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Sundaresan S, Johnson C, Dixon KB, Dole M, Kilkelly D, Antoun J, Flynn CR, Abumrad NN, Tamboli R. Intraduodenal nutrient infusion differentially alters intestinal nutrient sensing, appetite, and satiety responses in lean and obese subjects. Am J Clin Nutr 2023; 118:646-656. [PMID: 37661107 PMCID: PMC10517208 DOI: 10.1016/j.ajcnut.2023.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Intestinal nutrient sensing regulates food intake and energy metabolism by acting locally and relaying nutritional status to the brain. It is unclear whether these mechanisms are altered in obese humans. OBJECTIVES We aimed to investigate differences in duodenal nutrient sensing in humans with or without obesity and the effects of transiently blocking vagal transmission on nutrient sensing, hunger, and appetite. METHODS In a single-blinded, randomized, cross-over design, subjects with or without obesity (n = 14 and n = 11, respectively) were infused intraduodenally with saline or a combination of glucose and oleic acid for 90 min (glucose load: 22.5 g, 1 kcal/min; oleic acid load: 10 g, 1 kcal/min) in the presence or absence of local anesthetic (benzocaine). Blood was sampled at 10-min intervals (120-240 min) and 15-min intervals until termination of the study for measurements of gut hormones, insulin, leptin, and C-peptide. Hunger and satiety sensations were scored using the visual analog scale, and hepatic glucose production and glucose oxidation rates were measured. RESULTS Duodenal nutrient infusion in lean subjects led to a 65% drop in acyl ghrelin release and robustly increased cholecystokinin 8 (CCK-8) release (65%; P = 0.023); benzocaine infusion delayed this response (2-factor repeated-measures analysis of variance, P = 0.0065). In contrast, subjects with obesity had significantly blunted response to nutrient infusion, and no further effects were observed with benzocaine. Additionally, significant delays were observed in peptide YY (3-36), pancreatic polypeptide, glucose inhibitory peptide, and glucagon-like peptide 1 (7-36) response. No significant interactions were found between body mass index (BMI) or baseline hormone levels and areas under the curve for hormones except CCK-8 (BMI, P = 0.018; baseline CCK, P = 0.013). Nutrient-induced hunger and satiety sensations were impeded by benzocaine only in the lean cohort. Hunger and satiety sensations in subjects with obesity were not responsive to nutrient entry into the duodenum, and no additional effects were observed by blocking neural signaling. CONCLUSION Nutrient-induced gut hormone release and response to transient vagal blockade are significantly blunted in subjects with obesity. This trial was registered at clinicaltrials.org as NCT02537314.
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Affiliation(s)
- Sinju Sundaresan
- Department of Physiology, Midwestern University, Downers Grove, IL; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Connor Johnson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kala B Dixon
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael Dole
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Donna Kilkelly
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph Antoun
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Charles Robb Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Robyn Tamboli
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
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2
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Ribeiro FM, Silva MA, Lyssa V, Marques G, Lima HK, Franco OL, Petriz B. The molecular signaling of exercise and obesity in the microbiota-gut-brain axis. Front Endocrinol (Lausanne) 2022; 13:927170. [PMID: 35966101 PMCID: PMC9365995 DOI: 10.3389/fendo.2022.927170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is one of the major pandemics of the 21st century. Due to its multifactorial etiology, its treatment requires several actions, including dietary intervention and physical exercise. Excessive fat accumulation leads to several health problems involving alteration in the gut-microbiota-brain axis. This axis is characterized by multiple biological systems generating a network that allows bidirectional communication between intestinal bacteria and brain. This mutual communication maintains the homeostasis of the gastrointestinal, central nervous and microbial systems of animals. Moreover, this axis involves inflammatory, neural, and endocrine mechanisms, contributes to obesity pathogenesis. The axis also acts in appetite and satiety control and synthesizing hormones that participate in gastrointestinal functions. Exercise is a nonpharmacologic agent commonly used to prevent and treat obesity and other chronic degenerative diseases. Besides increasing energy expenditure, exercise induces the synthesis and liberation of several muscle-derived myokines and neuroendocrine peptides such as neuropeptide Y, peptide YY, ghrelin, and leptin, which act directly on the gut-microbiota-brain axis. Thus, exercise may serve as a rebalancing agent of the gut-microbiota-brain axis under the stimulus of chronic low-grade inflammation induced by obesity. So far, there is little evidence of modification of the gut-brain axis as a whole, and this narrative review aims to address the molecular pathways through which exercise may act in the context of disorders of the gut-brain axis due to obesity.
