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Malin SK, Frick H, Wisseman WS, Edwards ES, Edwards DA, Emerson SR, Kurti SP. β-Cell function during a high-fat meal in young versus old adults: role of exercise. Am J Physiol Regul Integr Comp Physiol 2023; 325:R164-R171. [PMID: 37306399 PMCID: PMC10393366 DOI: 10.1152/ajpregu.00047.2023] [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: 02/21/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
The acute effect of exercise on β-cell function during a high-fat meal (HFM) in young adults (YA) versus old adults (OA) is unclear. In this randomized crossover trial, YA (n = 5 M/7 F, 23.3 ± 3.9 yr) and OA (n = 8 M/4 F, 67.7 ± 6.0 yr) underwent a 180-min HFM (12 kcal/kg body wt; 57% fat, 37% CHO) after a rest or exercise [∼65% heart rate peak (HRpeak)] condition ∼12 h earlier. After an overnight fast, plasma lipids, glucose, insulin, and free fatty acid (FFA) were determined to estimate peripheral, or skeletal muscle, insulin sensitivity (Matsuda index) as well as hepatic [homeostatic model assessment of insulin resistance (HOMA-IR)] and adipose insulin resistance (adipose-IR). β-Cell function was derived from C-peptide and defined as early-phase (0-30 min) and total-phase (0-180 min) disposition index [DI, glucose-stimulated insulin secretion (GSIS) adjusted for insulin sensitivity/resistance]. Hepatic insulin extraction (HIE), body composition [dual-energy X-ray absorptiometry (DXA)], and peak oxygen consumption (V̇o2peak) were also assessed. OA had higher total cholesterol (TC), LDL, HIE, and DI across organs as well as lower adipose-IR (all, P < 0.05) and V̇o2peak (P = 0.056) despite similar body composition and glucose tolerance. Exercise lowered early-phase TC and LDL in OA versus YA (P < 0.05). However, C-peptide area under the curve (AUC), total phase GSIS, and adipose-IR were reduced postexercise in YA versus OA (P < 0.05). Skeletal muscle DI increased in YA and OA after exercise (P < 0.05), whereas adipose DI tended to decline in OA (P = 0.06 and P = 0.08). Exercise-induced skeletal muscle insulin sensitivity (r = -0.44, P = 0.02) and total-phase DI (r = -0.65, P = 0.005) correlated with reduced glucose AUC180min. Together, exercise improved skeletal muscle insulin sensitivity/DI in relation to glucose tolerance in YA and OA, but only raised adipose-IR and reduced adipose-DI in OA.NEW & NOTEWORTHY High-fat diets may induce β-cell dysfunction. This study compared how young and older adults responded to a high-fat meal with regard to β-cell function and whether exercise comparably impacted glucose regulation. Older adults secreted more insulin during the high-fat meal than younger adults. Although exercise increased β-cell function adjusted for skeletal muscle insulin sensitivity in relation to glucose tolerance, it raised adipose insulin resistance and reduced pancreatic β-cell function relative to adipose tissue in older adults. Additional work is needed to discern nutrient-exercise interactions across age to mitigate chronic disease risk.
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Affiliation(s)
- Steven K Malin
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, United States
| | - Hannah Frick
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
- Department of Kinesiology, Morrison Bruce Center, James Madison University, Harrisonburg, Virginia, United States
| | - William S Wisseman
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
| | - Elizabeth S Edwards
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
- Department of Kinesiology, Morrison Bruce Center, James Madison University, Harrisonburg, Virginia, United States
| | - David A Edwards
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, United States
| | - Sam R Emerson
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Stephanie P Kurti
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
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Pan B, Ge L, Xun YQ, Chen YJ, Gao CY, Han X, Zuo LQ, Shan HQ, Yang KH, Ding GW, Tian JH. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act 2018; 15:72. [PMID: 30045740 PMCID: PMC6060544 DOI: 10.1186/s12966-018-0703-3] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted a network meta-analysis to assess the comparative impact of different exercise training modalities on glycemic control, cardiovascular risk factors, and weight loss in patients with T2DM. METHODS We searched five electronic databases to identify randomized controlled trials (RCTs) that compared the differences between different exercise training modalities for patients with T2DM. The risk of bias in the included RCTs was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate mean difference the ratio of the mean and absolute risk differences. Data were analyzed using R-3.4.0. RESULTS A total of 37 studies with 2208 patients with T2DM were included in our study. Both supervised aerobic and supervised resistance exercises showed a significant reduction in HbA1c compared to no exercise (0.30% lower, 0.30% lower, respectively), however, there was a less reduction when compared to combined exercise (0.17% higher, 0.23% higher). Supervised aerobic also presented more significant improvement than no exercise in fasting plasma glucose (9.38 mg/dl lower), total cholesterol (20.24 mg/dl lower), triacylglycerol (19.34 mg/dl lower), and low-density lipoprotein cholesterol (11.88 mg/dl lower). Supervised resistance showed more benefit than no exercise in improving systolic blood pressure (3.90 mmHg lower]) and total cholesterol (22.08 mg/dl lower]. In addition, supervised aerobic exercise was more powerful in improving HbA1c and weight loss than unsupervised aerobic (HbA1c: 0.60% lower; weight loss: 5.02 kg lower) and unsupervised resistance (HbA1c: 0.53% lower) exercises. CONCLUSION Compared with either supervised aerobic or supervised resistance exercise alone, combined exercise showed more pronounced improvement in HbA1c levels; however, there was a less marked improvement in some cardiovascular risk factors. In terms of weight loss, there were no significant differences among the combined, supervised aerobic, and supervised resistance exercises. TRIAL REGISTRATION Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .
