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Arsenault BJ, Carpentier AC, Poirier P, Després JP. Adiposity, type 2 diabetes and atherosclerotic cardiovascular disease risk: Use and abuse of the body mass index. Atherosclerosis 2024; 394:117546. [PMID: 38692978 DOI: 10.1016/j.atherosclerosis.2024.117546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
The worldwide prevalence of individuals with an elevated body weight has increased steadily over the past five decades. Billions of research dollars have been invested to improve our understanding of the causes and consequences of having an elevated body weight. All this knowledge has, however, failed to influence populational body weight trajectories of most countries around the world. Research on the definition of "obesity" has also evolved. Body mass index (BMI), the most commonly used tool to make its diagnosis, has major limitations. In this review article, we will highlight evidence from observational studies, genetic association studies and randomized clinical trials that have shown the remarkable inter-individual differences in the way humans store energy as body fat. Increasing evidence also suggests that, as opposed to weight inclusive, lifestyle-based approaches, weight-centric approaches advising people to simply eat less and move more are not sustainable for most people for long-term weight loss and maintenance. It is time to recognize that this outdated approach may have produced more harm than good. On the basis of pathophysiological, genetic and clinical evidence presented in this review, we propose that it may be time to shift away from the traditional clinical approach, which is BMI-centric. Rather, emphasis should be placed on actionable lifestyle-related risk factors aiming at improving overall diet quality and increasing physical activity level in the general population.
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Affiliation(s)
- Benoit J Arsenault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec (QC), Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec (QC), Canada
| | - André C Carpentier
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke (QC), Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec (QC), Canada; Faculté de pharmacie, Université Laval, Québec (QC), Canada
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec (QC), Canada; VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Québec (QC), Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec (QC), Canada.
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Murphy-Després A, Chartrand DJ, Lemieux I, Tremblay A, Bergeron J, Poirier P, Alméras N, Després JP. Long-Term Improvement in Cardiorespiratory Fitness Ameliorates Insulin Sensitivity beyond Changes in Visceral/Ectopic Fat among Men with Visceral Obesity. Nutrients 2024; 16:1377. [PMID: 38732623 PMCID: PMC11085477 DOI: 10.3390/nu16091377] [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: 03/18/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
The SYNERGIE study documented the effects on cardiometabolic risk (CMR) indices of a 1-year lifestyle intervention targeting physical activity (PA) and diet followed by a 2-year maintenance period in men with visceral obesity. Improvements in CMR markers and a decrease in low-attenuation muscle (LAM) area were observed after 1 year. Despite a rebound in visceral adipose tissue (VAT) during the maintenance period, insulin resistance (IR) improved. We tested the hypothesis that variations in cardiorespiratory fitness (CRF) and LAM could explain the long-term improvement in IR. A health (n = 88; mean age 49.0 ± 8.2 years) and fitness (n = 72) evaluation was performed at 0, 1, and 3 years. Participants were classified into two groups based on their CRF response over the maintenance period (worsening: CRF- vs. maintenance/improvement: CRF+). During the maintenance period, changes in the psoas and core LAM areas correlated with changes in IR (r = 0.27; p < 0.05 and r = 0.34; p < 0.005) and changes in CRF (r = -0.31; p < 0.01 and r = -0.30; p < 0.05). IR improved in the CRF+ group (p < 0.05) but remained stable in the CRF- group. Men in the CRF+ group regained half of the changes in VAT volume and LAM at the psoas and mid-thigh compared to the CRF- group (p < 0.05). These results support the importance of targeting VAT and CRF/PA for the long-term management of CMR in men with visceral obesity.
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Affiliation(s)
- Adrien Murphy-Després
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Dominic J. Chartrand
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Isabelle Lemieux
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
| | - Angelo Tremblay
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Jean Bergeron
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1V 4G2, Canada
| | - Paul Poirier
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
- Faculty of Pharmacy, Université Laval, Québec, QC G1V 0A6, Canada
| | - Natalie Alméras
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Jean-Pierre Després
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, QC G1V 4G5, Canada; (A.M.-D.); (D.J.C.); (I.L.); (A.T.); (P.P.); (N.A.)
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- VITAM—Centre de Recherche en Santé Durable, CIUSSS de la Capitale-Nationale, Québec, QC G1J 2G1, Canada
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Relationships between circulating 25(OH) vitamin D, leptin levels and visceral adipose tissue volume: results from a 1-year lifestyle intervention program in men with visceral obesity. Int J Obes (Lond) 2019. [DOI: 10.1038/s41366-019-0347-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Carter S, Lemieux I, Li Z, Alméras N, Tremblay A, Bergeron J, Poirier P, Després JP, Picard F. Changes in IGFBP-2 levels following a one-year lifestyle modification program are independently related to improvements in plasma apo B and LDL apo B levels. Atherosclerosis 2018; 281:89-97. [PMID: 30658196 DOI: 10.1016/j.atherosclerosis.2018.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/31/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Recent transversal studies have associated insulin-like growth factor binding protein (IGFBP)-2 levels with glucose tolerance and parameters of the lipoprotein-lipid profile. Here, we aimed at determining the longitudinal effects of a one-year lifestyle modification program on IGFBP-2 levels and to identify specific metabolic improvements impacted by the changes in IGFBP-2. METHODS 99 middle-aged Caucasian men were involved in a lifestyle modification program consisting in personalized healthy eating and physical activity counseling, combined to elicit a daily 500 kcal deficit. Anthropometric and metabolic parameters as well as circulating IGFBP-2 levels were measured before and after one year of the lifestyle modification program. RESULTS The intervention triggered positive changes in many metabolic parameters and a 43% (p < 0.0001) increase of IGFBP-2 levels. Subjects with the most substantial increases in IGFBP-2 also experienced the most important metabolic improvements. Changes in IGFBP-2 levels (both absolute and relative) were correlated with markers of body fat distribution and lipoprotein-lipid profile, and independently associated with changes in LDL apolipoprotein (apo) B but not VLDL apo B concentrations. Further analyses showed that for similar changes in BMI, waist circumference and visceral adipose tissue volume, large changes in IGFBP-2 levels were required to observe improvements in LDL apo B levels. CONCLUSIONS The 1-year lifestyle modification program was associated with increased IGFBP-2 concentrations. Increases in IGFBP-2 levels were closely associated with reduced LDL apo B concentrations and independently of the modifications in fat mass and insulin sensitivity. Further mechanistic studies are required to assess the effects of IGFBP-2 levels on LDL metabolism.
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Affiliation(s)
- Sophie Carter
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Isabelle Lemieux
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada
| | - Zhuo Li
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada
| | - Natalie Alméras
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Angelo Tremblay
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Jean Bergeron
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Frédéric Picard
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, Québec, QC, Canada.
