Effect of exercise on cardiometabolic health of adults with overweight or obesity: Focus on blood pressure, insulin resistance, and intrahepatic fat-A systematic review and meta-analysis

Positive Effects of Aerobic-Resistance Exercise and an Ad Libitum High-Protein, Low-Glycemic Index Diet on Irisin, Omentin, and Dyslipidemia in Men with Abdominal Obesity: A Randomized Controlled Trial

OBJECTIVES

The aim of this research was to evaluate changes in body composition, adipokine levels, and dyslipidemia parameters in males with abdominal obesity following two distinct interventions: exercise alone and exercise combined with an ad libitum diet.

METHODS

This study included 44 males with abdominal obesity (mean age 34.7 ± 5.5 years, waist circumference [WC] 110.3 ± 8.5, BMI 32.0 ± 3.9), who were randomly assigned to three groups: an experimental group engaging in aerobic-resistance exercise (II, n = 16), an experimental group engaging in aerobic-resistance exercise combined with an ad libitum high-protein, low-glycemic index carbohydrate diet (III, n = 16), both interventions lasting 6 weeks, and a control group without interventions (I, n = 12). Body composition metrics (body mass index [BMI], waist circumference [WC], body fat [BF], abdominal fat [ABD]) and fat-free mass [FFM], along with biochemical blood analyses (irisin [IR], omentin [OMEN], glucose [GLU], insulin [INS], LDL- and HDL-cholesterol), were measured at baseline and after the 6-week intervention. The effects of the interventions on the analyzed variables across groups were assessed using mixed ANOVA tests with post-hoc comparisons. Effect size (ES) was also calculated using partial eta squared (ηp2).

RESULTS

The intervention in group III resulted in a significant decrease in IR (p < 0.01, ηp2 = 0.03) by 41% and LDL-C (p < 0.01, ηp2 = 0.02) by 14%. These effects were associated with a reduction in BF (p < 0.01, ηp2 = 0.02) by 14%, ABD (p < 0.01, ηp2 = 0.03) by 31%, and WC (p < 0.01, ηp2 = 0.01) by 3%. In group II, decreases after 6 weeks of intervention were noted only in WC (p = 0.02, ηp2 = 0.01) by 1% and in INS (p < 0.01, ηp2 = 0.04) by 47%. No differences were found between groups. The use of low-glycemic index carbohydrates (p < 0.01, ηp2 = 0.06) and increased protein intake (p < 0.01, ηp2 = 0.30) led to changes in the fiber-to-energy value of the diet ratio (p < 0.01, ηp2 = 0.18) and a reduction in dietary energy value (p < 0.01, ηp2 = 0.13) by 23%, resulting in a greater energy deficit than in the II group.

CONCLUSIONS

These findings highlight the effect of combining dietary and exercise interventions to achieve significant changes in body composition and metabolic parameters, even over a short period of intervention.

Current strategies for nonalcoholic fatty liver disease treatment (Review)

Nonalcoholic fatty liver disease (NAFLD), the most common chronic hepatic disease, has become a leading health problem worldwide. The present review summarized the methods and mechanisms to treat NAFLD, including the Mediterranean diet, physical activity and exercise, bariatric surgery and specific therapeutic agents, including statins, peroxisome proliferator‑activated receptor agonists, cenicriviroc and farnesoid X receptor agonists. Biologically active substances, such as peptides, alkaloids, polyphenolic compounds, silymarin, antibiotics, fatty acids, vitamins, probiotics, synbiotics and lamiaceae have also demonstrated actions that combat NAFLD. Considering their different mechanisms of action, combining some of them may prove an efficacious treatment for NAFLD. In this light, the present review describes recent progress and future prospects in treating NAFLD.

Recreational screen time and obesity risk in Korean children: a 3-year prospective cohort study

BACKGROUND

Studies have shown that prolonged television watching increases obesity risk among children. However, few studies examined the associations with other types of screen time, such as computer and smartphone use, using a prospective cohort study design. Further, little is known about the specific non-screen time activity that may yield the most benefits when reallocating screen time to other activities.

METHODS

We conducted a prospective cohort analysis using 3-year follow-up data from the Korean Children and Youth Panel Survey 2018 (n = 2,023; 4th grade elementary students who were not obese at baseline). Average time spent watching television, using computer and smartphone, and other after-school activities were self-reported at baseline. Weight and height were also self-reported at baseline and follow-up surveys through 2021. We performed multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between screen time and obesity incidence, adjusting for potential confounders. We also performed isotemporal substitution models to examine the associations of reallocating screen time to other non-screen time activities (physical activity, sleeping, hanging out with friends, reading, studying, and chatting with parents) in an equal time-exchange manner.

RESULTS

Longer combined screen time (≥ 240 vs. <120 m/d) was statistically significantly associated with an increased obesity risk (OR [95% CI] = 1.68 [1.03, 2.73]). The direction of associations with television watching (≥ 180 vs. <60 m/d: OR [95% CI] = 2.86 [1.58, 5.20]), computer use (≥ 120 vs. <60 m/d: 1.38 [0.52, 3.64]), and smartphone use (≥ 180 vs. <60 m/d: 1.42 [0.76, 2.65]) were all positive, although the association was most apparent and statistically significant for television watching only. The associations did not change after additional adjustment for other lifestyle factors, including physical activity, sleep, and breakfast skipping. In the isotemporal substitution models, reallocating 1-hour of screen time to reading (OR [95% CI] = 0.67 [0.48, 0.93]) was associated with a decreased obesity risk. Reallocating 1-hour of screen time to physical activity was only marginally significantly associated with obesity risk (0.79 [0.62, 1.01]).

CONCLUSIONS

Our data suggest that more efforts should focus on reducing screen time and increasing time for other non-screen time activities, particularly reading, for obesity prevention in children.

The effect of aerobic and high-intensity interval training on plasma pentraxin 3 and lipid parameters in overweight and obese women

Background

It is unclear whether different exercise programs lead to an increase in the concentration of plasma Pentraxin3 (PTX3), an anti-inflammatory protein. This study aimed to investigate the effects of aerobic exercise (AE) and high-intensity interval training (HIIT) on plasma PTX3 levels in overweight and obese women.

Method

A total of 45 sedentary women aged between 32.26 ± 6.30 voluntarily participated in the study. The control group (CG, n = 15) was selected among normal-weight women. Women in the group of participants who partook in exercise consisted of overweight and obese women according to a random method, including the AE group (n = 15) and the HIIT group (n = 15). The AE session conducted was 50 min in duration and consisted of warm-up exercises (5 min), and primary exercises (40 min, basic aerobic-step exercises). HIIT consists of warm-up exercises (5 min), primary exercises (work intervals: 6-10 × 1 min (80-90% HRmax), rest intervals: 1 min (walk, 50% HRmax), 21-29 min running. The exercises were applied for three sessions/week for 12 weeks. Fasting blood samples were taken from all participants before and after exercise and their body composition was measured.

Results

As a result of two different 12-week exercises, serum PTX3 levels increased significantly by 47.53% in the AE group and 50.21% in the HIIT group (p < 0.01). It was determined that the mean PTX3 before and after exercise increased from 1.71 ± 0.43 to 2.47 ± 0.40 ng/dL and HIIT from 1.62 ± 0.39 to 2.31 ± 0.33 ng/dL. A significant decrease in body mass index (BMI) values were detected, approximately 5.81% in the AE group and 5.06% in the HIIT group (p < .01). A significant decrease was detected in glucose, insulin, HOMA-IR, LDL-C, and hsCRP whereas HDL-C and VO2max value increased significantly in both exercise groups (p < .05; p < .01). There were no significant differences in TG and TC levels between groups (p > .05). Also, no significant differences were found between the two types of exercises in terms of parameters. A significant negative correlation in the total sample was found between PTX3 with BMI, fat mass, LDL-C, and hsCRP.