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Affiliation(s)
- Filipe M. Ribeiro
- Post-Graduation Program in Physical Education, Catholic University of Brasilia, Brasilia, Brazil
- Center for Proteomic and Biochemical Analysis, Post-Graduation in Genomic and Biotechnology Sciences, Catholic University of Brasilia, Brasília, Brazil
- Laboratory of Molecular Exercise Physiology - University Center of the Federal District - UDF, Brasilia, Brazil
| | - Maycon A. Silva
- Center for Proteomic and Biochemical Analysis, Post-Graduation in Genomic and Biotechnology Sciences, Catholic University of Brasilia, Brasília, Brazil
| | - Victória Lyssa
- Laboratory of Molecular Analysis, Graduate Program of Sciences and Technology of Health, University of Brasilia, Brasilia, Brazil
| | - Gabriel Marques
- Laboratory of Molecular Exercise Physiology - University Center of the Federal District - UDF, Brasilia, Brazil
| | - Henny K. Lima
- Center for Proteomic and Biochemical Analysis, Post-Graduation in Genomic and Biotechnology Sciences, Catholic University of Brasilia, Brasília, Brazil
| | - Octavio L. Franco
- Post-Graduation Program in Physical Education, Catholic University of Brasilia, Brasilia, Brazil
- Center for Proteomic and Biochemical Analysis, Post-Graduation in Genomic and Biotechnology Sciences, Catholic University of Brasilia, Brasília, Brazil
- S-Inova Biotech, Catholic University Dom Bosco, Biotechnology Program, Campo Grande, Brazil
| | - Bernardo Petriz
- Center for Proteomic and Biochemical Analysis, Post-Graduation in Genomic and Biotechnology Sciences, Catholic University of Brasilia, Brasília, Brazil
- Laboratory of Molecular Exercise Physiology - University Center of the Federal District - UDF, Brasilia, Brazil
- Postgraduate Program in Rehabilitation Sciences - University of Brasília, Brasília, Brazil
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3
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Ataeinosrat A, Haghighi MM, Abednatanzi H, Soltani M, Ghanbari-Niaki A, Nouri-Habashi A, Amani-Shalamzari S, Mossayebi A, Khademosharie M, Johnson KE, VanDusseldorp TA, Saeidi A, Zouhal H. Effects of Three Different Modes of Resistance Training on Appetite Hormones in Males With Obesity. Front Physiol 2022; 13:827335. [PMID: 35264977 PMCID: PMC8900747 DOI: 10.3389/fphys.2022.827335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/31/2022] [Indexed: 12/19/2022] Open
Abstract
Purpose This study explored the effect of three different modes of resistance training on appetite hormones [leptin, ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide tyrosine–tyrosine (PYY)], cardiometabolic and anthropometric measures in males with obesity. Methods Forty-four males with obesity (age: 27.5 ± 9.4 yrs.; mean weight: 93.2 ± 2.2 kg, body mass index: 32.9 ± 1.2 kg/m2) were randomized to traditional resistance training (TRT, n = 11), circuit resistance training (CRT, n = 11), interval resistance training (IRT, n = 11) or control (C, n = 11) groups. All resistance training groups received 50 min of supervised training per session, three days per week, for 12 weeks. Measurements were taken at baseline and after 12 weeks of training. Results Plasma levels of leptin, ghrelin, CCK, and PYY decreased significantly in all three different modalities of resistance training groups when compared to the control group (p < 0.05). GLP-1 increased significantly in both CRT and IRT groups compared to TRT and C groups (p < 0.05). Glucose-dependent insulinotropic polypeptide decreased significantly in CRT and IRT groups compared to the C group (p < 0.05). Adiponectin levels increased significantly in all resistance training groups compared to the C group (p < 0.05). Conclusion Overall, CRT and IRT protocols had the greatest impact on appetite hormones compared to individuals who engaged in TRT or did not exercise (C).