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Álvarez C, Ramírez-Vélez R, Ramírez-Campillo R, Ito S, Celis-Morales C, García-Hermoso A, Rodriguez-Mañas L, Lucia A, Izquierdo M. Interindividual responses to different exercise stimuli among insulin-resistant women. Scand J Med Sci Sports 2018; 28:2052-2065. [DOI: 10.1111/sms.13213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 01/08/2023]
Affiliation(s)
- C. Álvarez
- Department of Physical Activity Sciences; Universidad de Los Lagos; Osorno Chile
| | - R. Ramírez-Vélez
- School of Medicine and Health Sciences; Center for the Study of Physical Activity Measurement (CEMA); Universidad del Rosario; Bogotá Colombia
| | - R. Ramírez-Campillo
- Research Nucleus in Health; Physical Activity and Sports; Universidad de Los Lagos; Osorno Chile
| | - S. Ito
- Division of Cardiology; Sankuro Hospital; Toyota Japan
| | - C. Celis-Morales
- Centro de Investigación en Fisiología del Ejercicio (CIFE); Universidad Mayor; Santiago Chile
| | - A. García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud; Facultad de Ciencias Médicas; Universidad de Santiago de Chile, USACH; Santiago Chile
| | - L. Rodriguez-Mañas
- Division of Geriatric Medicine; University Hospital of Getafe; Madrid Spain
| | - A. Lucia
- Faculty of Sports Sciences; Universidad Europea de Madrid; Madrid Spain
| | - M. Izquierdo
- Department of Health Sciences; Public University of Navarre; CIBERFES (CB16/10/00315); Navarre Spain
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Badri NW, Flatt SW, Barkai HS, Pakiz B, Heath DD, Rock CL. Insulin Resistance Improves More in Women than In Men in Association with a Weight Loss Intervention. ACTA ACUST UNITED AC 2018; 8. [PMID: 29552423 PMCID: PMC5856149 DOI: 10.4172/2165-7904.1000365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Fasting glucose and homeostatic model assessment-insulin resistance (HOMA-IR) are important measures of the risk for metabolic syndrome and diabetes. Weight loss interventions are considered part of the first line of therapy for those who develop disease states associated with insulin resistance, such as pre-diabetes, diabetes, or metabolic syndrome. Sex differences in insulin resistance have been extensively reported, but sex differences in the ability to improve insulin sensitivity are not well-established. This study sought to identify factors that predict change in HOMA-IR in response to weight loss. Methods Non-diabetic subjects who were overweight/obese (n=100) were randomly assigned to a walnut-enriched reduced-energy diet or a standard reduced-energy-density diet in a 6-month weight loss intervention. There were no significant differences in weight change, glucose, insulin, or HOMA-IR between the two diet groups. These subjects were combined into a single cohort and analyzed with multivariate analysis. Results The combined groups lost an average of 8.7 kg (p<0.0001), decreased serum glucose by an average 0.2 mmol/L (p<0.001), and decreased HOMA-IR by an average of 1.4 (p<0.0001). Change in HOMA-IR (R2=0.69) was positively associated with weight change (p<0.0001) and male sex (p<0.01), and negatively associated with baseline HOMA-IR (p<0.0001). Conclusion Findings from this study suggest that men may have a more difficult time improving insulin sensitivity as compared with women with an equivalent weight loss and baseline HOMA-IR. One hypothesis to explain the differences across sexes may be due to sex differences in visceral adipose fat (VAT). This may mean that insulin resistant men require more aggressive intervention than women to prevent progression to metabolic syndrome or diabetes.
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Affiliation(s)
- N W Badri
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - S W Flatt
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - H S Barkai
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - B Pakiz
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - D D Heath
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C L Rock
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
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Liver Enzymes and the Development of Posttransplantation Diabetes Mellitus in Renal Transplant Recipients. Transplant Direct 2017; 3:e208. [PMID: 28894795 PMCID: PMC5585424 DOI: 10.1097/txd.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Posttransplantation diabetes mellitus (PTDM) is common in renal transplant recipients (RTR), increasing the risk of graft failure, cardiovascular disease, and mortality. Early detection of a high risk for PTDM is warranted. Because liver function and liver fat are involved, we investigated whether serum liver markers are associated with future PTDM in RTR. METHODS Between 2001 and 2003, 606 RTR with a functioning allograft beyond the first year after transplantation were included of which 500 participants (56% men; age, 50 ± 12 years) were free of diabetes at baseline and had liver enzyme values (1 missing) available. Serum concentrations of alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase were measured at baseline at 6.0 (6.2-11.5) years posttransplantation. PTDM cases were recorded until April 2012. RESULTS During median follow-up for 9.6 years (interquartile range [IQR], 6.2-10.2) beyond baseline, 76 (15.2%) patients developed PTDM. Comparing the highest to the lower tertiles, higher liver enzyme activities were significantly related to incident PTDM for ALT (hazard ratio [HR], 2.22; IQR, 1.42-3.48), for GGT (HR, 2.93; IQR, 1.87-4.61), and for alkaline phosphatase (HR, 1.78; IQR, 1.13-2.80). The associations of ALT and GGT with development of PTDM were independent of potential confounders and risk factors, including age, sex, renal function, medication use, lifestyle factors, adiposity, presence of the metabolic syndrome, fasting glucose, HbA1c, proinsulin, and cytomegalovirus status. CONCLUSIONS Markers for liver function and liver fat in the subclinical range are potential markers for future PTDM, independent of other known risk factors. This may allow for early detection and management of PTDM development.
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Kujawska-Łuczak M, Musialik K, Szulińska M, Swora-Cwynar E, Kargulewicz A, Grzymisławska M, Pupek-Musialik D, Bogdański P. The effect of orlistat versus metformin on body composition and insulin resistance in obese premenopausal women: 3-month randomized prospective open-label study. Arch Med Sci 2017; 13:725-731. [PMID: 28721138 PMCID: PMC5510517 DOI: 10.5114/aoms.2016.62014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 06/19/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Our aim was to evaluate the effects of metformin and orlistat on body composition and glucose-insulin homeostasis in obese premenopausal women. MATERIAL AND METHODS Seventy-three obese premenopausal Caucasian women aged 32.4 ±8.3 years were treated with either metformin (1000 mg/day; n = 37) or orlistat (360 mg/day; n = 36). Anthropometric parameters were measured using dual-energy X-ray absorptiometry. Glucose tolerance, using the oral glucose tolerance test; insulin resistance, using the homeostasis model assessment (HOMA-IR); and insulin sensitivity, using the Matsuda insulin sensitivity index (ISI Matsuda), were assessed at the commencement of the study and after 3 months. RESULTS Those treated with orlistat showed greater weight loss (-9.4 ±2.3 vs. -4.9 ±1.3 kg, p < 0.05) and decrease of fat mass (-5.4 ±3.0 vs. -3.5 ±0.7 kg, p < 0.05) than those treated with metformin. The percentage of android and gynoid fat deposits was reduced in both groups; however, a greater decrease in android fat was observed in those treated with metformin. Improvement in ISI Matsuda and post-load insulin were similar in both groups. High initial post-load insulin and low ISI Matsuda corresponded with reductions in total fat, trunk fat, and waist circumference in both groups, and a decrease in android fat in those treated with metformin. CONCLUSIONS Orlistat treatment resulted in greater weight loss and improvement in body composition; metformin treatment resulted in a reduction of android fat. Both drugs produced a comparable improvement in insulin/glucose homeostasis. Overall, insulin-resistant women showed improvement with treatment, irrespective of which drug was used.