Conclusion

The percentage change in PTX3 values was not different between exercise types, whereas PTX3 was increased with exercise, regardless of the type of exercise. It can be said that both aerobic and HIIT increase PTX3, VO2max levels and improve lipid metabolism in overweight and obese women.

Health-enhancing physical activity in obesity management: the need to (seriously) go beyond weight loss

There are many false hopes around the impact of physical activity and exercise in obesity management, especially regarding weight loss. Narrowly focusing on weight loss only leads to disappointment for patients and practitioners. Indeed, in persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight and fat loss compared to the absence of training. However the magnitude of this effect remains modest, amounting to only 2-3 kg additional weight or fat loss on average. We therefore argue that this conversation needs to be re-oriented towards the many potential health benefits of physical activity that can be seen beyond weight loss. Exercise training has been shown to improve the cardiometabolic risk profile by effects including decreasing abdominal visceral fat and improving insulin sensitivity. Aerobic, as well as combined aerobic and resistance (i.e. strength) training, increase cardiorespiratory fitness, a major risk factor for ill health. Resistance training improves muscle strength, another major component of physical fitness, even in the absence of a significant change in muscle mass. Beyond body mass loss, recognizing the broad value of physical activity/exercise in improving health and quality of life of people with obesity is a crucial perspective shift.

Diet and physical exercise in elderly people with obesity: The state of the art

Obesity is a disease that is assuming pandemic proportions in recent decades. With the advancement of medicine and increased access to care, average survival has increased, resulting in a larger number of elderly people. As a result, the amount of elderly people living with obesity is increasing, and the morbidity and impact of obesity on ageing implies severe limitations for these people. The link between obesity and ageing is not only epidemiological, but also strictly pathophysiological. Obesity accelerates the ageing process and ageing is characterised by pathophysiological mechanisms shared by obesity itself. Some examples of alterations shared by ageing and obesity are metabolic changes, sarcopenia and reduced functional capacity related to both loss of muscle strength and reduced cardiorespiratory fitness, as well as a general reduction in the perception of quality of life. The specific ability to antagonize these mechanisms through non-pharmacological treatment based on nutrition and exercise has always been one of the focal points of the international literature. Therefore, this review provides the state of the art on scientific knowledge regarding the main effects of an adequate nutritional plan and an individualised exercise prescription on the general health of elderly with obesity. In particular, this paper addresses the effect of nutrition and physical exercise on pathophysiological changes peculiar of ageing and obesity, providing also the scientific rational for nutritional and exercise prescription in the population.

Association of physical activity and sports participation with insulin resistance and non-alcoholic fatty liver disease in people with type 1 diabetes

AIM

To evaluate the association between physical activity (PA) and sports participation with insulin resistance and non-alcoholic fatty liver disease (NAFLD) in people with type 1 diabetes (T1D).

METHODS

People with T1D from a secondary and tertiary care centre were included. Questionnaire-derived PA was expressed in metabolic equivalent of task hours per week (METh/week). Insulin sensitivity was calculated with the estimated glucose disposal rate (eGDR). NAFLD was assessed by transient elastography (TE). Multivariate linear and logistic regression models were conducted, adjusted for age, sex, diabetes duration and BMI.

RESULTS

In total, 254 participants were included (men 56%, age 44 ± 14 years, diabetes duration 24 ± 14 years, median BMI 24.8 kg/m2), of which 150 participants underwent TE. Total PA (median 50.7 METh/week) was not significantly associated with insulin resistance (median eGDR 7.31 mg/kg/min) (beta -0.00, 95% CI -0.01 to 0.00) or with NAFLD (OR 1.00, 95% CI 0.99-1.01). Participating in sports was significantly associated with eGDR (beta 0.94, 95% CI 0.48-1.41) and with NAFLD (OR 0.21, 95% CI 0.08-0.56).

CONCLUSIONS

In our T1D population, we could not find any dose-dependent association between PA, insulin resistance and NAFLD. People participating in sports had a lower degree of insulin resistance and lower odds for NAFLD.

The effects of extracellular vesicles and their cargo on metabolism and its adaptation to physical exercise in insulin resistance and type 2 diabetes

Lifestyle modification represents the first-line strategy for the prevention and treatment of type 2 diabetes mellitus (T2DM), which is frequently associated with obesity and characterized by defective pancreatic insulin secretion and/or insulin resistance. Exercise training is an essential component of lifestyle modification and has been shown to ameliorate insulin resistance by reducing body fat mass and by enhancing skeletal muscle mitochondrial biogenesis and insulin-independent glucose uptake. Additionally, exercising stimulates the release of exerkines such as metabolites or cytokines, but also long non-coding RNA, microRNAs, cell-free DNA (cf-DNA), and extracellular vesicles (EVs), which contribute to inter-tissue communication. There is emerging evidence that EV number and content are altered in obesity and T2DM and may be involved in several metabolic processes, specifically either worsening or improving insulin resistance. This review summarizes the current knowledge on the metabolic effects of exercise training and on the potential role of humoral factors and EV as new biomarkers for early diagnosis and tailored treatment of T2DM.

Effects of 12-week Circuit Exercise Intervention on Blood Pressure, Vascular Function, and Inflammatory Cytokines in Obese Older Women with Sarcopenia

Background

This study investigates the effects of a 12-week circuit exercise program on blood pressure, vascular function, and inflammatory cytokines in older obese women with sarcopenia.

Methods

Twenty-eight older obese women with sarcopenia (mean age: 78.2 ± 3.7 years) were randomly divided into an exercise group (EG, n = 14) and a control group (CG, n = 14). The EG participated in a 12-week circuit exercise training regimen, conducted three times weekly, with each session lasting between 45 to 75 minutes (progressively increased over time). The CG was advised to maintain their regular daily routines throughout the intervention period. All dependent variables, including blood pressure, vascular function, and inflammation cytokines, were evaluated pre- and post-intervention.

Results

Positive changes were observed in the EG in body composition (body fat mass; p < 0.001, body fat percentage; p < 0.01, free-fat mass; p < 0.01), blood pressure (heart rate; p < 0.05, rate pressure product; p < 0.01), vascular function (brachial-ankle pulse wave velocity; p < 0.05, flow-mediated dilation; p < 0.001), and inflammation cytokines (interleukin-6; p < 0.05). In the CG, there was an increase in body fat mass (p < 0.05) and body fat percentage (p < 0.05), while no changes were observed in other variables.

Conclusions

The 12-week circuit exercise program significantly reduced blood pressure, improved vascular function, and decreased inflammatory cytokines in obese older women with sarcopenia. However, individual variations in response highlight the need for personalized exercise regimens.

An overview of therapeutic options of obesity management in India: the Integrated Diabetes and Endocrinology Academy (IDEA) 2023 Congress update

INTRODUCTION

With newer anti-obesity medications (AOMs) being introduced at a rapid pace, it is prudent to make a concise and updated clinical practice document that may help busy clinicians in daily clinical practice. A group of metabolic physicians, diabetologists, endocrinologists, and bariatric surgeons assembled during the Integrated Diabetes and Endocrine Academy 2023 Congress (IDEACON, July 2023, Kolkata, India) to compile an update of pharmacotherapeutic options for managing people with obesity in India.