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Affiliation(s)
- Bei Pan
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Long Ge
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
- The First Clinical Medical College, Lanzhou University, Lanzhou, 730000 China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province China
| | - Yang-qin Xun
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province China
| | - Ya-jing Chen
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Cai-yun Gao
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Xue Han
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Li-qian Zuo
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Hou-qian Shan
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Ke-hu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province China
| | - Guo-wu Ding
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Jin-hui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province China
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Teeman CS, Kurti SP, Cull BJ, Emerson SR, Haub MD, Rosenkranz SK. Postprandial lipemic and inflammatory responses to high-fat meals: a review of the roles of acute and chronic exercise. Nutr Metab (Lond) 2016; 13:80. [PMID: 27891165 PMCID: PMC5112627 DOI: 10.1186/s12986-016-0142-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022] Open
Abstract
Postprandial lipemia is an independent risk factor for development of cardiovascular disease. Postprandial inflammation following the prolonged elevation of triglycerides occurring subsequent to ingestion of high-fat meals, provides a likely explanation for increased disease risk. Substantial evidence has shown that acute exercise is an effective modality for attenuation of postprandial lipemia following a high-fat meal. However, much of the evidence pertaining to exercise intensity, duration, and overall energy expenditure for reducing postprandial lipemia is inconsistent. The effects of these different exercise variables on postprandial inflammation is largely unknown. Long-term, frequent exercise, however, appears to effectively reduce systemic inflammation, especially in at-risk or diseased individuals. With regard to an acute postprandial response, without a recent bout of exercise, high levels of chronic exercise do not appear to reduce postprandial lipemia. This review summarizes the current literature on postprandial and inflammatory responses to high-fat meals, and the roles that both acute and chronic exercise play. This review may be valuable for health professionals who wish to provide evidence-based, pragmatic advice for reducing postprandial lipemia and cardiovascular disease risk for their patients. A brief review of proposed mechanisms explaining how high-fat meals may result in pro-inflammatory and pro-atherosclerotic environments is also included.