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Affiliation(s)
- Magdalena Kujawska-Łuczak
- Department of Internal Medicine, Metabolic Disorders, and Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Musialik
- Department of Education and Obesity Treatment and Metabolic Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Szulińska
- Department of Education and Obesity Treatment and Metabolic Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewelina Swora-Cwynar
- Department of Internal Medicine, Metabolic Disorders and Dietetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Angelina Kargulewicz
- Department of Internal Medicine, Metabolic Disorders and Dietetics, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Danuta Pupek-Musialik
- Department of Internal Medicine, Metabolic Disorders, and Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Bogdański
- Department of Education and Obesity Treatment and Metabolic Disorders, Poznan University of Medical Sciences, Poznan, Poland
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Borel AL, Nazare JA, Baillot A, Alméras N, Tremblay A, Bergeron J, Poirier P, Després JP. Cardiometabolic risk improvement in response to a 3-yr lifestyle modification program in men: contribution of improved cardiorespiratory fitness vs. weight loss. Am J Physiol Endocrinol Metab 2017; 312:E273-E281. [PMID: 28028035 DOI: 10.1152/ajpendo.00278.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/06/2016] [Accepted: 12/27/2016] [Indexed: 12/16/2022]
Abstract
Our objective was to examine the respective contributions of changes in visceral adiposity, subcutaneous adiposity, liver fat, and cardiorespiratory fitness (CRF) to the improvements in cardiometabolic risk markers in response to a 3-yr healthy eating/physical activity lifestyle intervention. Ninety-four out of 144 viscerally obese healthy men completed a 3-yr lifestyle intervention. Body weight, body composition, and fat distribution were assessed by anthropometry and DEXA/computed tomography. CRF, adipokines, lipoprotein/lipid profile, and 75 g of oral glucose tolerance were assessed. CRF and visceral and subcutaneous adiposity significantly improved over the 3-yr intervention, with a nadir in year 1 and a partial regain in year 3 Liver fat (estimated by insulin hepatic extraction) stabilized from year 1 to year 3, whereas HOMA-IR, ISI-Matsuda index, and adiponectin continued to improve. Multivariate analysis revealed that both visceral adiposity and estimated liver fat reductions contributed to the improved ISI-Matsuda index observed over 3 yr (r2 = 0.28, P < 0.001). Three-year changes in fat mass and CRF were independently associated with changes in visceral fat (adjusted r2 = 0.40, P < 0.001), whereas only changes in CRF were associated with changes in estimated liver fat (adjusted r2 = 0.18, P < 0.001). A long-term (3 yr) healthy eating/physical activity intervention in men improves several cardiometabolic risk markers over the long term (3 yr) despite a partial body weight regain observed between year 1 and year 3 The improvement in CRF contributes to visceral and estimated liver fat losses over the long term, which in turn explain the benefits of the lifestyle intervention on cardiometabolic risk profile.
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Affiliation(s)
- Anne-Laure Borel
- Grenoble Alpes University Hospital, Endocrinology Department, Grenoble, France
- Grenoble Alpes University, Hypoxia Physiopathology (HP2), Laboratory Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France
| | - Julie-Anne Nazare
- Centre de Recherche en Nutrition Humaine Rhône-Alpes, Centre Européen de Nutrition pour la Santé, Cardiovasculaire, Métabolisme, Diabétologie et Nutrition INSERM U1060 U060, University of Lyon, Lyon, France
| | - Aurélie Baillot
- Nursing Department, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Natalie Alméras
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Angelo Tremblay
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Jean Bergeron
- Endocrinology and Nephrology Unit, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada; and
| | - Paul Poirier
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | - Jean-Pierre Després
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada;
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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Ji B, Qu H, Wang H, Wei H, Deng H. Association Between the Visceral Adiposity Index and Homeostatic Model Assessment of Insulin Resistance in Participants With Normal Waist Circumference. Angiology 2016; 68:716-721. [PMID: 28743220 DOI: 10.1177/0003319716682120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We assessed the correlation between the visceral adiposity index (VAI; a useful indicator of adipose distribution and function) and homeostatic model assessment of insulin resistance (HOMA-IR) in participants with normal waist circumference. A cross-sectional study was conducted, which included 1834 Chinese adults. The blood pressure, anthropometric measurements, fasting and postprandial blood glucose, fasting insulin, and lipid profiles were measured. The VAI and HOMA-IR were calculated. Participants were divided into 4 groups according to the HOMA-IR level, and the correlation between the VAI and HOMA-IR was analyzed. The VAI gradually increased across the HOMA-IR quartiles ( P < .05), and a Pearson correlation analysis showed that VAI was positively related to the HOMA-IR ( P < .001) in males and females. After adjusting for the other covariates, VAI was independently correlated with the HOMA-IR. A logistic regression analysis indicated that VAI elevation was the main risk factor for the increased HOMA-IR in both genders. Overall, the VAI was closely correlated with the HOMA-IR in a population without central obesity.
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Affiliation(s)
- Baolan Ji
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Qu
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Wang
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huili Wei
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huacong Deng
- 1 Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Gangloff A, Bergeron J, Lemieux I, Després JP. Changes in circulating vitamin D levels with loss of adipose tissue. Curr Opin Clin Nutr Metab Care 2016; 19:464-470. [PMID: 27537278 DOI: 10.1097/mco.0000000000000315] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Low vitamin D levels have been extensively reported in obesity. Thus, the pandemic of obesity has been paralleled by a high prevalence of low vitamin D status. Given the well documented associations linking poor vitamin D status to adverse health outcomes (diabetes, cardiovascular disease, cancers, all-cause mortality), a proper understanding of the mechanisms linking excess adiposity to low vitamin D status is key to identify and implement effective interventions to replenish vitamin D levels in obese individuals. In this review, we will discuss recent literature investigating the effects of adipose tissue volume loss through energy restriction and/or physical activity on circulating 25-hydroxyvitamin D [25(OH)D] levels. RECENT FINDINGS Improvements of circulating 25(OH)D levels with adiposity loss through lifestyle interventions without supplementation is being reported by a growing number of studies, including recent randomized controlled trials. SUMMARY Low 25(OH)D is one of the metabolic disturbances associated with excess adiposity, particularly visceral adiposity. Recommendations for the treatment of obesity-related vitamin D deficiency should emphasize the role of visceral adiposity loss through healthy lifestyle habits, in conjunction with weight-adjusted vitamin D supplementation, not only to replenish 25(OH)D levels but also to address other visceral adiposity-related disturbances, such as insulin resistance, inflammation, hypertension, and dyslipidemia.
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Affiliation(s)
- Anne Gangloff
- aQuébec Heart and Lung Institute Research Centre bLipid Clinic, CHU de Québec-Université Laval cEndocrinology and Nephrology Unit, CHU de Québec Research Centre dFaculty of Medicine, Department of Kinesiology, Université Laval, Québec City, Québec, Canada
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Leclerc J, Arsenault M, Després JP, Brassard P, Gaudreault V, Bergeron J, Alméras N, Tremblay A, Auclair A, Ross MK, Denault-Bissonnette S, Poirier P. Determinants of Improvement In Left Ventricular Diastolic Function Following a 1-Year Lifestyle Modification Program in Abdominally Obese Men with Features of the Metabolic Syndrome. Metab Syndr Relat Disord 2016; 14:483-491. [PMID: 27754772 DOI: 10.1089/met.2016.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal obesity and presence of the metabolic syndrome (MetS) are associated with cardiac abnormalities. Among those, left ventricular diastolic dysfunction (LVDD) is the most frequently encountered in clinical practice. Few studies evaluated the reversibility of LVDD by an approach promoting lifestyle modifications in abdominally obese subjects with MetS. METHODS We assessed the impact of a 1-year lifestyle modification program combining nutritional and physical activity counseling on LVDD and metabolic profile of abdominally obese men with MetS. Echocardiograms, oral glucose tolerance test, lipids profile, dual energy X-ray absorptiometry, computed tomography scans (visceral obesity assessment), heart rate variability (HRV), as well as maximal and submaximal exercise tests were performed in participants before and after a 1-year program combining healthy eating and a physical activity/exercise program. RESULTS Fifty-one abdominally obese men participated in this study. At baseline, 86% of the participants had LVDD (n = 44). After the 1-year program, LVDD improved in 57% of participants (n = 29, P < 0.0001). All metabolic, adiposity, and exercise tolerance measures improved from baseline (P < 0.0001), but were not associated with improvement in LVDD. Participants who improved LVDD had better exercise performance at baseline. Exercise tolerance during the submaximal exercise test, parasympathetic cardiac autonomic activity, and fasting insulin predicted 50% of LVDD improvements. CONCLUSIONS There was a significant improvement in LVDD after a 1-year lifestyle intervention program in abdominally obese men with MetS, such an improvement being associated with increased exercise tolerance, enhanced HRV, and reduced insulin levels.