AREAS COVERED

After an extensive review of the literature by experts in different domains, this update provides all available information on the management of obesity, with a special emphasis on both currently available and soon-to-be-available AOMs, in people with obesity.

EXPERT OPINION

Several newer AOMs have been shown to reduce body weight significantly, thus poised to make a paradigm shift in the management of obesity. While the tolerability and key adverse events associated with these AOMs appear to be acceptable in randomized controlled trials, pharmacovigilance is vital in real-world settings, given the absence of sufficiently long-term studies. The easy availability and affordability of these drugs is another area of concern, especially in developing countries like India.

Cold-induced changes in plasma signaling lipids are associated with a healthier cardiometabolic profile independently of brown adipose tissue

Cold exposure activates brown adipose tissue (BAT) and potentially improves cardiometabolic health through the secretion of signaling lipids by BAT. Here, we show that 2 h of cold exposure in young adults increases the levels of omega-6 and omega-3 oxylipins, the endocannabinoids (eCBs) anandamide and docosahexaenoylethanolamine, and lysophospholipids containing polyunsaturated fatty acids. Contrarily, it decreases the levels of the eCBs 1-LG and 2-LG and 1-OG and 2-OG, lysophosphatidic acids, and lysophosphatidylethanolamines. Participants overweight or obese show smaller increases in omega-6 and omega-3 oxylipins levels compared to normal weight. We observe that only a small proportion (∼4% on average) of the cold-induced changes in the plasma signaling lipids are slightly correlated with BAT volume. However, cold-induced changes in omega-6 and omega-3 oxylipins are negatively correlated with adiposity, glucose homeostasis, lipid profile, and liver parameters. Lastly, a 24-week exercise-based randomized controlled trial does not modify plasma signaling lipid response to cold exposure.

Exploring factors influencing farmers' health self-assessment in China based on the LASSO method

As the main force and practice subject of rural revitalisation, farmers' health is intricately linked to agricultural production and the rural economy. This study utilizes open data from the 2015 China Nutrition and Health Survey and employs the Least Absolute Shrinkage and Selection Operator (LASSO) method to explore the factors influencing farmers' self-assessment of health. The findings reveal that education level, proactive nutrition knowledge seeking, healthy dietary preferences and habits, and the use of clean cooking fuel positively impact farmers' health self-assessment. Conversely, age, history of illness or injury, and participation in medical insurance negatively affect their self-assessment. Furthermore, factors influencing farmers' health self-assessment exhibit heterogeneity across regions. Our findings suggest that promoting health education, disseminating nutritional dietary knowledge, and enhancing rural household infrastructure play an important role in improving farmers' self-evaluation of health. Therefore, policymakers should design more targeted health interventions and infrastructure improvement plans based on farmers' self-assessment of health and the level of regional economic development.

The effects of combined exercise training on glucose metabolism and inflammatory markers in sedentary adults: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to determine the magnitude of the effect of combined exercise training on glucose metabolism markers, adipokines, and inflammatory cytokines in non-diabetic sedentary adults. PubMed, Web of Science, Scopus, Cochrane Library electronic databases and reference lists of included studies were explored for randomized controlled trials (RCTs) that included physically inactive adults and provided combined training interventions (aerobic plus resistance exercise). Effects on fasting glucose and insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), HbA1c, adiponectin, leptin, IL-6, TNF-α, and C-reactive protein (CRP) in exercise vs control groups were analyzed using random effects meta-analysis. The Cochrane Risk of Bias Tool for Randomized Trials 2.0 (RoB 2) was used to assess the risk of bias. A total of 24 RCTs were included in the quantitative analysis. Combined exercise training significantly decrease fasting glucose (standardized mean difference, SMD: - 0.474, 95% CI [- 0.829, - 0.120], p = 0.009, 35 study arms), fasting insulin (SMD: - 1.024, 95% CI [- 1.502, - 0.545], p < 0.001, 27 study arms), HOMA-IR (SMD: - 0.946, 95% CI [- 1.450, - 0.442], p < 0.001, 23 study arms), TNF-α (SMD: - 0.972, 95% CI [- 1.361, - 0.582], p < 0.001, 10 study arms), and CRP (SMD: - 0.507, 95% CI [- 0.818, - 0.196], p = 0.001, 14 study arms). No significant effects were observed for HbA1c, adiponectin, leptin, and IL-6 levels. Random effects meta-regression models by age, sex, and intervention length were not able to explain any of the variation in the effect size of HOMA-IR. Findings from this systematic review and meta-analysis suggest that combined exercise training improves some glucose metabolism markers and inflammatory parameters in sedentary adults without diabetes.

Combined versus independent effects of exercise training and intermittent fasting on body composition and cardiometabolic health in adults: a systematic review and meta-analysis

INTRODUCTION AND AIM

Exercise training (Ex) and intermittent fasting (IF) are effective for improving body composition and cardiometabolic health overweight and obese adults, but whether combining Ex and IF induces additive or synergistic effects is less well established. We therefore, performed a systematic review and meta-analysis to compare the combined versus independent effects of Ex and IF on body composition and cardiometabolic health in adults.

METHOD

An electronic search was conducted in three main online databases including PubMed, Web of Science, and Scopus, from inception to March 9, 2023 for studies involving Ex plus IF trials versus standalone Ex and/or IF interventions in adults. Interventions had a duration of ≥ 2 weeks. Standardized (SMD) or weighted mean differences (WMD) and 95% confidence intervals were calculated in order to compare effects on body weight, body mass index (BMI), body fat lean body mass (LBM), visceral fat, and waist circumference. For cardiometabolic health, outcomes included fasting glucose, insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), triglycerides (TG), high-density lipoprotein cholesterol (HDL), systolic (SBP) and diastolic (DBP) blood pressure, and VO2max/peak.

RESULTS

Ex plus IF decreased body weight [WMD: -3.03 kg (95% CI: -3.44 to -2.61), p = 0.001], BMI [WMD: -1.12 kg.m2 (95% CI: -1.28 to -0.95), p = 0.001], body fat [SMD: -0.72 (95% CI: -1.23 to -0.21), p = 0.005], visceral fat [SMD: -0.34 (95% CI: -0.63 to -0.05), p = 0.01], and waist circumference [WMD: -2.63 cm (95% CI: -4.16 to -1.11), p = 0.001] more than Ex alone. However, changes in body composition and cardiometabolic health markers were not significantly different for Ex plus IF when compared with IF alone, with the exception of VO2max/peak [SMD: 0.55 (95% CI: 0.14 to 0.97), p = 0.009].

CONCLUSION

We demonstrate that a combination of Ex and IF produces superior changes in body composition, but not in markers of cardiometabolic health when compared with Ex or IF alone. Ex plus IF could therefore be effective for weight and fat loss but has no additive or synergistic effects for other cardiometabolic health markers.

Cdo1-Camkk2-AMPK axis confers the protective effects of exercise against NAFLD in mice

Exercise is an effective non-pharmacological strategy for ameliorating nonalcoholic fatty liver disease (NAFLD), but the underlying mechanism needs further investigation. Cysteine dioxygenase type 1 (Cdo1) is a key enzyme for cysteine catabolism that is enriched in liver, whose role in NAFLD remains poorly understood. Here, we show that exercise induces the expression of hepatic Cdo1 via the cAMP/PKA/CREB signaling pathway. Hepatocyte-specific knockout of Cdo1 (Cdo1LKO) decreases basal metabolic rate of the mice and impairs the effect of exercise against NAFLD, whereas hepatocyte-specific overexpression of Cdo1 (Cdo1LTG) increases basal metabolic rate of the mice and synergizes with exercise to ameliorate NAFLD. Mechanistically, Cdo1 tethers Camkk2 to AMPK by interacting with both of them, thereby activating AMPK signaling. This promotes fatty acid oxidation and mitochondrial biogenesis in hepatocytes to attenuate hepatosteatosis. Therefore, by promoting hepatic Camkk2-AMPK signaling pathway, Cdo1 acts as an important downstream effector of exercise to combat against NAFLD.