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Affiliation(s)
- Colby S. Teeman
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 212 Justin Hall, 1324 Lovers Lane, 66506 Manhattan, KS USA
- Physical Activity and Nutrition-Clinical Research Consortium (PAN-CRC), College of Human Ecology, Kansas State University, 1105 Sunset Ave, 66502 Manhattan, KS USA
| | - Stephanie P. Kurti
- Department of Kinesiology, Kansas State University, 1A Natatorium, 920 Denison Ave, 66506 Manhattan, KS USA
- Physical Activity and Nutrition-Clinical Research Consortium (PAN-CRC), College of Human Ecology, Kansas State University, 1105 Sunset Ave, 66502 Manhattan, KS USA
| | - Brooke J. Cull
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 212 Justin Hall, 1324 Lovers Lane, 66506 Manhattan, KS USA
- Physical Activity and Nutrition-Clinical Research Consortium (PAN-CRC), College of Human Ecology, Kansas State University, 1105 Sunset Ave, 66502 Manhattan, KS USA
| | - Sam R. Emerson
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 212 Justin Hall, 1324 Lovers Lane, 66506 Manhattan, KS USA
- Physical Activity and Nutrition-Clinical Research Consortium (PAN-CRC), College of Human Ecology, Kansas State University, 1105 Sunset Ave, 66502 Manhattan, KS USA
| | - Mark D. Haub
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 212 Justin Hall, 1324 Lovers Lane, 66506 Manhattan, KS USA
- Physical Activity and Nutrition-Clinical Research Consortium (PAN-CRC), College of Human Ecology, Kansas State University, 1105 Sunset Ave, 66502 Manhattan, KS USA
| | - Sara K. Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 212 Justin Hall, 1324 Lovers Lane, 66506 Manhattan, KS USA
- Physical Activity and Nutrition-Clinical Research Consortium (PAN-CRC), College of Human Ecology, Kansas State University, 1105 Sunset Ave, 66502 Manhattan, KS USA
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Dadgostar H, Firouzinezhad S, Ansari M, Younespour S, Mahmoudpour A, Khamseh ME. Supervised group-exercise therapy versus home-based exercise therapy: Their effects on Quality of Life and cardiovascular risk factors in women with type 2 diabetes. Diabetes Metab Syndr 2016; 10:S30-S36. [PMID: 26822461 DOI: 10.1016/j.dsx.2016.01.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/09/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Exercise is an integral part of diabetes care. In Iranian women with type II diabetes, we compared the effects of supervised group exercise therapy with the effects of home-based exercise therapy on health-related quality of life (HRQOL), anthropometric parameters, glycaemic control and lipid profile. MATERIALS AND METHODS One hundred and two diabetic women were randomised to supervised and home-based groups. METHODS Over 12 weeks, participants received supervised group-exercise therapy or a home-based exercise-therapy program. During the intervention, they were assessed three times: at baseline, and at weeks 6 and 12. Generalized Estimating Equation models were used to examine the associations between the type of exercise-therapy program and changes over time in anthropometric and biochemical outcomes, and in HRQOL scales of SF36 questionnaire. RESULTS Relative to home-based group, supervised group improved significantly regarding role-physical, general health, mean body weight and body mass index from baseline to week 12 (p=0.01). Their reduction in mean body-fat mass from baseline to week 6 (p=0.04) was greater. Similarly, their role-physical, general health and role-emotional improved significantly during the intervention (p<0.05). From baseline to the twelfth week, the HbA1c level fell significantly (p<0.05) in both groups. CONCLUSIONS Supervised group-exercise therapy was more effective than home-based exercise therapy in improving HRQOL and body composition in diabetic women. However, home-based exercise therapy also produced significant improvements in glycaemic control, body composition and lipid profile. Whether in a supervised or home-based setting, the exercise intervention can therefore be effective in improving health outcomes in diabetic patients.
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Affiliation(s)
- Haleh Dadgostar
- Minimally Invasive Surgery Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Sports Medicine Department, Rasoul-e-Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Firouzinezhad
- Sports Medicine Department, Rasoul-e-Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Majid Ansari
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Head of Rehabilitation Medicine, Noorafshar Sports Medicine and Rehabilitation Hospital, Tehran, Iran
| | - Shima Younespour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Mahmoudpour
- Sc Corrective Exercise & Sports Injuries: Energy Sports & Medicine Group, Iran
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center (Firouzgar Hospital), Iran University of Medical Sciences, Tehran, Iran
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Abstract
Cardiovascular disease is a major cause of morbidity and mortality in patients with type 2 diabetes mellitus, with a two- to fourfold increase in cardiovascular disease risk compared with non-diabetic individuals. Abnormalities in lipid metabolism that are observed in the context of type 2 diabetes are among the major factors contributing to an increased cardiovascular risk. Diabetic dyslipidaemia includes not only quantitative lipoprotein abnormalities, but also qualitative and kinetic abnormalities that, together, result in a shift towards a more atherogenic lipid profile. The primary quantitative lipoprotein abnormalities are increased triacylglycerol (triglyceride) levels and decreased HDL-cholesterol levels. Qualitative lipoprotein abnormalities include an increase in large, very low-density lipoprotein subfraction 1 (VLDL1) and small, dense LDLs, as well as increased triacylglycerol content of LDL and HDL, glycation of apolipoproteins and increased susceptibility of LDL to oxidation. The main kinetic abnormalities are increased VLDL1 production, decreased VLDL catabolism and increased HDL catabolism. In addition, even though LDL-cholesterol levels are typically normal in patients with type 2 diabetes, LDL particles show reduced turnover, which is potentially atherogenic. Although the pathophysiology of diabetic dyslipidaemia is not fully understood, the insulin resistance and relative insulin deficiency observed in patients with type 2 diabetes are likely to contribute to these lipid changes, as insulin plays an important role in regulating lipid metabolism. In addition, some adipocytokines, such as adiponectin or retinol-binding protein 4, may also contribute to the development of dyslipidaemia in patients with type 2 diabetes.