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Affiliation(s)
- Jacinthe Leclerc
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Marie Arsenault
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada
| | - Jean-Pierre Després
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Patrice Brassard
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Valérie Gaudreault
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Jean Bergeron
- 3 Faculté de médecine, Université Laval , Québec, Canada .,5 Centre Hospitalier Universitaire de Québec-Université Laval , Québec, Canada
| | - Natalie Alméras
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada
| | - Angelo Tremblay
- 4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Audrey Auclair
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Marie-Kristelle Ross
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada .,6 Centre Hospitalier de Lévis , Québec, Québec, Canada
| | - Stéphanie Denault-Bissonnette
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada .,5 Centre Hospitalier Universitaire de Québec-Université Laval , Québec, Canada
| | - Paul Poirier
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
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Lesser IA, Guenette JA, Hoogbruin A, Mackey DC, Singer J, Gasevic D, Lear SA. Association between exercise-induced change in body composition and change in cardiometabolic risk factors in postmenopausal South Asian women. Appl Physiol Nutr Metab 2016; 41:931-7. [DOI: 10.1139/apnm-2016-0082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The South Asian population suffers from a high prevalence of type 2 diabetes and cardiovascular disease (CVD). A unique obesity phenotype of elevated visceral adipose tissue (VAT) is associated with CVD risk among South Asians. Exercise-induced reduction in VAT and body fat is an effective mechanism to improve cardiometabolic risk factors but this has not been shown in South Asians. Whether exercise-induced changes in measurements such as waist circumference (WC) are independently related to changes in cardiometabolic risk factors in South Asians is unknown. Multi-slice computed tomography scanning was used to assess VAT, cardiometabolic risk factors through a fasting blood sample, and body fat using dual-energy X-ray absorptiometry. Forty- nine postmenopausal South Asian women who participated in two 12-week aerobic exercise programs were included. Bivariate correlations were used to assess associations between change in cardiometabolic risk factors and change in body composition. Regression analyses were conducted with change in glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) as dependent variables and change in body composition as independent variables of interest. There were significant associations between changes in fasting insulin, glucose, and HOMA-IR with change in VAT. The association between change in VAT and these cardiometabolic risk factors was independent of change in other body composition variables of interest. South Asian women should be encouraged to engage in aerobic activity to reduce their risk of type 2 diabetes and CVD, and physicians should be aware of improvements in glucose regulation with exercise training not observed through reductions in WC.
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Affiliation(s)
- Iris A. Lesser
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
| | - Jordan A. Guenette
- Department of Physical Therapy and Centre for Heart Lung Innovation, University of British Columbia and St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Amandah Hoogbruin
- Faculty of Health, Kwantlen Polytechnic University, Surrey, BC V3W 2M8, Canada
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia and St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Danijela Gasevic
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AD, UK
| | - Scott A. Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Division of Cardiology, Providence Health Care, Vancouver, BC V6Z 1Y6, Canada
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Böhm A, Weigert C, Staiger H, Häring HU. Exercise and diabetes: relevance and causes for response variability. Endocrine 2016; 51:390-401. [PMID: 26643313 PMCID: PMC4762932 DOI: 10.1007/s12020-015-0792-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/28/2015] [Indexed: 12/31/2022]
Abstract
Exercise as a key prevention strategy for diabetes and obesity is commonly accepted and recommended throughout the world. Unfortunately, not all individuals profit to the same extent, some exhibit exercise resistance. This phenomenon of non-response to exercise is found for several endpoints, including glucose tolerance and insulin sensitivity. Since these non-responders are of notable quantity, there is the need to understand the underlying mechanisms and to identify predictors of response. This displays the basis to develop personalized training intervention regimes. In this review, we summarize the current knowledge on response variability, with focus on human studies and improvement of glucose homeostasis as outcome.
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Affiliation(s)
- Anja Böhm
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany
| | - Cora Weigert
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany
| | - Harald Staiger
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076, Tübingen, Germany.
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany.
- German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany.
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LÉVESQUE VALÉRIE, VALLIÈRES MAGGIE, POIRIER PAUL, DESPRÉS JEANPIERRE, ALMÉRAS NATALIE. Targeting Abdominal Adiposity and Cardiorespiratory Fitness in the Workplace. Med Sci Sports Exerc 2015; 47:1342-50. [DOI: 10.1249/mss.0000000000000559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Effect of adipose tissue volume loss on circulating 25-hydroxyvitamin D levels: results from a 1-year lifestyle intervention in viscerally obese men. Int J Obes (Lond) 2015; 39:1638-43. [PMID: 26095245 DOI: 10.1038/ijo.2015.118] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 05/21/2015] [Accepted: 06/12/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND/OBJECTIVES Although weight loss has been associated with changes in circulating 25-hydroxyvitamin D (25(OH)D) levels, the quantification of the increase in 25(OH)D levels as a function of adipose tissue volume loss precisely assessed by imaging has not been reported before. The objective of this substudy was to describe the effects of a 1-year lifestyle intervention on plasma 25(OH)D levels. The relationships between changes in 25(OH)D levels and changes in adiposity volume (total and by adipose tissue compartment) were studied. SUBJECTS/METHODS This intervention study was performed between 2004 and 2006 and participants were recruited from the general community. Sedentary, abdominally obese and dyslipidemic men (n=103) were involved in a 1-year lifestyle modification program. Subjects were individually counseled by a kinesiologist and a nutritionist once every 2 weeks during the first 4 months with subsequent monthly visits in order to elicit a 500-kcal daily energy deficit and to increase physical activity/exercise habits. Body weight, body composition and fat distribution were assessed by dual-energy X-ray absorptiometry and computed tomography, whereas the 25(OH)D levels were measured with an automated assay. RESULTS The 1-year intervention resulted in a 26% increase in circulating 25(OH)D (from 48±2 nmol l(-1) or 19±0.8 ng ml(-1) (±s.e.m.) to 58±2 nmol l(-1) or 23±0.8 ng ml(-1), P<0.0001) along with a 26% decrease in visceral adiposity volume (from 1947±458 to 1459±532 cm3). One-year increases in 25(OH)D levels correlated inversely with changes in all adiposity indices, especially Δvisceral (r=-0.36, P<0.0005) and Δtotal abdominal (r=-0.37, P<0.0005) adipose tissue volumes. CONCLUSIONS These results indicate that there is a linear increase in circulating 25(OH)D levels as a function of adiposity volume loss, and therefore suggest a role of adiposity reduction in the management of obesity-associated vitamin D insufficiency.
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Sasakabe T, Haimoto H, Umegaki H, Wakai K. Association of decrease in carbohydrate intake with reduction in abdominal fat during 3-month moderate low-carbohydrate diet among non-obese Japanese patients with type 2 diabetes. Metabolism 2015; 64:618-25. [PMID: 25682064 DOI: 10.1016/j.metabol.2015.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 01/08/2015] [Accepted: 01/23/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The effectiveness of a moderate low-carbohydrate diet (M-LCD) has been demonstrated in terms of glycemic control, body weight and serum lipid profiles. We investigated the effect of a 3-month M-LCD on visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and examined an association between decrease in carbohydrate intake and reduction in abdominal fat among patients with Type 2 diabetes mellitus (T2DM). METHODS Seventy-six patients (45 men and 31 women; mean age ± SD: 59.5 ± 11.1 years) with T2DM were instructed to follow an M-LCD for 3 months. We assessed abdominal fat distribution using computed tomography and macronutrient intakes from 3-day dietary records at baseline and after 3 months. RESULTS The patients complied well with the M-LCD - %carbohydrate: %fat: %protein at baseline and after 3 months were 51:27:15 and 41:33:18 in men and 54:27:16 and 42:37:19 in women, respectively. VAT and SAT significantly decreased during the 3 months (P for time < 0.001 for both). Decrease in carbohydrate intake (g/day) and %carbohydrate were correlated with decrease (%) in VAT. The correlations were significant in men (Spearman correlation coefficient r = 0.469 for carbohydrate intake (g) and r = 0.402 for %carbohydrate) but not in women (r = 0.269 and 0.278, respectively). The correlations in men remained significant in multiple regression analysis adjusted for age and changes in energy intake. CONCLUSIONS In men, decrease in carbohydrate intake was significantly correlated with VAT loss during a 3-month M-LCD, independently of reduction in energy intake.