Influence of Sociodemographic Variables and Healthy Habits on the Values of Insulin Resistance Indicators in 386,924 Spanish Workers

BACKGROUND

Insulin resistance (IR) is an alteration of the action of insulin in cells, which do not respond adequately to this action, leading to an increase in blood glucose levels. IR produces a very diverse clinical picture and increases the cardiometabolic risk of the population that suffers from it. Among the factors that influence IR are genetics, unhealthy lifestyle habits, overweight, and obesity. The objective of this work was to determine how different sociodemographic variables and healthy habits influence the values of different scales that assess the risk of presenting IR in a group of Spanish workers.

METHODS

An observational, cross-sectional, descriptive study was carried out in 386,924 workers from different Spanish regions. Different sociodemographic variables and lifestyle habits were studied (age, social class, educational level, smoking, Mediterranean diet, physical exercise) along with their association with four scales to evaluate the risk of insulin resistance (TyG index, TyG-BMI, METS-IR, TG/HDL-c). To analyse the quantitative variables, Student's t test was used, while the Chi-squared test was used for the qualitative variables. A multinomial logistic regression analysis was performed, calculating the odds ratio with its 95% confidence intervals. The accepted level of statistical significance was set at p < 0.05.

RESULTS

In the multivariate analysis, all variables, except educational level, increased the risk of presenting high values on the IR risk scales, especially a sedentary lifestyle and low adherence to the Mediterranean diet.

CONCLUSIONS

Our results demonstrate an association between the practice of regular physical exercise and a reduction in the risk of IR; a strong role of the Mediterranean diet as a protective factor for IR; an association between aging and increased IR, which has also been suggested in other studies; and, finally, a relationship between a low socioeconomic level and an increase in IR.

Exercise in the Management of Metabolic-Associated Fatty Liver Disease (MAFLD) in Adults: A Position Statement from Exercise and Sport Science Australia

Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150-240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2-4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology.

Non-drug interventions of traditional Chinese medicine in preventing type 2 diabetes: a review

Traditional Chinese medicine (TCM) is increasingly used to manage type 2 diabetes and its nonpharmacological interventions are showing potential for preventing type 2 diabetes. This study mainly reviews relevant research. The most mentioned non-drug treatments for preventing type 2 diabetes in TCM are healthy diet, physical activity, emotional therapy, and acupuncture. In most studies, blood glucose status in patients with prediabetes and type 2 diabetes was significantly improved after TCM non-drug interventions, and there was no significant difference between the adverse effect of TCM and control groups or other intervention groups, while the methodological quality of the clinical trials involving TCM generally kept a low level. The effectiveness of TCM in preventing type 2 diabetes has yet to be validated in large randomized controlled trials and the underlying mechanism also needs further exploration.

Physical activity and exercise for weight loss and maintenance in people living with obesity

Physical activity and exercise training programs are integral part of a comprehensive obesity management approach. In persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight loss compared to the absence of training. However the magnitude of effect remains modest amounting to only 2-3 kg additional weight loss on average. Comparable effects have been observed for total fat loss. Exercise training, specifically aerobic training, is also associated with decreased abdominal visceral fat as assessed by imaging techniques, which is likely to benefit cardiometabolic health in persons with obesity. Based on data from controlled trials with randomization after prior weight loss, the evidence for weight maintenance with exercise training is as yet not conclusive, although retrospective analyses point to the value of relatively high-volume exercise in this regard. Resistance (i.e. muscle-strengthening) training is specifically advised for lean mass preservation during weight loss. Given the relatively limited effect of exercise training on weight loss as such, the changes in physical fitness brought about by exercise training cannot be overlooked as they provide major health benefits to persons with obesity. Aerobic, as well as combined aerobic and resistance training, increase cardiorespiratory fitness (VO2max) while resistance training, but not aerobic training, improves muscle strength even in the absence of a significant change in muscle mass. Regarding the overall management strategy, adherence in the long term to new lifestyle habits remains a challenging issue to be addressed by further research.

Ectopic lipid deposition in muscle and liver, quantified by proton magnetic resonance spectroscopy

Advances in the development of noninvasive imaging techniques have spurred investigations into ectopic lipid deposition in the liver and muscle and its implications in the development of metabolic diseases such as type 2 diabetes. Computed tomography and ultrasound have been applied in the past, though magnetic resonance-based methods are currently considered the gold standard as they allow more accurate quantitative detection of ectopic lipid stores. This review focuses on methodological considerations of magnetic resonance-based methods to image hepatic and muscle fat fractions, and it emphasizes anatomical and morphological aspects and how these may influence data acquisition, analysis, and interpretation.

Moderate- and High-Intensity Endurance Training Alleviate Diabetes-Induced Cardiac Dysfunction in Rats

Exercise training is an encouraging approach to treat cardiac dysfunction in type 2 diabetes (T2DM), but the impact of its intensity is not understood. We aim to investigate whether and, if so, how moderate-intensity training (MIT) and high-intensity interval training (HIIT) alleviate adverse cardiac remodeling and dysfunction in rats with T2DM. Male rats received standard chow (n = 10) or Western diet (WD) to induce T2DM. Hereafter, WD rats were subjected to a 12-week sedentary lifestyle (n = 8), running MIT (n = 7) or HIIT (n = 7). Insulin resistance and glucose tolerance were assessed during the oral glucose tolerance test. Plasma advanced glycation end-products (AGEs) were evaluated. Echocardiography and hemodynamic measurements evaluated cardiac function. Underlying cardiac mechanisms were investigated by histology, western blot and colorimetry. We found that MIT and HIIT lowered insulin resistance and blood glucose levels compared to sedentary WD rats. MIT decreased harmful plasma AGE levels. In the heart, MIT and HIIT lowered end-diastolic pressure, left ventricular wall thickness and interstitial collagen deposition. Cardiac citrate synthase activity, mitochondrial oxidative capacity marker, raised after both exercise training modalities. We conclude that MIT and HIIT are effective in alleviating diastolic dysfunction and pathological cardiac remodeling in T2DM, by lowering fibrosis and optimizing mitochondrial capacity.

Exercise metabolism and adaptation in skeletal muscle

Viewing metabolism through the lens of exercise biology has proven an accessible and practical strategy to gain new insights into local and systemic metabolic regulation. Recent methodological developments have advanced understanding of the central role of skeletal muscle in many exercise-associated health benefits and have uncovered the molecular underpinnings driving adaptive responses to training regimens. In this Review, we provide a contemporary view of the metabolic flexibility and functional plasticity of skeletal muscle in response to exercise. First, we provide background on the macrostructure and ultrastructure of skeletal muscle fibres, highlighting the current understanding of sarcomeric networks and mitochondrial subpopulations. Next, we discuss acute exercise skeletal muscle metabolism and the signalling, transcriptional and epigenetic regulation of adaptations to exercise training. We address knowledge gaps throughout and propose future directions for the field. This Review contextualizes recent research of skeletal muscle exercise metabolism, framing further advances and translation into practice.