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Affiliation(s)
- Ali Ataeinosrat
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Hossein Abednatanzi
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Soltani
- Department of Biological Sciences in Sport, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abbass Ghanbari-Niaki
- Exercise Biochemistry Division, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Mazandaran, Iran
| | - Akbar Nouri-Habashi
- Department of Exercise Physiology and Corrective Movements, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | - Sadegh Amani-Shalamzari
- Department of Exercise Physiology, Faculty of Physical Education and Sports Science, Kharazmi University, Tehran, Iran
| | - Ali Mossayebi
- Department of Kinesiology, College of Health Sciences, University of Texas at El Paso, El Paso, TX, United States
| | - Mitra Khademosharie
- Department of Physical Education, Faculty of Literature, Kosar University of Bojnord, Bojnord, Iran
| | - Kelly E Johnson
- Department of Kinesiology, Coastal Carolina University, Conway, SC, United States
| | - Trisha A VanDusseldorp
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
| | - Hassane Zouhal
- Laboratoire Mouvement, Sport, Santé (M2S), University of Rennes, Rennes, France.,Institut International des Sciences du Sport (2I2S), Iroduer, France
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Beaulieu K, Blundell JE, van Baak MA, Battista F, Busetto L, Carraça EV, Dicker D, Encantado J, Ermolao A, Farpour-Lambert N, Pramono A, Woodward E, Bellicha A, Oppert JM. Effect of exercise training interventions on energy intake and appetite control in adults with overweight or obesity: A systematic review and meta-analysis. Obes Rev 2021; 22 Suppl 4:e13251. [PMID: 33949089 PMCID: PMC8365695 DOI: 10.1111/obr.13251] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
This systematic review examined the impact of exercise training interventions on energy intake (EI) and appetite control in adults with overweight/obesity (≥18 years including older adults). Articles were searched up to October 2019. Changes in EI, fasting appetite sensations, and eating behavior traits were examined with random effects meta-analysis, and other outcomes were synthesized qualitatively. Forty-eight articles were included (median [range] BMI = 30.6 [27.0-38.4] kg/m2 ). Study quality was rated as poor, fair, and good in 39, seven, and two studies, respectively. Daily EI was assessed objectively (N = 4), by self-report (N = 22), with a combination of the two (N = 4) or calculated from doubly labeled water (N = 1). In studies rated fair/good, no significant changes in pre-post daily EI were found and a small but negligible (SMD < 0.20) postintervention difference when compared with no-exercise control groups was observed (five study arms; MD = 102 [1, 203] kcal). There were negligible-to-small pre-post increases in fasting hunger and dietary restraint, decrease in disinhibition, and some positive changes in satiety and food reward/preferences. Within the limitations imposed by the quality of the included studies, exercise training (median duration of 12 weeks) leads to a small increase in fasting hunger and a small change in average EI only in studies rated fair/good. Exercise training may also reduce the susceptibility to overconsumption (PROSPERO: CRD42019157823).
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Affiliation(s)
- Kristine Beaulieu
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - John E Blundell
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Marleen A van Baak
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Francesca Battista
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Obesity Management Task Force (OMTF), European Association for the Study of Obesity (EASO), Teddington, UK.,Department of Medicine, University of Padova, Padova, Italy
| | - Eliana V Carraça
- Faculdade de Educação Física e Desporto, CIDEFES, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Dror Dicker
- Obesity Management Task Force (OMTF), European Association for the Study of Obesity (EASO), Teddington, UK.,Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Encantado
- APPsyCI - Applied Psychology Research Center Capabilities & Inclusion, ISPA - University Institute, Lisbon, Portugal
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Nathalie Farpour-Lambert
- Obesity Management Task Force (OMTF), European Association for the Study of Obesity (EASO), Teddington, UK.,Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Adriyan Pramono
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Euan Woodward
- Obesity Management Task Force (OMTF), European Association for the Study of Obesity (EASO), Teddington, UK
| | - Alice Bellicha
- INSERM, Nutrition and obesities: systemic approaches, NutriOmics, Sorbonne University, Paris, France.,UFR SESS-STAPS, University Paris-Est Créteil, Créteil, France
| | - Jean-Michel Oppert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière hospital, Department of Nutrition, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
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5
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Winn NC, Pettit-Mee R, Walsh LK, Restaino RM, Ready ST, Padilla J, Kanaley JA. Metabolic Implications of Diet and Energy Intake during Physical Inactivity. Med Sci Sports Exerc 2019; 51:995-1005. [PMID: 30694977 DOI: 10.1249/mss.0000000000001892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Physical inactivity is associated with disruptions in glucose metabolism and energy balance, whereas energy restriction may blunt these adverse manifestations. During hypocaloric feeding, higher-protein intake maintains lean mass which is an important component of metabolic health. This study determined whether mild energy restriction preserves glycemic control during physical inactivity and whether this preservation is more effectively achieved with a higher-protein diet. METHODS Ten adults (24 ± 1 yr) consumed a control (64% carbohydrate, 20% fat, 16% protein) and higher-protein diet (50% carbohydrate, 20% fat, 30% protein) during two 10-d inactivity periods (>10,000 → ~5000 steps per day) in a randomized crossover design. Energy intake was decreased by ~400 kcal·d to account for reduced energy expenditure associated with inactivity. A subset of subjects (n = 5) completed 10 d of inactivity while consuming 35% excess of their basal energy requirements, which served as a positive control condition (overfeeding+inactivity). RESULTS Daily steps were decreased from 12,154 ± 308 to 4275 ± 269 steps per day (P < 0.05) which was accompanied by reduced V˙O2max (-1.8 ± 0.7 mL·kg·min, P < 0.05), independent of diet conditions. No disruptions in fasting or postprandial glucose, insulin, and nonesterified fatty acids in response to 75 g of oral glucose were observed after inactivity for both diet conditions (P > 0.05). Overfeeding+inactivity increased body weight, body fat, homeostasis model assessment of insulin resistance, and 2-h postprandial glucose and insulin concentrations (P < 0.05), despite no changes in lipid concentrations. CONCLUSIONS We show that independent of diet (normal vs higher-protein), mild energy restriction preserves metabolic function during short-term inactivity in healthy subjects. That is, metabolic deterioration with inactivity only manifests in the setting of energy surplus.