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Affiliation(s)
- Tae Sasakabe
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Hajime Haimoto
- Department of Internal Medicine, Haimoto Clinic, 1-80 Yayoi-cho, Kasugai, Aichi 486-0838, Japan
| | - Hiroyuki Umegaki
- Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
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Glueck CJ, Wang P, Woo JG, Morrison JA, Khoury PR, Daniels SR. Adolescent and young adult female determinants of visceral adipose tissue at ages 26-28 years. J Pediatr 2015; 166:936-46.e1-3. [PMID: 25641236 DOI: 10.1016/j.jpeds.2014.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/17/2014] [Accepted: 12/12/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess adolescent and young adult determinants of visceral adipose tissue (VAT) at ages 26-28 years. STUDY DESIGN Prospective study (ages 9-28 years) of cardiometabolic measures, menarche age, menses irregularities, metabolic syndrome, impaired fasting glucose-type 2 diabetes mellitus, and VAT in 400 girls (248 black, 152 white). RESULTS Adolescent (age 14-19) independent variables for greater VAT at ages 26-28 included larger mean waist circumference (partial R(2) = 30.8%), earlier age at menarche (0.9%), and white race (1.8%). Young adult (ages 20-28 years) independent variables for greater VAT included larger mean waist circumference (partial R(2) = 61.7%), greater triglyceride levels (3.3%), lower high-density lipoprotein cholesterol (1.0%), and greater insulin resistance (homeostasis model assessment-estimated insulin resistance; 0.4%). Independent variables for greater VAT when both adolescent and young adult variables were used included waist (tertile rank change from adolescence to young adulthood, partial R(2) = 58.3%), greater young adult triglyceride levels (4.4%), white race (1.8%), greater young adult homeostasis model assessment-estimated insulin resistance (age 20-28, 2.4%), and earlier menarche age (0.7%). Menses irregularities were not independently associated with young adult VAT. CONCLUSIONS Adolescent girls with early menarche and larger waist circumference should be targets for primary prevention of accretion of VAT. In young adulthood, VAT is associated with dysregulated cardiometabolic profiles, which is greater for those with waist circumference increases from adolescence to adulthood. Waist circumference during young adulthood, and to a lesser degree during adolescence, is an inexpensive surrogate for VAT at ages 26-28 years.
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Affiliation(s)
- Charles J Glueck
- Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH.
| | - Ping Wang
- Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH
| | - Jessica G Woo
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John A Morrison
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Vinet A, Obert P, Dutheil F, Diagne L, Chapier R, Lesourd B, Courteix D, Walther G. Impact of a lifestyle program on vascular insulin resistance in metabolic syndrome subjects: the RESOLVE study. J Clin Endocrinol Metab 2015; 100:442-50. [PMID: 25353072 DOI: 10.1210/jc.2014-2704] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT AND OBJECTIVE Impaired insulin-dependent vasodilation might contribute to microvascular dysfunction of metabolic syndrome (MetS). The aims of this study were to assess the insulin vasoreactivity in MetS, and to evaluate the effects of a lifestyle program. DESIGN, SETTING, PARTICIPANTS, AND OUTCOME MEASURES: Laser Doppler measurements were used to assess cutaneous blood flux (CBF) and flowmotion in response to iontophoresis of insulin and acetylcholine (ACh) in 38 MetS and 18 controls. Anthropometric, plasma insulin, glycemia, and inflammatory markers were measured. MetS subjects (n = 24) underwent a 6-month lifestyle intervention (M6) with a 3-week residential program (D21). RESULTS The absolute and relative peak insulin and ACh CBF were significantly higher in controls than in MetS subjects. Significant inverse correlations were found between peak insulin CBF and glycemia, insulin and glycated hemoglobin, active plasminogen activator inhibitor-1 (PAI-1), C-reactive protein (CRP), and IL-6. With respect to flowmotion, MetS subjects showed lower values in total spectrum CBF and in all its components (except respiratory one). At D21 and M6, peak insulin CBF increased and was no longer different from control values whereas peak ACh CBF did not change. From D21, all the different components and the total CBF spectrum became similar to the control values. The changes in peak insulin CBF and in endothelial component between M6 and baseline were inversely correlated with the change in CRP and PAI-1. CONCLUSIONS The local vasodilatory effects to insulin and its overall flowmotion are impaired in MetS subjects in relation to inflammation. The lifestyle intervention reversed this insulin-induced vascular dysfunction in parallel to decreased inflammation level.
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Affiliation(s)
- Agnes Vinet
- Avignon University (A.V., P.O., L.D., G.W.), LAPEC EA4278, F-84000 Avignon, France; School of Exercise Science (P.O., F.D., D.C.), Australian Catholic University, Melbourne, 3065 Australia; Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions (F.D., B.L., D.C.), EA3533, F-63000 Clermont-Ferrand, France; University Hospital of Clermont-Ferrand (F.D., B.L.), CHU G. Montpied, F-63000 Clermont-Ferrand, France; and Omental (R.C.)-Thermalia Center, F-63140 Châtelguyon, France
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Lévesque V, Poirier P, Després JP, Alméras N. Assessing and targeting key lifestyle cardiovascular risk factors at the workplace: Effect on hemoglobin A1c levels. Ann Med 2015; 47:605-14. [PMID: 26542534 DOI: 10.3109/07853890.2015.1091943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Despite the key role played by lifestyle habits in the epidemic of type 2 diabetes (T2D), nutritional quality and physical activity are not systematically considered in clinical practice. The project was conducted to verify whether assessing/targeting lifestyle habits could reduce hemoglobin A1c (HbA1c) levels of employees. METHODS The intervention consisted of a 3-month competition among teams of five employees to favor peer-based support in the adoption of healthier lifestyle habits (Eat better, Move more, and Quit smoking) (n = 900). A comprehensive cardiometabolic/cardiorespiratory health assessment was conducted before and after the contest (nutrition/physical activity questionnaires, blood pressure, anthropometric measurements, lipid profile, HbA1c, fitness). HbA1c levels were used to identify individuals with prediabetes (5.7%-6.4%) or T2D (≥6.5%). RESULTS At baseline, 51% of the employees had increased HbA1c levels (≥5.7%). The HbA1c levels were associated with waist circumference, independently of body mass index. Subjects with prediabetes showed a higher waist circumference as well as a more deteriorated cardiometabolic profile compared to workers with normal HbA1c levels. After the intervention, employees with elevated HbA1c significantly reduced their HbA1c levels. CONCLUSION Results suggest that assessing/targeting key lifestyle correlates of the cardiometabolic profile represents a relevant approach to target abdominal obesity and fitness with a significant impact on HbA1c levels.