Interventions to Address Cardiovascular Risk in Obese Patients: Many Hands Make Light Work

Obesity is a growing public health epidemic worldwide and is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk; indeed, several obesity-related mechanisms drive structural, functional, humoral, and hemodynamic heart alterations. On the other hand, obesity may indirectly cause CV disease, mediated through different obesity-associated comorbidities. Diet and physical activity are key points in preventing CV disease and reducing CV risk; however, these strategies alone are not always sufficient, so other approaches, such as pharmacological treatments and bariatric surgery, must support them. Moreover, these strategies are associated with improved CV risk factors and effectively reduce the incidence of death and CV events such as myocardial infarction and stroke; consequently, an individualized care plan with a multidisciplinary approach is recommended. More precisely, this review explores several interventions (diet, physical activity, pharmacological and surgical treatments) to address CV risk in obese patients and emphasizes the importance of adherence to treatments.

The role of physical activity in obesity: let's actively manage obesity

Obesity, physical inactivity and sedentary behaviour are major public health concerns. A complex interaction of many factors leads to obesity, which requires an individualised multicomponent management strategy. As new interventions become available to help individuals manage obesity, it is essential that physical activity remains a core part of the approach. Here, we summarise current evidence regarding the benefits of physical activity as part of a management strategy of obesity. Additionally, we discuss current methods for increasing physical activity levels in individuals with obesity and outline the role of sport and exercise medicine physicians as part of the multidisciplinary team.

The effects of exercise training on postprandial glycemia and insulinemia in adults with overweight or obesity and with cardiometabolic disorders: a systematic review and meta-analysis

BACKGROUND

We performed a systematic review and meta-analysis to investigate the effects of exercise training on postprandial glycemia (PPG) and insulinemia (PPI) in adults with overweight or obesity and with cardiometabolic disorders.

METHODS

PubMed, Web of Science, and Scopus databases were searched until May 2022 using the key words "exercise," "postprandial," and "randomized control trial" to identify original studies investigating the effects of exercise training on PPG and/or PPI in adults with a body mass indexes (BMI) ≥ 25 kg.m². Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models to calculate effect sizes for outcomes and to generate forest plots. Sub-group analyses and meta-regressions were performed for potential categorical and continuous moderators.

RESULTS

Twenty-nine studies involving 41 intervention arms and 1,401 participants were included in the systematic review and meta-analysis. Overall, exercise training significantly decreased PPG [-0.36 (95% CI -0.50 to -0.22), p=0.001] and PPI [-0.37 (95% CI -0.52 to -0.21), p=0.001]. Subgroup analyses showed that PPG decreased following both aerobic and resistance training; whereas PPI was reduced following aerobic training, independent of age, BMI, and baseline glucose levels. Meta-regression analyses showed that frequency of exercise sessions, intervention durations, and duration of exercise time, did not moderate the effects of exercise training on PPI or PPG (p>0.05).

CONCLUSION

In adults with overweight or obesity and with cardiometabolic disorders, exercise training is effective for reducing PPG and PPI, across ages and BMIs, irrespective of baseline glucose levels and exercise training characteristics.

Test-Retest Reliability and Internal Consistency of a Newly Developed Questionnaire to Assess Explanatory Variables of 24-h Movement Behaviors in Adults

A questionnaire on explanatory variables for each behavior of the 24-h movement behaviors (i.e., physical activity, sedentary behavior, sleep) was developed based on three levels of the socio-ecological model, i.e., the intrapersonal level, interpersonal level and the physical environmental level. Within these levels, different constructs were questioned, i.e., autonomous motivation, attitude, facilitators, internal behavioral control, self-efficacy, barriers, subjective norm, social modeling, social support, home environment, neighborhood, and work environment. The questionnaire was tested for test-retest reliability (i.e., intraclass correlation (ICC)) for each item and internal consistency for each construct (i.e., Cronbach's Alpha Coefficient) among a group of 35 healthy adults with a mean age of 42.9 (±16.1) years. The total questionnaire contained 266 items, consisting of 14 items on general information, 70 items on physical activity, 102 items on sedentary behavior, 45 items on sleep and 35 items on the physical environment. Seventy-one percent of the explanatory items showed moderate to excellent reliability (ICC between 0.50 and 0.90) and a majority of constructs had a good homogeneity among items (Cronbach's Alpha Coefficient ≥ 0.70). This newly developed and comprehensive questionnaire might be used as a tool to understand adults' 24-h movement behaviors.

Multimorbidity of cardiometabolic diseases: a cross-sectional study of patterns, clusters and associated risk factors in sub-Saharan Africa

OBJECTIVE

To determine the patterns of cardiometabolic multimorbidity and associated risk factors in sub-Saharan Africa (SSA).

DESIGN

We used data from the WHO STEPwise approach to non-communicable disease risk factor surveillance cross-sectional surveys conducted between 2014 and 2017.

PARTICIPANTS

The participants comprised 39, 658 respondents aged 15-69 years randomly selected from nine SSA countries using a multistage stratified sampling design.

PRIMARY OUTCOME MEASURE

Using latent class analysis and agglomerative hierarchical clustering algorithms, we analysed the clustering of cardiometabolic diseases (CMDs) including high blood sugar, hypercholesterolaemia, hypertension and cardiovascular diseases (CVDs) such as heart attack, angina and stroke. Clusters of lifestyle risk factors: harmful salt intake, physical inactivity, obesity, tobacco and alcohol use were also computed. Prevalence ratios (PR) from modified Poisson regression were used to assess the association of cardiometabolic multimorbidity with sociodemographic and lifestyle risk factors.

RESULTS

Two distinct classes of CMDs were identified: relatively healthy group with minimal CMDs (95.2%) and cardiometabolic multimorbidity class comprising participants with high blood sugar, hypercholesterolaemia, hypertension and CVDs (4.8%). The clusters of lifestyle risk factors included alcohol, tobacco and harmful salt consumption (27.0%), and physical inactivity and obesity (5.8%). The cardiometabolic multimorbidity cluster exhibited unique sociodemographic and lifestyle risk profiles. Being female (PR=1.7, 95% CI (1.5 to 2.0), middle-aged (35-54 years) (3.9 (95% CI 3.2 to 4.8)), compared with age 15-34 years, employed (1.2 (95% CI 1.1 to 1.4)), having tertiary education (2.5 (95% CI 2.0 to 3.3)), vs no formal education and clustering of physical inactivity and obesity (2.4 (95% CI 2.0 to 2.8)) were associated with a higher likelihood of cardiometabolic multimorbidity.

CONCLUSION

Our findings show that cardiometabolic multimorbidity and lifestyle risk factors cluster in distinct patterns with a disproportionate burden among women, middle-aged, persons in high socioeconomic positions, and those with sedentary lifestyles and obesity. These results provide insights for health systems response in SSA to focus on these clusters as potential targets for integrated care.

