg in DG. The lower (P < 0.05) glucagon and homeostatic model assessment of insulin resistance indicated an improvement in insulin sensitivity in FDG. In conclusion, football combined with restricted diet was effective in enhancing VO₂max , reducing total cholesterol and triglycerides, and increasing insulin sensitivity, potentially providing better tools for the prevention of T2D complications than diet alone.
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Affiliation(s)
- M V de Sousa
- Laboratory of Medical Investigation, LIM-18, Endocrinology Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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23
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Annuzzi G, Rivellese AA, Bozzetto L, Riccardi G. The results of Look AHEAD do not row against the implementation of lifestyle changes in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2014; 24:4-9. [PMID: 24388434 DOI: 10.1016/j.numecd.2013.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 11/29/2013] [Accepted: 12/13/2013] [Indexed: 12/13/2022]
Abstract
The Look AHEAD trial, evaluating the effects of weight loss on cardiovascular (CV) morbidity and mortality in overweight/obese people with type 2 diabetes (T2D), was interrupted after a median 9.5-year follow-up because the incidence of CV events was not different between the Intensive Lifestyle Intervention (ILI) and the control groups, and unlikely to statistically change thereafter. This made health providers and patients wondering about clinical value of diet and physical exercise in diabetic patients. Many factors may have made difficult to ascertain benefits of lifestyle intervention, besides the lower than predicted CV event rates. Among others, LDL-cholesterol was lowered more, with a higher use of statins, in the control group. Anyhow, ILI significantly improved numerous health conditions, including quality of life, CV risk factors and blood glucose control, with more diabetes remissions and less use of insulin. The intervention aimed at weight loss by reducing fat calories, and using meal replacements and, eventually, orlistat, likely underemphasizing dietary composition. There is suggestive evidence, in fact, that qualitative changes in dietary composition aiming at higher consumption of foods rich in fiber and with a high vegetable/animal fat ratio favorably influence CV risk in T2D patients. In conclusion, the Look AHEAD showed substantial health benefits of lifestyle modifications. Prevention of CV events may need higher attention to dietary composition, contributing to stricter control of CV risk factors. As a better health-related quality of life in people with diabetes is an important driver of our clinical decisions, efforts on early implementation of behavioral changes through a multifactorial approach are strongly justified.
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Affiliation(s)
- G Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy.
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy
| | - L Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy
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