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Affiliation(s)
- Valérie Lévesque
- a Quebec Heart and Lung Institute , Québec , QC , Canada.,b Department of Kinesiology , Faculty of Medicine, Université Laval , Québec , QC , Canada
| | - Paul Poirier
- a Quebec Heart and Lung Institute , Québec , QC , Canada.,c Faculty of Pharmacy, Université Laval , Québec , QC , Canada
| | - Jean-Pierre Després
- a Quebec Heart and Lung Institute , Québec , QC , Canada.,b Department of Kinesiology , Faculty of Medicine, Université Laval , Québec , QC , Canada
| | - Natalie Alméras
- a Quebec Heart and Lung Institute , Québec , QC , Canada.,b Department of Kinesiology , Faculty of Medicine, Université Laval , Québec , QC , Canada
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Abstract
A clustering of metabolic abnormalities such as dyslipidemia, hypertension, and diabetes mellitus, all of which are major risk factors for cardiovascular disease (CVD), occurs more often than by chance. Numerous epidemiological studies, as well as basic researches, have revealed that visceral fat accumulation is closely involved in this risk clustering. This morbid condition is now well recognized as the metabolic syndrome. The concept of the metabolic syndrome, i.e., the involvement of visceral adiposity in the clustering of CVD risk factors, implies that an effective CVD risk reduction will be accomplished by an intervention to reduce visceral fat deposits. The primary strategy of the intervention is lifestyle modification, which can be put into practice in healthcare fields, without necessity of medical treatment. Now that CVD is a leading global health burden, the metabolic syndrome attracts increasing attention in the world. To take global action against the syndrome, several working groups developed its internationally unified diagnostic criteria. Most recently, the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) jointly proposed the criteria, although some cautions will be needed in their practical use. In this review, we mainly focus on the findings observed in clinical and epidemiological studies, to discuss a practical strategy of the management of the metabolic syndrome in healthcare fields.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Shah RV, Murthy VL, Abbasi SA, Blankstein R, Kwong RY, Goldfine AB, Jerosch-Herold M, Lima JAC, Ding J, Allison MA. Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study. JACC Cardiovasc Imaging 2014; 7:1221-35. [PMID: 25440591 PMCID: PMC4268163 DOI: 10.1016/j.jcmg.2014.07.017] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to evaluate differential effects of visceral fat (VF) and subcutaneous fat and their effects on metabolic syndrome (MetS) risk across body mass index (BMI) categories. BACKGROUND The regional distribution of adipose tissue is an emerging risk factor for cardiometabolic disease, although serial changes in fat distribution have not been extensively investigated. VF and its alterations over time may be a better marker for risk than BMI in normal weight and overweight or obese individuals. METHODS We studied 1,511 individuals in the MESA (Multi-Ethnic Study of Atherosclerosis) with adiposity assessment by computed tomography (CT). A total of 253 participants without MetS at initial scan underwent repeat CT (median interval 3.3 years). We used discrete Cox regression with net reclassification to investigate whether baseline and changes in VF area are associated with MetS. RESULTS Higher VF was associated with cardiometabolic risk and coronary artery calcification, regardless of BMI. After adjustment, VF was more strongly associated with incident MetS than subcutaneous fat regardless of weight, with a 28% greater MetS hazard per 100 cm(2)/m VF area and significant net reclassification (net reclassification index: 0.44, 95% confidence interval [CI]: 0.29 to 0.60) over clinical risk. In individuals with serial imaging, initial VF (hazard ratio: 1.24 per 100 cm(2)/m, 95% CI: 1.08 to 1.44 per 100 cm(2)/m, p = 0.003) and change in VF (hazard ratio: 1.05 per 5% change, 95% CI: 1.01 to 1.08 per 5% change, p = 0.02) were associated with MetS after adjustment. Changes in subcutaneous fat were not associated with incident MetS after adjustment for clinical risk and VF area. CONCLUSIONS VF is modestly associated with BMI. However, across BMI, a single measure of and longitudinal change in VF predict MetS, even accounting for weight changes. Visceral adiposity is essential to assessing cardiometabolic risk, regardless of age, race, or BMI, and may serve as a marker and target of therapy in cardiometabolic disease.
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Affiliation(s)
- Ravi V Shah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Venkatesh L Murthy
- Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology (Nuclear Medicine and Cardiothoracic Imaging Divisions), University of Michigan, Ann Arbor, Michigan.
| | - Siddique A Abbasi
- Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ron Blankstein
- Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raymond Y Kwong
- Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael Jerosch-Herold
- Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - João A C Lima
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Jingzhong Ding
- Department of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Matthew A Allison
- Department of Family and Preventative Medicine, University of California-San Diego, San Diego, California
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Visceral, subcutaneous abdominal adiposity and liver fat content distribution in normal glucose tolerance, impaired fasting glucose and/or impaired glucose tolerance. Int J Obes (Lond) 2014. [DOI: 10.1038/ijo.2014.163] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jankovic A, Korac A, Srdic-Galic B, Buzadzic B, Otasevic V, Stancic A, Vucetic M, Markelic M, Velickovic K, Golic I, Korac B. Differences in the redox status of human visceral and subcutaneous adipose tissues--relationships to obesity and metabolic risk. Metabolism 2014; 63:661-71. [PMID: 24582138 DOI: 10.1016/j.metabol.2014.01.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Metabolic homeostasis depends on adipocyte metabolic responses/processes, most of which are redox-regulated. Besides, visceral and subcutaneous adipose tissues (VAT and SAT, respectively) differ metabolically and in their contribution to metabolic complications, but their redox characteristics in humans are still unknown. To understand the molecular mechanisms of metabolic syndrome development, we analysed the redox characteristics of VAT and SAT in groups with various body weights and metabolic risks. MATERIAL AND METHODS Fifty premenopausal women were classified according to body mass index into normal-weight and obese groups, and these groups were further sub-classified into metabolically healthy and metabolically obese ("at risk") based on the homeostasis model assessment of insulin resistance (HOMA-IR) index and the triglyceride, total-, LDL- and HDL-cholesterol levels. Antioxidant components, NADPH oxidase protein and 4-hydroxynonenal (4-HNE) levels were analysed in VAT and SAT. RESULTS Compared with the SAT, the VAT showed a higher basal level of glutathione (GSH) and GSH-dependent enzyme activities. Compared with the metabolically healthy normal-weight controls, the obese groups of women showed lower GSH levels in both depots. However, in these groups, additional prooxidative changes (increased NADPH oxidase and 4-HNE and decreased levels of SOD and/or CAT) were observed only in VAT. CONCLUSIONS Because of the critical role of thiol-redox homeostasis in lipogenesis, interdepot-differences in the GSH-dependent antioxidant part may be connected to the higher metabolic activity found in VAT. Analogously, the lower GSH levels that occur during obesity and the corresponding additional redox imbalance may be signs of VAT metabolic dysfunction that underlie the subsequent metabolic impairment.
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Affiliation(s)
- Aleksandra Jankovic
- Department of Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 11060 Belgrade, Serbia
| | - Aleksandra Korac
- Center for Electron Microscopy, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia
| | - Biljana Srdic-Galic
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Biljana Buzadzic
- Department of Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 11060 Belgrade, Serbia
| | - Vesna Otasevic
- Department of Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 11060 Belgrade, Serbia
| | - Ana Stancic
- Department of Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 11060 Belgrade, Serbia
| | - Milica Vucetic
- Department of Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 11060 Belgrade, Serbia
| | - Milica Markelic
- Center for Electron Microscopy, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia
| | - Ksenija Velickovic
- Center for Electron Microscopy, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Golic
- Center for Electron Microscopy, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia
| | - Bato Korac
- Department of Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 11060 Belgrade, Serbia.