The effect of acute and chronic exercise on hepatic lipid composition

Exercise is recommended for those with, or at risk of nonalcoholic fatty liver disease (NAFLD), owing to beneficial effects on hepatic steatosis and cardiometabolic risk. Whilst exercise training reduces total intrahepatic lipid in people with NAFLD, accumulating evidence indicates that exercise may also modulate hepatic lipid composition. This metabolic influence is important as the profile of saturated (SFA), monounsaturated (MUFA), and polyunsaturated fatty acids (PUFA) dramatically affect the metabolic consequences of hepatic lipid accumulation; with SFA being especially lipotoxic. Relatedly, obesity and NAFLD are associated with hepatic PUFA depletion and elevated SFA. This review summarizes the acute (single bout) and chronic (exercise training) effects of exercise on hepatic lipid composition in rodents (acute studies: n = 3, chronic studies: n = 13) and humans (acute studies: n = 1, chronic studies: n = 3). An increased proportion of hepatic PUFA after acute and chronic exercise is the most consistent finding of this review. Mechanistically, this may relate to an enhanced uptake of adipose-derived PUFA (reflecting habitual diet), particularly in rodents. A relative decrease in the proportion of hepatic MUFA after chronic exercise is also documented repeatedly, particularly in rodent models with elevated hepatic MUFA. This outcome is related to decreased hepatic stearoyl-CoA desaturase-1 activity in some studies. Findings regarding hepatic SFA are less consistent and limited by the absence of metabolic challenge in rodent models. These findings require confirmation in well-controlled interventions in people with NAFLD. These studies will be facilitated by recently validated magnetic resonance spectroscopy techniques, able to precisely quantify hepatic lipid composition in vivo.

Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial

Innovative non-pharmacological lifestyle strategies to treat non-alcoholic fatty liver disease (NAFLD) are critically needed. This study compared the effects of alternate day fasting (ADF) combined with exercise to fasting alone, or exercise alone, on intrahepatic triglyceride (IHTG) content. Adults with obesity and NAFLD (n = 80, 81% female, age: 23-65 years) were randomized to 1 of 4 groups for 3 months: combination of ADF (600 kcal/2,500 kJ "fast day" alternated with an ad libitum intake "feast day") and moderate-intensity aerobic exercise (5 session per week, 60 min/session); ADF alone; exercise alone; or a no-intervention control group. By month 3, IHTG content was significantly reduced in the combination group (-5.48%; 95% CI, -7.77% to -3.18%), compared with the exercise group (-1.30%; 95% CI, -3.80% to 1.20%; p = 0.02) and the control group (-0.17%; 95% CI, -2.17% to 1.83%; p < 0.01) but was not significantly different versus the ADF group (-2.25%; 95% CI, -4.46% to -0.04%; p = 0.05). Body weight, fat mass, waist circumference, and alanine transaminase (ALT) levels significantly decreased, while insulin sensitivity significantly increased in the combination group compared with the control group. Lean mass, aspartate transaminase (AST), HbA1c, blood pressure, plasma lipids, liver fibrosis score, and hepatokines (fetuin-A, FGF-21, and selenoprotein P) did not differ between groups. Combining intermittent fasting with exercise is effective for reducing hepatic steatosis in patients with NAFLD but may offer no additional benefit versus fasting alone.

Role of physical activity and cardiorespiratory fitness in metabolically healthy obesity: a narrative review

Obesity has been associated with a multitude of metabolic disorders, often clustering with risk factors of cardiovascular disease and type 2 diabetes mellitus, hypertension, dyslipidaemia. Overall, obesity is a worldwide, growing health concern. However, a subgroup of obese individuals with a low burden of metabolic abnormalities have been identified and described as metabolically healthy obese (MHO). Whether the MHO phenotype is protective against obesity-related metabolic disorders in the long-term is presently unclear, and current research examining the potential transition has yielded inconsistent results. In this current narrative review, we aim to provide insights on the role of physical activity (PA) and cardiorespiratory fitness (CRF) in MHO. Lifestyle factors such as PA and CRF may influence the MHO phenotype. Limited studies have characterised energy expenditure and CRF in MHO and metabolically unhealthy obese. However, higher levels of PA, less sedentary behaviour and higher CRF have been observed in MHO individuals. Considering the multiple benefits of PA, it is high time to advocate this lifestyle change beyond its influence on energy balance in a weight loss programme to improve cardiovascular and metabolic risk factors irrespective of body weight and fat mass changes. Improved CRF via increased PA, especially exercise participation, while avoiding weight gain is not only a realistic goal, but should be the primary intervention for MHO populations to prevent the transition to an abnormal metabolic state.

The Relationship between Health-Related Fitness and Quality of Life in Nonalcoholic Fatty Liver Disease

BACKGROUND

It is well known that patients with nonalcoholic fatty liver disease (NAFLD) suffer from impaired quality of life (QoL) and decreased health-related fitness. Studies on the relationship between them have been scarce.

METHODS

A cross-sectional survey was performed in 104 NAFLD patients. Liver fat content and fibrosis were assessed using transient elastography. Health-related fitness was measured by fitness test. VO₂max was determined by YMCA submaximal cycle ergometer test. Body composition was tested by bioimpedance analysis. QoL was evaluated using the 36-item Short Form Health Survey Questionnaire (SF-36).

RESULTS

Most patients had severe liver steatosis without significant fibrosis. Most of them exhibited poor health-related fitness. Multiple linear regression analyses demonstrated that body compositions (waist circumference, hip circumference, percent body fat, percent skeletal muscle, visceral fat area) dependently contributed to QoL (health transition, role limitation due to physical problem, general health, physical functioning and vitality). VO₂max was positively related with physical functioning.

CONCLUSION

For NAFLD patients, decreased health-related fitness was associated with impaired QoL both in the physical and mental dimension. Our results indicate that visceral fat together with muscle mass and VO₂max could serve as individual exercise intervention targets to improve QoL.

Acute Effects of Whole-Body Electromyostimulation on Energy Expenditure at Resting and during Uphill Walking in Healthy Young Men

The effects of the different electrical frequencies of whole-body electrical stimulation (WB-EMS) on energy expenditure (EE) and the respiratory exchange ratio (RER) remain poorly understood. This study aimed to determine the effects of different WB-EMS electrical frequencies on EE and the RER during supine resting and uphill walking. A total of 10 healthy and recreationally active men (21.6 ± 3.3 years old) participated in the present study. Participants completed two testing sessions in a randomized order. In each session, a variety of impulse frequencies (1 hertz (Hz), 2 Hz, 4 Hz, 6 Hz, 8 Hz, and 10 Hz) were applied in a randomized order, allowing a 10 min passive recovery between them. Oxygen consumption and carbon dioxide production were measured to calculate EE and the RER. All frequencies increased EE at rest (all p ≤ 0.001), with 4 Hz being the frequency producing the highest increase (Δ = 8.89 ± 1.49 kcal/min), as did 6 Hz (Δ = 8.05 ± 1.52 kcal/min) and 8 Hz (Δ = 7.04 ± 2.16 kcal/min). An increment in the RER at rest was observed with 4 Hz, 6 Hz, 8 Hz and 10 Hz (all p ≤ 0.016), but not with 1 Hz and 2 Hz (p ≥ 0.923). During uphill walking, the frequency that elicited the highest increase in EE was 6 Hz (Δ = 4.87 ± 0.84 kcal/min) compared to the unstimulated condition. None of the impulse frequencies altered the RER during uphill walking. WB-EMS increases EE in healthy young men both during resting and uphill walking.

Prospective evaluation of cardiac effects of first-time marathon training, running, and recovery in middle-aged men: cohort study rationale and design

BACKGROUND

Several phenomena may point to potentially detrimental cardiac effects of endurance exercise, such as elevated circulating cardiac troponin levels and reductions in systolic and diastolic function directly after marathon completion. Furthermore, while myocardial abnormalities have been reported in patients who recovered from COVID-19, the cardiac impact of extensive endurance exercise in individuals who recovered from COVID-19 remains unknown. We therefore aim to investigate (potentially detrimental) cardiac effects of first-time marathon training and participation, including a subset of participants who recovered from COVID-19, in apparently healthy middle-aged men.