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Affiliation(s)
- Bruno Vergès
- Service Endocrinologie, Diabétologie et Maladies Métaboliques, Hôpital du Bocage, 2 bd Maréchal de Lattre de Tassigny, 21000, Dijon, France,
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Chan DC, Barrett PHR, Watts GF. The metabolic and pharmacologic bases for treating atherogenic dyslipidaemia. Best Pract Res Clin Endocrinol Metab 2014; 28:369-85. [PMID: 24840265 DOI: 10.1016/j.beem.2013.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dyslipoproteinaemia is a cardinal feature of the metabolic syndrome that accelerates atherosclerosis. It is characterized by high plasma concentrations of triglyceride-rich and apolipoprotein (apo) B-containing lipoproteins, with depressed high-density lipoprotein (HDL) and increased small dense low-density lipoprotein (LDL) particle concentrations. Dysregulation of lipoprotein metabolism in the metabolic syndrome may be due to a combination of overproduction of very-low density lipoprotein (VLDL) apoB, decreased catabolism of apoB-containing particles, and increased catabolism of HDL apoA-I particles. These abnormalities are due to a global metabolic effect of insulin resistance and visceral obesity. Lifestyle modifications (dietary restriction and increased exercise) and pharmacological treatments favourably alter lipoprotein transport by decreasing the hepatic secretion of VLDL-apoB and the catabolism of HDL apoA-I, as well as by increasing the clearance of LDL-apoB. The safety and tolerability of combination drug therapy based on statins is important and merits further investigation. There are several pipeline therapies for correcting triglyceride-rich lipoprotein and HDL metabolism. However, their clinical efficacy, safety and cost-effectiveness remain to be demonstrated.
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Affiliation(s)
- Dick C Chan
- Metabolic Research Centre, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - P Hugh R Barrett
- Metabolic Research Centre, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Faculty of Engineering, Computing and Mathematics, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Metabolic Research Centre, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia.
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Kadoglou NPE, Fotiadis G, Athanasiadou Z, Vitta I, Lampropoulos S, Vrabas IS. The effects of resistance training on ApoB/ApoA-I ratio, Lp(a) and inflammatory markers in patients with type 2 diabetes. Endocrine 2012; 42:561-9. [PMID: 22407494 DOI: 10.1007/s12020-012-9650-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/28/2012] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the effects of resistance training (RT) on novel cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). We enrolled 52 overweight/obese, type 2 diabetic patients, with inadequate glycemic control (HbA1c > 6.5 %), but without overt diabetic vascular complications. Participants were randomly assigned into two equivalent groups (n = 26): (1) Resistance exercise group: subjects underwent a supervised RT program (3-times/week, 60 min/session, 2-3 sets of 8 machine-weight exercises, 60-80 % of one-repetition maximum). (2) Control group (CG): at study entrance, they received a structured exercise counseling to increase daily physical activity. Clinical parameters, cardiorespiratory capacity, glycemic and lipid profile, apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), Lipoprotein(a) [Lp(a)], insulin resistance (HOMA-IR), high-sensitivity CRP (hsCRP), fibrinogen were measured before and after 3 months. RT significantly reduced glycemic indexes, insulin resistance and systolic blood pressure, compared to CG (p < 0.05). Moreover, exercise-treated patients conferred a remarkable downregulation in ApoB levels (from 135.92 ± 30.97 mg/dL to 85.9 ± 26.46 mg/dL, p < 0.001) as compared to CG (from 126.33 ± 36.59 mg/dL to 116.23 ± 27.52 mg/dL, p = 0.872) (p < 0.001). Similarly, ApoB/ApoA-I ratio was considerably decreased in REG rather than CG (-0.32 ± 0.09 vs 0.02 ± 0.01, p < 0.001). Notably, ApoA-I, Lp(a), hsCRP, fibrinogen, the rest of lipid parameters, body weight and exercise capacity remained unaltered in both groups (p > 0.05). Among variables, HOMA-IR reduction was found to be an independent predictor of changes in ApoB/ApoA-I ratio (R (2) = 0.406, p = 0.041) in REG. Long-term RT ameliorated glycemic control, insulin sensitivity and ApoB/ApoA-I ratio in individuals with T2DM. Although we did not observe significant benefits in the rest of cardiovascular risk factors, our results indicate a merely beneficial impact of RT.