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Affiliation(s)
- Nathan C Winn
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
| | - Ryan Pettit-Mee
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
| | - Lauren K Walsh
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
| | - Robert M Restaino
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO
| | - Sean T Ready
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO.,Department of Child Health, University of Missouri, Columbia, MO
| | - Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
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Zouhal H, Sellami M, Saeidi A, Slimani M, Abbassi-Daloii A, Khodamoradi A, El Hage R, Hackney AC, Ben Abderrahman A. Effect of physical exercise and training on gastrointestinal hormones in populations with different weight statuses. Nutr Rev 2019; 77:455-477. [DOI: 10.1093/nutrit/nuz005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hassane Zouhal
- Movement, Sport and Health Sciences Laboratory, University of Rennes 2, Rennes, France
| | - Maha Sellami
- Sport Science Program, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Ayoub Saeidi
- Department of Biological Sciences in Sport and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Maamer Slimani
- Higher Institute of Sport and Physical Education of Ksar Said, Tunis, Tunisia
| | - Asieh Abbassi-Daloii
- Department of Sport Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
| | - Arash Khodamoradi
- Department of Biological Sciences in Sport and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Abderraouf Ben Abderrahman
- Laboratory of Biomonitoring of the Environment, Faculty of Science of Bizerte, University of Carthage, Carthage, Tunisia
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7
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Acute and Chronic Effects of Exercise on Appetite, Energy Intake, and Appetite-Related Hormones: The Modulating Effect of Adiposity, Sex, and Habitual Physical Activity. Nutrients 2018; 10:nu10091140. [PMID: 30131457 PMCID: PMC6164815 DOI: 10.3390/nu10091140] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022] Open
Abstract
Exercise facilitates weight control, partly through effects on appetite regulation. Single bouts of exercise induce a short-term energy deficit without stimulating compensatory effects on appetite, whilst limited evidence suggests that exercise training may modify subjective and homeostatic mediators of appetite in directions associated with enhanced meal-induced satiety. However, a large variability in responses exists between individuals. This article reviews the evidence relating to how adiposity, sex, and habitual physical activity modulate exercise-induced appetite, energy intake, and appetite-related hormone responses. The balance of evidence suggests that adiposity and sex do not modify appetite or energy intake responses to acute or chronic exercise interventions, but individuals with higher habitual physical activity levels may better adjust energy intake in response to energy balance perturbations. The effect of these individual characteristics and behaviours on appetite-related hormone responses to exercise remains equivocal. These findings support the continued promotion of exercise as a strategy for inducing short-term energy deficits irrespective of adiposity and sex, as well as the ability of exercise to positively influence energy balance over the longer term. Future well-controlled studies are required to further ascertain the potential mediators of appetite responses to exercise.
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8
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Winn NC, Liu Y, Rector RS, Parks EJ, Ibdah JA, Kanaley JA. Energy-matched moderate and high intensity exercise training improves nonalcoholic fatty liver disease risk independent of changes in body mass or abdominal adiposity - A randomized trial. Metabolism 2018; 78:128-140. [PMID: 28941598 DOI: 10.1016/j.metabol.2017.08.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Exercise training is commonly prescribed for individuals diagnosed with nonalcoholic fatty liver disease (NAFLD); however, consensus regarding the volume and intensity of exercise for optimal benefits is lacking. Thus, we determined whether high intensity interval exercise training (HIIT) produced greater reductions in intrahepatic lipid (IHL) content and NAFLD risk factors compared with energy-matched moderate intensity continuous exercise training (MICT) in obese adults with liver steatosis. METHODS Eighteen obese adults were randomized to either 4weeks of HIIT (4min 80% VO2peak/3min, 50% VO2peak) or MICT (55% VO2peak, ~60min), matched for energy expenditure (~400kcal/session) and compared to five non-exercising age-matched control subjects. IHL was measured by 1H-MRS and frequent blood samples were analyzed for glucose, insulin, c-peptide, and NEFA levels during a liquid meal test (180min) to characterize metabolic phenotype. RESULTS Baseline body weight, visceral abdominal adiposity, and fasting insulin concentrations were greater in the MICT vs HIIT group (P<0.05), while IHL was tightly matched between MICT and HIIT subjects (P>0.05), albeit higher than control subjects (P<0.01). Visceral abdominal adiposity, body mass, liver aminotransferases (ALT, AST), and hepatic apoptotic/inflammatory markers (cytokeratin 18 and fetuin a) were not reduced with either exercise training intervention (P>0.05). Both HIIT and MICT lowered IHL (HIIT, -37.0±12.4%; MICT, -20.1±6.6%, P<0.05); however, the reduction in IHL was not statistically different between exercise intensities (P=0.25). Furthermore, exercise training decreased postprandial insulin, c-peptide, and lipid peroxidation levels (iAUC, P<0.05). CONCLUSIONS Collectively, these findings indicate that energy-matched high intensity and moderate intensity exercise are effective at decreasing IHL and NAFLD risk that is not contingent upon reductions in abdominal adiposity or body mass.