STUDY DESIGN

This exploratory prospective cohort study investigates cardiac effects of first-time marathon running in 24 middle-aged (35-50 years) healthy men. Primary outcomes are cardiac morphological changes from pre-training up to 1 month after marathon completion, measured with magnetic resonance imaging (MRI) at 4 time points: 1) baseline (4 months before the marathon), 2) pre-marathon (2 weeks before the marathon), 3) post-marathon (< 24 h post-marathon), and 4) recovery (4 weeks after the marathon). Secondary parameters include other cardiac or non-cardiac changes: 1) quantitative MRI myocardial mapping, including mean diffusivity and extracellular volume fraction, 2) echocardiographic morphology and function changes, 3) VO₂max, 4) electrocardiogram changes, and 5) levels of cardiac biomarkers.

DISCUSSION

This study will contribute to our understanding of cardiac adaptations and maladaptations to first-time marathon running in middle-aged men, and the interaction between extreme endurance exercise and potential detrimental cardiac effects, also in the context of COVID-19. Results will inform on future research directions while providing new clinical insights for health professionals involved in athlete care.

Meteorin-like protein (Metrnl): A metabolic syndrome biomarker and an exercise mediator

Metrnl is a secreted protein able to activate different intracellular signaling pathways in adipocytes, macrophages, myocytes and cardiomyocytes with physiological effects of the browning of white adipose tissue (BWT), insulin sensitivity, inflammation inhibition, skeletal muscle regeneration and heart protection. Shown to be regulated by obesity, diabetes, caloric restriction, weight loss and heart diseases, Metrnl is definitely involved in metabolic turbulences, and may play roles in metabolic syndrome (MetS). However, due to the conflicting data yielded, Metrnl is still far from clinical application as a diagnostic and/or a therapeutic agent or even a therapeutic target in MetS-related diseases such as type 2 diabetes (T2D) and obesity. Nevertheless, blood Metrnl levels as well as Metrnl as a cardiokine have been reported to play cardioprotective roles against heart diseases. Considering the established metabolic and anti-inflammatory hallmarks, exercise-induced Metrnl (as a myokine) is regarded as an exercise mediator in improving obesity-induced complications such as insulin resistance, T2D and inflammation. Besides, due to its healing role in muscle damage, Metrnl is also a potential therapeutic candidate to enhance regeneration with ageing or other inflammatory myopathies like Duchenne muscular dystrophy (DMD). Therefore, there are still many exercise-related questions unanswered on Metrnl, such as Metrnl-mediated fat browning in humans, exercise effects on heart Metrnl production and secretion and the effects of other exercise-induced skeletal muscle stressors like hypoxia and oxidative in Metrnl production other than exercise-induced muscle damage.

Very Low-Carbohydrate High-Fat Diet Improves Risk Markers for Cardiometabolic Health More Than Exercise in Men and Women With Overfat Constitution: Secondary Analysis of a Randomized Controlled Clinical Trial

Purpose

This randomized controlled parallel-group study examined the effects of a very low-carbohydrate high-fat (VLCHF) diet and high-intensity interval training (HIIT) program over 12-weeks on cardiometabolic risk factors in individuals with overfat constitution.

Methods

Ninety-one participants out of 109 completed the study. The participants were randomly allocated to the HIIT (N = 22), VLCHF (N = 25), VLCHF+HIIT (N = 25), or control (N = 19) groups for 12 weeks. Fasting plasma samples were collected before the intervention and after 4 and 12 weeks. The analyzed outcomes included complete blood count, glucose, insulin, glycated hemoglobin, triglycerides (TG), cholesterol, high- and low-density lipoprotein (HDL-C and LDL-C), lipoprotein(a), adiponectin (Adpn), leptin (Lep), tumor necrosis factor α (TNF-α), other interleukins (hs-IL-6, IL-1β, and IL-10), and IL-1RA. The homeostasis model assessment of insulin resistance (HOMA-IR), Adpn/Lep ratio, TG/HDL-C ratio, and TyG index were calculated and analyzed. Blood pressure was measured before the intervention, after 4, 8, and 12 weeks (ClinicalTrials.gov: NCT03934476).

Results

Absolute changes in HOMA-IR, Adpn/Lep ratio, LDL-C, and diastolic blood pressure after 12 weeks differed by study groups (p < 0.05). The most pronounced changes were revealed in the VLCHF (ΔM [95% CI]; HOMA-IR: -0.75 [-1.13; -0.55]; Adpn/Lep: 9.34 [6.33; 37.39]; LDL-C: 0.06 [-0.12; 0.50] mmol/l) and VLCHF+HIIT (HOMA-IR: -0.44 [-1.14; 0.12]; Adpn/Lep: 4.26 [2.24; 13.16]; LDL-C: 0.25 [-0.04; 0.50] mmol/l) groups.

Conclusions

A 12-week VLCHF diet intervention in individuals with overfat constitution is effective for favorable changes in HOMA-IR (compared to HIIT), Adpn/Lep ratio, and diastolic blood pressure. HIIT, or HIIT combined with the VLCHF diet, had no additional benefits for the analyzed variables. No adverse side effects were observed.

The Effect of High-intensity Interval Training vs Moderate-intensity Continuous Training on Liver Fat: A Systematic Review and Meta-Analysis

CONTEXT

Non-alcoholic fatty liver disease, characterized by excess fat accumulation in the liver, is considered the hepatic manifestation of metabolic syndrome. Recent findings have shown that high-intensity interval training (HIIT) can reduce liver fat but it is unclear whether this form of exercise is superior to traditional moderate-intensity continuous training (MICT).

OBJECTIVE

The aim of this systematic review was to determine the effect of HIIT vs MICT on liver fat in adults. A secondary aim was to investigate the interaction between total weekly exercise volume and exercise-related energy expenditure and change in liver fat.

METHODS

Relevant databases were searched up to December 2020 for randomized trials, comparing HIIT to control, MICT to control, or HIIT to MICT. Studies were excluded if they did not implement 2 or more weeks' intervention or assess liver fat using magnetic resonance-based techniques. Weighted mean differences and 95% CIs were calculated. Regression analyses were undertaken to determine the interaction between weekly exercise volume in minutes and kilocalories (kcal) with change in liver fat content.

RESULTS

Of the 28 268 studies screened, 19 were included involving 745 participants. HIIT and MICT both elicited moderate reductions in liver fat content when compared to control (HIIT: -2.85%, 95% CI, -4.86 to -0.84, P = .005, I2 = 0%, n = 114, low-certainty evidence; MICT: -3.14%, 95% CI, -4.45 to -1.82, P < .001, I2 = 5.2%, n = 533, moderate-certainty evidence). There was no difference between HIIT and MICT (-0.34%, 95% CI, -2.20 to 1.52, P = .721, I2 = 0%, n = 177, moderate-certainty evidence). Neither total exercise volume in minutes (β = .0002, SE = 0.0017, Z = 0.13, P = .89) nor exercise-related energy expenditure in kcal (β = .0003, SE = 0.0002, Z = 1.21, P = .23) were related to changes in liver fat content.

CONCLUSION

HIIT elicits comparable improvements in liver fat to MICT despite often requiring less energy and time commitment. Further studies should be undertaken to assess the relative importance of aerobic exercise prescription variables, such as intensity, on liver fat.