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Borel AL, Boulet G, Nazare JA, Smith J, Alméras N, Tremblay A, Bergeron J, Poirier P, Carpentier AC, Després JP. Improved plasma FFA/insulin homeostasis is independently associated with improved glucose tolerance after a 1-year lifestyle intervention in viscerally obese men. Diabetes Care 2013; 36:3254-61. [PMID: 23695818 PMCID: PMC3781540 DOI: 10.2337/dc12-2353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Elevated plasma free fatty acids (FFAs) are one important link between excess visceral adiposity, insulin resistance, and the development of type 2 diabetes. Effects of lifestyle interventions on FFA metabolism are poorly known. This open-label study was conducted to test the effects of a 1-year healthy eating/physical activity intervention program on plasma FFA homeostasis in 117 viscerally obese men with dyslipidemia associated with insulin resistance (waist circumference≥90 cm, triglycerides≥1.69 mmol/L, and/or HDL-cholesterol<1.03 mmol/L). RESEARCH DESIGN AND METHODS Body weight, body composition, and fat distribution were assessed by dual-energy X-ray absorptiometry/computed tomography. Oral loads of lipid (60 g fat/m2 body surface area) and glucose (75 g) were measured before and after the intervention. RESULTS After 1 year of lifestyle intervention, visceral adiposity was reduced by -26% (95% CI -29 to -23), whereas cardiorespiratory fitness improved by +20% (95% CI +16 to +24). After 1 year, the suppression of FFAs after the glucose load improved, whereas insulin concentrations were drastically reduced. After the oral lipid load, the late increase in FFA was reduced together with reduced circulating insulin. We calculated an insulin sensitivity index to reflect the concentration of insulin needed to manage plasma FFAs after the oral lipid load, which increased after the intervention and was associated with improved glucose tolerance, independent of changes in visceral or total adiposity. CONCLUSIONS A 1-year healthy eating/physical activity intervention improved the suppression of FFAs after oral glucose and lipid load tests in viscerally obese men, possibly due to improved responsiveness to insulin. This insulin-mediated regulation of postprandial plasma FFA levels could be a link between visceral obesity and impaired glucose homeostasis.
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The severity of nocturnal hypoxia but not abdominal adiposity is associated with insulin resistance in non-obese men with sleep apnea. PLoS One 2013; 8:e71000. [PMID: 23951064 PMCID: PMC3741390 DOI: 10.1371/journal.pone.0071000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/01/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Beyond obesity, sleep apnea syndrome is frequently associated with excess abdominal adiposity that could contribute to the deteriorated cardiometabolic risk profile of apneic patients. METHODS The present study addressed the respective contribution of the severity of sleep apnea syndrome and excess abdominal adiposity to the cardiometabolic risk profile of 38 non obese men with polysomnography-diagnosed sleep apnea syndrome (apnea-hypopnea index >15 events/hour). These otherwise healthy men performed a 75g-oral glucose tolerance test (OGTT) with plasma lipid/inflammatory and redox profiles. Twenty-one apneic men with high-waist circumference (>94 cm) were compared to 17 apneic men with low-waist circumference. RESULTS Apneic men with high-waist circumference had higher AUC glucose and AUC insulin than apneic men with low-waist circumference. Accordingly, apneic men with high-waist circumference had higher hepatic insulin resistance as reflected by higher HOMA-resistance index, and lower global insulin sensitivity as reflected by lower insulin sensitivity index of Matsuda (derived from OGTT). The sleep structure and the apnea-hypopnea index were not different between the two groups. However, apneic men with high-waist circumference presented with lower mean nocturnal oxyhemoglobin (SpO2). In the 38 men, waist circumference and mean nocturnal SpO2 were inversely correlated (r = -0.43, p = 0.011) and were both associated with plasma glucose/insulin homeostasis indices: the higher the waist circumference, the lower the mean nocturnal SpO2, the lower the insulin-sensitivity. Finally, in multivariable regression model, mean nocturnal SpO2 and not waist circumference was associated with insulin-resistance. CONCLUSION Thus, excess abdominal adiposity in non obese apneic men was associated with a deteriorated insulin-sensitivity that could be driven by a more severe nocturnal hypoxemia.
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Nazare JA, Smith J, Borel AL, Alméras N, Tremblay A, Bergeron J, Poirier P, Després JP. Changes in both global diet quality and physical activity level synergistically reduce visceral adiposity in men with features of metabolic syndrome. J Nutr 2013; 143:1074-83. [PMID: 23719226 DOI: 10.3945/jn.113.175273] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
With regard to the beneficial impact of lifestyle interventions on weight and abdominal obesity management, our objective was to identify which components of a lifestyle-intervention program [physical activity (PA), energy and macronutrient intake, diet quality] had an influence on visceral adipose tissue (VAT) loss. The present lifestyle intervention targeted a daily energy deficit (500 kcal), coupled with a PA program (160 min/wk). From the 144 participants initially recruited, 93 viscerally obese men (age: 49 ± 1 y; waist circumference: 108 ± 9 cm; plasma triglyceride concentration: 2.46 ± 0.09 mmol/L) who completed a 3-d dietary journal both at baseline and after 1 y of intervention and a daily PA journal for 1 y were considered in the present analyses. Body composition and fat distribution were assessed by using dual-energy X-ray absorptiometry and computed tomography. After 1 y, abdominally obese men significantly improved their diet quality, as assessed by the Dietary Approaches to Stop Hypertension (DASH)-derived diet quality (DQ) score (P < 0.0001). Improved DQ and higher levels of PA were both independently and significantly associated with reductions in body weight, fat mass, VAT, and thigh muscle fat content, beyond reported energy intake or diet macronutrient composition. When stratified according to the level of PA and DQ [PA- (low PA), DQ- (low DQ), PA+ (high PA), DQ+ (high DQ)], the PA+/DQ+ group showed reductions in VAT that were 20% greater than in the PA-/DQ+ group, 28% greater than in the PA+/DQ- group, and 50% (P < 0.05) greater than in the PA-/DQ- group. Our results highlight the strong contribution of DQ beyond macronutrient and energy content to changes in body composition and suggest that synergistic changes in both DQ and PA levels optimally reduce VAT in men with features of metabolic syndrome.
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Affiliation(s)
- Julie-Anne Nazare
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada
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Smith J, Nazare JA, Borel AL, Aschner P, Barter PJ, Van Gaal L, Matsuzawa Y, Kadowaki T, Ross R, Brulle-Wohlhueter C, Alméras N, Haffner SM, Balkau B, Després JP. Assessment of cardiometabolic risk and prevalence of meeting treatment guidelines among patients with type 2 diabetes stratified according to their use of insulin and/or other diabetic medications: results from INSPIRE ME IAA. Diabetes Obes Metab 2013; 15:629-41. [PMID: 23356633 DOI: 10.1111/dom.12075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/01/2012] [Accepted: 01/20/2013] [Indexed: 01/21/2023]
Abstract
AIM Visceral adipose tissue (VAT) and liver fat (LF) are strongly associated with type 2 diabetes. It is not known, however, how diabetes treatment and/or risk factor management modulates the association between VAT, LF and diabetes. The aim was to determine the level of VAT and LF in patients with type 2 diabetes according to their treatment status and achievement of the American Diabetes Association's (ADA) diabetes management goals. METHODS We performed a cross-sectional analysis of the baseline data of the International Study of the Prediction of Intra-Abdominal Adiposity and its Relationship with Cardiometabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA), a 3-year prospective cardiometabolic imaging study conducted in 29 countries. Patients (n = 3991) were divided into four groups: (i) those without type 2 diabetes (noT2D n = 1003 men, n = 1027 women); (ii) those with type 2 diabetes but not treated with diabetes medications (T2Dnomeds n = 248 men, n = 198 women); (iii) those with type 2 diabetes and treated with diabetes medications but not yet using insulin (T2Dmeds-ins n = 591 men, n = 484 women) and (iv) those with type 2 diabetes and treated with insulin (T2Dmeds+ins n = 233 men, n = 207 women). Abdominal and liver adiposity were measured by computed tomography. RESULTS Fewer patients with high VAT or LF achieved the ADA's goals for high-density lipoprotein cholesterol (HDL-C) or triglycerides compared to patients with low VAT or LF. Visceral adiposity (p = 0.02 men, p = 0.003 women) and LF (p = 0.0002 men, p = 0.0004 women) increased among patients who met fewer of the ADA treatment criteria, regardless of type 2 diabetes treatment. CONCLUSION Residual cardiometabolic risk exists among patients with type 2 diabetes characterized by elevated VAT and LF.