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Affiliation(s)
- Nathan C Winn
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Ying Liu
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - R Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States; Medicine-Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, United States; Research Service, Harry S. Truman Memorial VA Hospital, University of Missouri, Columbia, MO, United States
| | - Elizabeth J Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Jamal A Ibdah
- Medicine-Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, United States
| | - Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States.
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9
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García-Hermoso A, Ceballos-Ceballos RJM, Poblete-Aro CE, Hackney AC, Mota J, Ramírez-Vélez R. Exercise, adipokines and pediatric obesity: a meta-analysis of randomized controlled trials. Int J Obes (Lond) 2017; 41:475-482. [PMID: 28017965 PMCID: PMC5382285 DOI: 10.1038/ijo.2016.230] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/14/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVE Adipokines are involved in the etiology of diabetes, insulin resistance, and the development of atherosclerosis and other latent-onset complications. The objective of this meta-analysis was to determine the effectiveness of exercise interventions on adipokines in pediatric obesity. SUBJECTS/METHODS A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on adipokines (adiponectin, leptin, resistin and visfatin) in pediatric obesity (6-18 years old). Fourteen randomized controlled trials (347 youths) were included. Weighted mean difference (WMD) and 95% confidence intervals were calculated. RESULTS Exercise was associated with a significant increase in adiponectin (WMD=0.882 μg ml-1, 95% CI, 0.271-1.493) but did not alter leptin and resistin level. Likewise, exercise intensity and change in body fat; as well as total exercise program duration, duration of the sessions, and change in body fat all significantly influenced the effect of exercise on adiponectin and leptin, respectively. CONCLUSIONS Exercise seems to increase adiponectin levels in childhood obesity. Our results also suggested that exercise on its own, without the concomitant presence of changes in body composition levels, does not affect leptin levels.
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Affiliation(s)
- A García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - R J M Ceballos-Ceballos
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - C E Poblete-Aro
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - A C Hackney
- Endocrine Section-Applied Physiology Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Mota
- CIAFEL–Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - R Ramírez-Vélez
- Centro de Estudios para la Medición de la Actividad Física «CEMA», Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
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10
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Winn NC, Grunewald ZI, Liu Y, Heden TD, Nyhoff LM, Kanaley JA. Plasma Irisin Modestly Increases during Moderate and High-Intensity Afternoon Exercise in Obese Females. PLoS One 2017; 12:e0170690. [PMID: 28125733 PMCID: PMC5268488 DOI: 10.1371/journal.pone.0170690] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Irisin is an exercise-responsive myokine that has been proposed to exert anti-obesity benefits; yet its response during exercise in obese women is not described. This study characterized plasma irisin levels during a single bout of afternoon isocaloric-exercise of different intensities (moderate- vs high-intensity) in obese females. METHODS Eleven obese females participated in 3 randomized study days beginning at 1600h: 1) no exercise (NoEx), 2) moderate exercise (ModEx; 55%VO2max) and 3) high intensity interval exercise (IntEx; 4 min (80%VO2max)/3 min (50% VO2max). Frequent blood samples were analyzed for glucose and lactate (whole-blood), and insulin, c-peptide, glucagon, and irisin (plasma) throughout 190 min of testing. RESULTS Plasma irisin increased above baseline during ModEx and IntEx (P<0.05), but not NoEx (P>0.05). Peak irisin levels during ModEx and IntEx exercise were 11.9± 3.4% and 12.3 ± 4.1% relative to baseline (P<0.05), respectively, with no differences between exercise intensities (P>0.05). Irisin levels remained elevated above resting for 125 minutes post-exercise during ModEx, whereas levels returned to baseline within 15 minutes post-exercise during IntEx. Similarly, no associations were found between plasma irisin levels and circulating lactate, glucose, insulin, c-peptide, or glucagon among study days (P>0.05). However, there was an inverse association between basal irisin and lean mass (r = -0.70, P = 0.01). CONCLUSION A single bout of moderate and high intensity afternoon exercise induces modest increases in circulating irisin concentrations during exercise; however the regulation post-exercise appears to be dimorphic between exercise intensity in obese females. Future studies are needed to compare morning and afternoon exercise on irisin secretion.