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Affiliation(s)
- Nikolaos P E Kadoglou
- Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Ag Ioannis, 62110, Serres, Greece.
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Chan DC, Watts GF. Dyslipidaemia in the metabolic syndrome and type 2 diabetes: pathogenesis, priorities, pharmacotherapies. Expert Opin Pharmacother 2010; 12:13-30. [PMID: 20629587 DOI: 10.1517/14656566.2010.502529] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE OF THE FIELD Dyslipoproteinaemia is a cardinal feature of the metabolic syndrome that accelerates atherosclerosis. It is usually characterized by high plasma concentrations of triglyceride-rich and apolipoprotein B (apoB)-containing lipoproteins, with depressed concentrations of high-density lipoprotein (HDL). Drug interventions are essential for normalizing metabolic dyslipidaemia. AREAS COVERED IN THIS REVIEW This review discusses the mechanisms and treatment for dyslipidaemia in the metabolic syndrome and type 2 diabetes. WHAT THE READER WILL GAIN A comprehensive understanding of the pathophysiology and pharmacotherapy of dyslipidaemia in the metabolic syndrome and diabetes. TAKE HOME MESSAGE Dysregulation of lipoprotein metabolism may be due to a combination of overproduction of triglyceride-rich lipoproteins, decreased catabolism of apoB-containing particles, and increased catabolism of HDL particles. These abnormalities may be consequent on a global metabolic effect of insulin resistance and an excess of both visceral and hepatic fat. Lifestyle modifications may favourably alter lipoprotein transport in the metabolic syndrome. Patients with dyslipidaemia and established cardiovascular disease should receive a statin as first-line therapy. Combination with other lipid-regulating agents, such as ezetimibe, fibrates, niacins and fish oils may optimize the benefit of statin on atherogenic dyslipidaemia.
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Affiliation(s)
- Dick C Chan
- University of Western Australia, Metabolic Research Centre, School of Medicine and Pharmacology, GPO Box X2213, Perth, WA 6847, Australia.
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Chan DC, Watts GF. Nutrition and metabolism: new studies of the effects of diets and exercise on lipid and lipoprotein metabolism. Curr Opin Lipidol 2010; 21:91-2. [PMID: 20101120 DOI: 10.1097/mol.0b013e32833537b5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Structured exercise is considered an important cornerstone to achieve good glycemic control and improve cardiovascular risk profile in Type 2 diabetes. Current clinical guidelines acknowledge the therapeutic strength of exercise intervention. This paper reviews the wide pathophysiological problems associated with Type 2 diabetes and discusses the benefits of exercise therapy on phenotype characteristics, glycemic control and cardiovascular risk profile in Type 2 diabetes patients. Based on the currently available literature, it is concluded that Type 2 diabetes patients should be stimulated to participate in specifically designed exercise intervention programs. More attention should be paid to cardiovascular and musculoskeletal deconditioning as well as motivational factors to improve long-term treatment adherence and clinical efficacy. More clinical research is warranted to establish the efficacy of exercise intervention in a more differentiated approach for Type 2 diabetes subpopulations within different stages of the disease and various levels of co-morbidity.
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Affiliation(s)
- Stephan F E Praet
- Department of Rehabilitation Medicine, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands.
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Therapeutic regulation of apoB100 metabolism in insulin resistance in vivo. Pharmacol Ther 2009; 123:281-91. [DOI: 10.1016/j.pharmthera.2009.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 04/16/2009] [Indexed: 11/16/2022]
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Abstract
Effects and mechanisms of a single bout of physical load and of the regular exercise (training) on the carbohydrate and fat metabolism are reviewed. During exercise and in the following couple of hours sugar utilization improves, "activity functions like insulin". Proper exercise contributes to using up the fat reserves, and slimmer body, fat reduction can be maintained by the combination of exercise and diet-control. Instructions in "exercise for everybody" and particularly for both type diabetics are detailed. In prevention of cardio-metabolic pathologies the most important measure were avoiding the overweight state by rational alimentation and regular physical activity.
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Affiliation(s)
- Péter Apor
- Semmelweis Egyetem Testnevelés- és Sporttudományi Kar Budapest Czakó u. 9. 1016
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