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Affiliation(s)
- J Smith
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
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Effects of Pioglitazone on Asymmetric Dimethylarginine and Components of the Metabolic Syndrome in Nondiabetic Patients (EPICAMP Study): A Double-Blind, Randomized Clinical Trial. PPAR Res 2013; 2013:358074. [PMID: 23710164 PMCID: PMC3654334 DOI: 10.1155/2013/358074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 04/01/2013] [Indexed: 12/22/2022] Open
Abstract
The present trial aimed to investigate the effects of pioglitazone on the serum level of asymmetric dimethylarginine (ADMA), a marker of endothelial function, and some indices of inflammation and glucose and lipid metabolism in nondiabetic metabolic syndrome patients. 104 eligible participants (57% female; age between 20 and 70) were enrolled in a double-blind placebo-controlled trial and were randomized to receive either pioglitazone (uptitrated to 30 mg/day) or matching placebo for 24 weeks. Participants were clinically examined and a blood sample was obtained at baseline and at the end of the trial. Pioglitazone significantly improved C-reactive protein level irrespective of changes in insulin sensitivity. Compared with the placebo group, alanine and aspartate transaminases were decreased and high-density lipoprotein cholesterol was increased after treatment with pioglitazone. A considerably greater weight gain was also recorded in the intervention group. We failed to observe any significant changes in serum ADMA in either group and between groups with and without adjustment for age, sex, and components of the metabolic syndrome. In a nutshell, pioglitazone seems to have positive effects on lipid profile, liver transaminases, and systemic inflammation. However, its previously demonstrated endothelial function-improving properties do not seem to be mediated by ADMA.
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Gaudreault V, Després JP, Rhéaume C, Alméras N, Bergeron J, Tremblay A, Poirier P. Exercise-Induced Hypertension in Men with Metabolic Syndrome: Anthropometric, Metabolic, and Hemodynamic Features. Metab Syndr Relat Disord 2013. [DOI: 10.1089/met.2012.0071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Valérie Gaudreault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Caroline Rhéaume
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Natalie Alméras
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Jean Bergeron
- Centre de recherche du Centre Hospitalier Universitaire de Québec, pavillon CHUL, Québec, Canada
| | - Angelo Tremblay
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
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Mattei J, Qi Q, Hu FB, Sacks FM, Qi L. TCF7L2 genetic variants modulate the effect of dietary fat intake on changes in body composition during a weight-loss intervention. Am J Clin Nutr 2012; 96:1129-36. [PMID: 23034957 PMCID: PMC3471200 DOI: 10.3945/ajcn.112.038125] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND TCF7L2 gene variants have been associated with increased risk of type 2 diabetes and higher adiposity. Observational studies and short-term trials have suggested that macronutrients may modify these effects. However, to our knowledge, this has yet to be verified in long-term interventions. OBJECTIVE In a long-term intervention setting, we investigated the effects of TCF7L2 polymorphisms rs7903146 and rs12255372 and dietary total fat on changes in body composition and subsequent glycemic control. DESIGN Data were analyzed for 591 participants in the Preventing Overweight Using Novel Dietary Strategies (Pounds Lost) trial, which is a 2-y weight-loss randomized clinical trial of diets that differed in macronutrient proportions. Adjusted means for changes in body composition at 6 and 24 mo were obtained for gene main effects and interactions with a low-fat diet (20% from energy) compared with a high-fat diet (40% from energy). Interactions with protein and carbohydrate intakes were also tested. Predicted changes in glycemic control from changes in adiposity were determined by genotype and diet type. RESULTS Significant interactions were observed for rs12255372 TT (risk genotype) and fat intake for changes in BMI, total fat mass, and trunk fat mass (all P/q < 0.05) at 6 mo, with nonsignificant larger decreases for TT carriers on a low-fat diet. No significant associations were observed at 24 mo or for other macronutrients. Changes in body composition for TT carriers predicted reductions in plasma glucose and insulin only on the low-fat diet. CONCLUSIONS Individuals with the TCF7L2 rs12255372 risk genotype may reduce body adiposity by consuming a diet lower in total fat. These reductions may induce better glycemic control for such individuals predisposed to type 2 diabetes. The Pounds Lost trial was registered at clinicaltrials.gov as NCT00072995.
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Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
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Kei AA, Filippatos TD, Tsimihodimos V, Elisaf MS. A review of the role of apolipoprotein C-II in lipoprotein metabolism and cardiovascular disease. Metabolism 2012; 61:906-21. [PMID: 22304839 DOI: 10.1016/j.metabol.2011.12.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 12/21/2022]
Abstract
The focus of this review is on the role of apolipoprotein C-II (apoC-II) in lipoprotein metabolism and the potential effects on the risk of cardiovascular disease (CVD). We searched PubMed/Scopus for articles regarding apoC-II and its role in lipoprotein metabolism and the risk of CVD. Apolipoprotein C-II is a constituent of chylomicrons, very low-density lipoprotein, low-density lipoprotein, and high-density lipoprotein (HDL). Apolipoprotein C-II contains 3 amphipathic α-helices. The lipid-binding domain of apoC-II is located in the N-terminal, whereas the C-terminal helix of apoC-II is responsible for the interaction with lipoprotein lipase (LPL). At intermediate concentrations (approximately 4 mg/dL) and in normolipidemic subjects, apoC-II activates LPL. In contrast, both an excess and a deficiency of apoC-II are associated with reduced LPL activity and hypertriglyceridemia. Furthermore, excess apoC-II has been associated with increased triglyceride-rich particles and alterations in HDL particle distribution, factors that may increase the risk of CVD. However, there is not enough current evidence to clarify whether increased apoC-II causes hypertriglyceridemia or is an epiphenomenon reflecting hypertriglyceridemia. A number of pharmaceutical interventions, including statins, fibrates, ezetimibe, nicotinic acid, and orlistat, have been shown to reduce the increased apoC-II concentrations. An excess of apoC-II is associated with increased triglyceride-rich particles and alterations in HDL particle distribution. However, prospective trials are needed to assess if apoC-II is a CVD marker or a risk factor in high-risk patients.
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Affiliation(s)
- Anastazia A Kei
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45 110 Ioannina, Greece
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Normalization of visceral adiposity is required to normalize plasma apolipoprotein B levels in response to a healthy eating/physical activity lifestyle modification program in viscerally obese men. Atherosclerosis 2012; 221:577-82. [PMID: 22321874 DOI: 10.1016/j.atherosclerosis.2012.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/12/2012] [Accepted: 01/12/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Little is known about how visceral adipose tissue (VAT) influences circulating apolipoprotein B (apoB) levels, which reflect atherogenic risk. We have examined the effects of a 1-year lifestyle modification program on plasma apoB levels in viscerally obese men and compared post-intervention levels to those of a reference group of lean healthy men. METHODS Fasting plasma apoB levels were measured in 107 non-diabetic, viscerally obese men, before and after a 1-year lifestyle intervention program aiming at improving nutritional and physical activity/exercise habits. RESULTS After the intervention, subjects significantly decreased their volume of VAT (Δ = -26 ± 18%, p < 0.0001) measured by computed tomography and significantly, but modestly reduced their fasting apoB levels (Δ = -3 ± 14%, p = 0.04). When compared to the reference group, men in the intervention group still had higher apoB levels suggesting that they did not "normalize" their apoB concentrations to the level of the healthy non-obese reference men. To further explore the relationship between VAT and apoB, men in the intervention group were stratified according to quartiles of VAT achieved after the intervention. Only men of the lowest quartile of VAT (corresponding to 844 ± 42 cm(3), similar to the value of the reference group; 809 ± 52 cm(3) of VAT) showed plasma apoB levels which were similar to those of the reference group (0.98 ± 0.21 vs. 0.99 ± 0.24 g/L, NS, for lowest VAT quartile and reference group, respectively). CONCLUSION These results suggest that, in order to "normalize" apoB levels in response to a lifestyle modification program, viscerally obese dyslipidemic men need to achieve levels of VAT similar to healthy non-obese men.
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