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Affiliation(s)
- Nathan C. Winn
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States of America
| | - Zachary I. Grunewald
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States of America
| | - Ying Liu
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States of America
| | - Timothy D. Heden
- East Carolina Diabetes and Obesity Institute and Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States of America
| | - Lauren M. Nyhoff
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States of America
| | - Jill A. Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States of America
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11
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Exercise, Appetite and Weight Control: Are There Differences between Men and Women? Nutrients 2016; 8:nu8090583. [PMID: 27657127 PMCID: PMC5037567 DOI: 10.3390/nu8090583] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 12/22/2022] Open
Abstract
Recent years have witnessed significant research interest surrounding the interaction among exercise, appetite and energy balance, which has important implications for health. The majority of exercise and appetite regulation studies have been conducted in males. Consequently, opportunities to examine sex-based differences have been limited, but represent an interesting avenue of inquiry considering postulations that men experience greater weight loss after exercise interventions than women. This article reviews the scientific literature relating to the acute and chronic effects of exercise on appetite control in men and women. The consensus of evidence demonstrates that appetite, appetite-regulatory hormone and energy intake responses to acute exercise do not differ between the sexes, and there is little evidence indicating compensatory changes occur after acute exercise in either sex. Limited evidence suggests women respond to the initiation of exercise training with more robust compensatory alterations in appetite-regulatory hormones than men, but whether this translates to long-term differences is unknown. Current exercise training investigations do not support sex-based differences in appetite or objectively assessed energy intake, and increasing exercise energy expenditure elicits at most a partial energy intake compensation in both sexes. Future well-controlled acute and chronic exercise studies directly comparing men and women are required to expand this evidence base.
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12
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Kullman EL, Kelly KR, Haus JM, Fealy CE, Scelsi AR, Pagadala MR, Flask CA, McCullough AJ, Kirwan JP. Short-term aerobic exercise training improves gut peptide regulation in nonalcoholic fatty liver disease. J Appl Physiol (1985) 2016; 120:1159-64. [PMID: 27032902 DOI: 10.1152/japplphysiol.00693.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/28/2016] [Indexed: 02/06/2023] Open
Abstract
Obesity-related nonalcoholic fatty liver disease (NAFLD) is now the most common chronic liver disease. Exercise and diet are uniformly prescribed treatments for NAFLD; however, there are limited empirical data on the effects of exercise training on metabolic function in these patients. The purpose of this study was to investigate the fasting and glucose-stimulated adaptation of gut peptides to short-term aerobic exercise training in patients with NAFLD. Twenty-two obese subjects, 16 with NAFLD [body mass index (BMI), 33.2 ± 1.1 (SE) kg/m(2)] and 6 obese controls (BMI, 31.3 ± 1.2 kg/m(2)), were enrolled in a supervised aerobic exercise program (60 min/day, 85% of their heart rate maximum, for 7 days). Fasting and glucose-stimulated glucagon-like peptide-1 (GLP-17-36) and peptide tyrosine tyrosine (PYYTotal) concentrations in plasma were assessed before and after the exercise program. Initially, the NAFLD group had higher fasting PYY (NAFLD = 117 ± 18.6, control = 47.2 ± 6.4 pg/ml, P < 0.05) and GLP-1 (NAFLD = 12.4 ± 2.2, control = 6.2 ± 0.2 pg/ml, P < 0.05) and did not significantly increase GLP-1 or PYY in response to glucose ingestion. After the exercise program, fasting GLP-1 was reduced in the NAFLD group (10.7 ± 2.0 pg/ml, P < 0.05). Furthermore, exercise training led to significant increase in the acute (0-30 min) PYY and GLP-1 responses to glucose in the NAFLD group, while the total area under the glucose-stimulated GLP-1 response curve was reduced in both NAFLD and controls (P < 0.05). In summary, 7 days of vigorous aerobic exercise normalized the dynamic PYY and GLP-1 responses to nutrient stimulation and reduced the GLP-1 response in NAFLD, suggesting that exercise positively modulates gut hormone regulation in obese adults with NAFLD.
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Affiliation(s)
- Emily L Kullman
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karen R Kelly
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacob M Haus
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ciaran E Fealy
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amanda R Scelsi
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mangesh R Pagadala
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chris A Flask
- Department of Radiology and Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; and
| | - Arthur J McCullough
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio; Metabolic Translational Research Center, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
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13
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Khandekar N, Berning BA, Sainsbury A, Lin S. The role of pancreatic polypeptide in the regulation of energy homeostasis. Mol Cell Endocrinol 2015; 418 Pt 1:33-41. [PMID: 26123585 DOI: 10.1016/j.mce.2015.06.028] [Citation(s) in RCA: 21] [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] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 06/03/2015] [Indexed: 12/13/2022]
Abstract
Imbalances in normal regulation of food intake can cause obesity and related disorders. Inadequate therapies for such disorders necessitate better understanding of mechanisms that regulate energy homeostasis. Pancreatic polypeptide (PP), a robust anorexigenic hormone, effectively modulates food intake and energy homeostasis, thus potentially aiding anti-obesity therapeutics. Intra-gastric and intra-intestinal infusion of nutrients stimulate PP secretion from the gastrointestinal tract, leading to vagal stimulation that mediates complex actions via the neuropeptide Y4 receptor in arcuate nucleus of the hypothalamus, subsequently activating key hypothalamic nuclei and dorsal vagal complex of the brainstem to influence energy homeostasis and body composition. Novel studies indicate affinity of PP for the relatively underexplored neuropeptide y6 receptor, mediating actions via the suprachiasmatic nucleus and pathways involving vasoactive intestinal polypeptide and insulin like growth factor 1. This review highlights detailed mechanisms by which PP mediates its actions on energy balance through various areas in the brain.
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Affiliation(s)
- Neeta Khandekar
- Neurological Diseases Division, Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - Britt A Berning
- Neurological Diseases Division, Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, NSW 2006, Australia
| | - Shu Lin
- Neurological Diseases Division, Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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14
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Heden TD, Liu Y, Kanaley JA. Impact of Exercise Timing on Appetite Regulation in Individuals with Type 2 Diabetes. Med Sci Sports Exerc 2015; 48:182-9. [PMID: 26285022 DOI: 10.1249/mss.0000000000000755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Exercise improves appetite regulation, but it is not known if premeal or postmeal exercise more effectively improves appetite regulation in individuals with type 2 diabetes. For the first time, this study compared how premeal and postmeal exercise alters appetite regulation in individuals with type 2 diabetes. METHODS Twelve obese individuals with type 2 diabetes performed 3 different trials, all in a random order, in which they consumed a dinner meal with the following: no resistance exercise (RE), premeal RE, or postmeal RE beginning 45 min after dinner. A visual analog scale was used to assess perceived hunger and fullness, and frequent blood samples were drawn for determination of acylated ghrelin, pancreatic polypeptide (PP), and peptide tyrosine tyrosine (PYY) concentrations. RESULTS Premeal RE increased premeal perceived fullness, reduced perceived hunger, and reduced acylated ghrelin concentrations compared with the no RE and postmeal RE trial (P < 0.05). In the postprandial period, both premeal and postmeal RE reduced perceived hunger compared with no RE, whereas only postmeal RE reduced postprandial perceived fullness (P < 0.05) compared with no RE. Premeal or postmeal RE did not alter PYY concentrations. In both the premeal and postprandial period, RE reduced PP concentrations compared with no RE (P < 0.05), but upon cessation of RE, PP concentrations rebounded to concentrations that were similar to no RE. CONCLUSIONS Both premeal and postmeal RE reduced perceived hunger and increased perceived fullness, effects that may help control food intake and aid in weight management efforts in individuals with type 2 diabetes.
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Affiliation(s)
- Timothy D Heden
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
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15
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Abstract
The gastrointestinal (GI) tract comprises a large endocrine organ that regulates not only nutrient sensing and metabolising but also satiety and energy homeostasis. More than 20 hormones secreted from the stomach, intestine, and pancreas as well as signaling mediators of the gut microbiome are involved in this process. A better understanding of how related pathways affect body weight and food intake will help us to find new strategies and drugs to treat obesity. For example, weight loss secondary to lifestyle intervention is often accompanied by unfavorable changes in multiple GI hormones, which may cause difficulties in maintaining a lower body weight status. Conversely, bariatric surgery favorably changes the hormone profile to support improved satiety and metabolic function. This partially explains stronger sustained body weight reduction resulting in better long-term results of improved metabolic functions. This review focuses on GI hormones and signaling mediators of the microbiome involved in satiety regulation and energy homeostasis and summarizes their changes following weight loss. Furthermore, the potential role of GI hormones as anti-obesity drugs is discussed.
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Affiliation(s)
- Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, Institute for Pediatric Endocrinology, Diabetes and Nutrition Medicine, University of Witten/Herdecke, Datteln, Germany,
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16
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Marić G, Gazibara T, Zaletel I, Labudović Borović M, Tomanović N, Ćirić M, Puškaš N. The role of gut hormones in appetite regulation (review). ACTA ACUST UNITED AC 2015; 101:395-407. [PMID: 25532952 DOI: 10.1556/aphysiol.101.2014.4.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Eating process is an aggregate of complex and different forms of behavior. Its regulation is based on energy homeostasis and appetite control which includes two components: the homeostatic and the hedonistic control. Important signals in appetite regulation are gut-derived hormones. They are produced by enteroendocrine cells in response to nutrient and energy intake, and achieve their effects by influencing brain structures involved in food intake regulation. The key brain structure involved in this process is the hypothalamus. Gut hormones reach the hypothalamus from the circulation or by the vagal nerve via the nucleus of the solitary tract. Among gut peptides, ghrelin is the only orexigenic hormone, leading to an increase in food intake and body weight. All others, such as cholecystokinin, glucagon like peptide-1, oxyntomodulin, peptide tyrosine tyrosine or pancreatic polypeptide, are anorexigenic, leading to decrease in food intake. Also, gut-derived endocannabinoids exert orexigenic effect on appetite. Keeping in mind the growing problem of obesity, the crucial issue when considering gut derived peptides is to understand their mechanisms of acting because of potential role in clinical therapy, and discovering long-lasting gut peptides or their analogues, with no or minimal side effects.
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Affiliation(s)
- G Marić
- University of Belgrade Institute of Epidemiology, Faculty of Medicine Belgrade Serbia
| | - T Gazibara
- University of Belgrade Institute of Epidemiology, Faculty of Medicine Belgrade Serbia
| | - I Zaletel
- University of Belgrade Institute of Histology and Embryology, Faculty of Medicine Višegradska 26 11000 Belgrade Serbia
| | - M Labudović Borović
- University of Belgrade Institute of Histology and Embryology, Faculty of Medicine Višegradska 26 11000 Belgrade Serbia
| | - N Tomanović
- University of Belgrade Institute of Pathology, Faculty of Medicine Belgrade Serbia
| | - M Ćirić
- University of Nis Institute of Physiology, Faculty of Medicine Nis Serbia
| | - Nela Puškaš
- University of Belgrade Institute of Histology and Embryology, Faculty of Medicine Višegradska 26 11000 Belgrade Serbia
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17
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Abstract
As obesity continues to be a global epidemic, research into the mechanisms of hunger and satiety and how those signals act to regulate energy homeostasis persists. Peptide YY (PYY) is an acute satiety signal released upon nutrient ingestion and has been shown to decrease food intake when administered exogenously. More recently, investigators have studied how different factors influence PYY release and circulating levels in humans. Some of these factors include exercise, macronutrient composition of the diet, body-weight status, adiposity levels, sex, race and ageing. The present article provides a succinct and comprehensive review of the recent literature published on the different factors that influence PYY release and circulating levels in humans. Where human data are insufficient, evidence in animal or cell models is summarised. Additionally, the present review explores the recent findings on PYY responses to different dietary fatty acids and how this new line of research will make an impact on future studies on PYY. Human demographics, such as sex and age, do not appear to influence PYY levels. Conversely, adiposity or BMI, race and acute exercise all influence circulating PYY levels. Both dietary fat and protein strongly stimulate PYY release. Furthermore, MUFA appear to result in a smaller PYY response compared with SFA and PUFA. PYY levels appear to be affected by acute exercise, macronutrient composition, adiposity, race and the composition of fatty acids from dietary fat.
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18
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Wuorinen EC. The Psychophysical Connection Between Exercise, Hunger, and Energy Intake. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827613520526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Exercise is vitally important in the prevention of weight gain or maintaining weight status, as well as weight loss. High-intensity exercise causes a short-term suppression of hunger of approximately 15 to 60 minutes. Although there is evidence for compensatory food consumption, it usually does not make up for the energy deficit created by exercise. The exception occurs when individuals consume or reward themselves with energy-dense foods or drink. Because people tend to eat the same volume of food each day, on days when they exercise, they will remain in an energy deficit. However, on sedentary days, a positive energy balance is likely if caloric restriction is not imposed, which could result in weight gain. Caloric restriction alone leads to loss of lean body mass, while the inclusion of exercise with an energy deficit helps conserve lean tissue. There are a myriad physiological factors such as the concentration of hormones (GLP-1, PYY3-36, leptin, and ghrelin) and metabolites (free fatty acids and glucose) that either stimulate or inhibit signals for hunger and/or energy intake, but the effect of exercise on these circulating factors is complex and not completely understood.
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