A Combination of Aerobic Exercise at Fatmax and Low Resistance Training Increases Fat Oxidation and Maintains Muscle Mass, in Women Waiting for Bariatric Surgery

PURPOSE

There is no consensus on the best exercise recommendation for women affected by severe obesity while they are waiting for bariatric surgery. For this reason, the effects of a combination of aerobic exercise performed at the intensity at which maximal fat oxidation is reached (Fatmax) with low-intensity resistance training were studied.

MATERIALS AND METHODS

Twenty sedentary middle-aged Caucasian women (43.2 ± 7.5 years, BMI = 46.5 ± 5.9 kg·m^-2) were allocated to a control group (CG, n = 10) that followed solely the conventional preoperative care or to an experimental group (EG, n = 10) that, in addition, performed a 12-week individualized and supervised physical activity program (PAP) that combined aerobic training at Fatmax with low-intensity resistance training.

RESULTS

After the PAP, maximal fat oxidation during exercise increased in the EG (0.187 ± 0.068 vs 0.239 ± 0.080 g·min^-1, p = 0.025, pre vs. post, respectively), but resting fat oxidation did not (0.088 ± 0.034 vs 0.092 ± 0.029 g·min^-1, p = 0.685, pre vs. post, respectively). Additionally, the resting metabolic rate in the EG was also unchanged (1869 ± 406 vs. 1894 ± 336 kcal; p = 0.827, pre vs. post, respectively), probably because of the effects of resistance training on the maintenance of fat-free mass. No significant changes were observed in the CG.

CONCLUSION

A PAP that combines aerobic exercise at Fatmax with low resistance training may counteract some of the deleterious side effects of the standard presurgical care of women waiting for bariatric surgery and increase maximal fat oxidation during exercise.

Impact of BMI, Physical Activity, and Sitting Time Levels on Health-Related Outcomes in a Group of Overweight and Obese Adults with and without Type 2 Diabetes

Physical activity level and sedentary behaviors affect health status in people with obesity and type 2 diabetes (DM2); their assessment is mandatory to properly prescribe exercise programs. From January 2011 to February 2014, 293 overweight/obese adults (165 women and 128 men, mean age of 51.9 ± 9.5 years and 54.6 ± 8.3 years, respectively), with and without DM2, participated in a three-month intensive exercise program. Before starting, participants were allocated into three subgroups (overweight, body mass index or BMI = 25-29.9; class 1 of obesity, BMI = 30-34.4; or class 2 (or superior) of obesity, BMI > 35). The international physical activity questionnaire (IPAQ-it) was used to evaluate participants' baseline sitting time (SIT) and physical activity level (PAL). Stratified multiple analyses were performed using four subgroups of SIT level according to Ekelund et al., 2016 (low, 8 h/day of SIT) and three subgroups for PAL (high, moderate, and low). Health-related measures such as anthropometric variables, body composition, hematic parameters, blood pressure values, and functional capacities were studied at the beginning and at the end of the training period. An overall improvement of PAL was observed in the entire sample following the three-month intensive exercise program together with a general improvement in several health-related measures. The BMI group factor influenced the VO₂ max variations, leg press values, triglycerides, and anthropometric variables, while the SIT group factor impacted the sitting time, VO₂ max, glycemic profile, and fat mass. In this study, baseline PAL and SIT did not seem to influence the effects of an exercise intervention. The characteristics of our educational program, which also included a physical exercise protocol, allowed us to obtain positive results.

Development and validation of dietary and lifestyle insulinemic indices among Iranian adult population

BACKGROUND

There is no study regarding developing a valid index to predict insulin-related disorders in the Iranian population based on their dietary habits and lifestyle. In the current study, we aimed to develop and validate insulinemic potential indices of diet and lifestyle in Iranian adults.

METHODS

In this cross-sectional study, we analysed data of 1063 men and women aged ≥ 25 years among participants of the examination three of Tehran lipid and glucose study (TLGS) (2006-2008). Dietary intakes were assessed using a valid semi-quantitative food frequency questionnaire. Dietary and lifestyle indices were developed using stepwise linear regression analysis based on dietary intakes, body mass index, and physical activity data. Fasting serum insulin concentration and homeostatic model assessment for insulin resistance (HOMA-IR) were used as biomarkers of hyperinsulinemia (HI) and insulin resistance (IR). Validation analyses were performed in examination four of TLGS.

RESULTS

We developed four indices related to insulin homeostasis, including the dietary index for HI (DIH), the dietary index for IR (DIR), the lifestyle index for HI (LIH), and the lifestyle index for IR (LIR). Based on multivariable-adjusted models, the relative values of the biomarker in subjects in the highest quartile of indices were 45% for LIH (95% CI 1.36-1.55, P_trend < 0.001), 28% for DIR (95% CI 1.13-1.42, P_trend = 0.019), and 51% for LIR (95% CI 1.41-1.61, P_trend < 0.001), higher than those in the reference quartile, respectively.

CONCLUSION

We designed and validated indices to determine the insulin potential of diet and lifestyle for the Iranian population, according to Iran's demographic and dietary intake characteristics.

Metabolic benefits of changing sedentary lifestyles in nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials

This study seeks to evaluate the effects of a reversal of sedentary lifestyles on the improvement of metabolic profiles in patients with NAFLD. The PubMed, Cochrane Library, Web of Science, and CNKI databases were searched up to May 15, 2021. Ten randomized controlled trials on changes in the sedentary lifestyle of patients with NAFLD were included in the analysis. Data from self-controlled case arms of randomized controlled trials investigating sedentary lifestyle alterations were extracted, and the effect size was reported as the MD and 95% CI. A total of 455 participants in 10 studies met the selection criteria. The results showed that changing a sedentary lifestyle can significantly improve ALT [MD = 4.35 (U/L), 95% CI: 0.53, 8.17], CHOL [MD = 0.31 (mmol/L), 95% CI: 0.19, 0.43], TG [MD = 0.22 (mmol/L), 95% CI: 0.10~0.34], LDL-C [MD = 0.30 (mmol/L), 95% CI: 0.02, 0.57], fasting blood glucose [MD = 0.17 (mmol/L), 95% CI: 0.03, 0.31], insulin [MD = 3.23 (pmol/L), 95% CI: 1.37~5.08], and HOMA-IR levels (MD = 0.39, 95% CI: 0.15, 0.63). Changing sedentary lifestyle can also significantly improve body mass index (BMI) [MD = 1.12 (kg/m²), 95% CI: 0.66, 0.58], body fat (%) [MD = 0.34 (%), 95% CI: 0.13, 0.55] and VO_2peak levels [MD = -4.00 (mL/kg/min), 95% CI: -5.93, -2.06]. No differences in AST or GGT were noted before or after lifestyle changes. Altering a sedentary lifestyle to a lifestyle with regular exercise can slightly improve the levels of liver enzymes, blood lipids, blood glucose, insulin resistance, and body mass index in NAFLD patients.

Physical Activity, Obesity and Weight Loss Maintenance

Regular physical activity has an impact on all human organ systems and mediates multiple beneficial effects on overall health. Physical activity alone is a poor strategy for weight loss; however, physical activity is of crucial importance for weight loss maintenance. The role of exercise in maintaining a stable body weight is not clear but might be related to better appetite regulation and food preference. In relation to exercise, muscle secretes myokines and other factors that can influence the metabolism in other organs, not least fat and brain tissues. Thereby, physical activity reduces the risk of obesity-associated diseases, such as type 2 diabetes and cardiovascular diseases, independently of weight loss and BMI. Therefore, physical activity should always be included in weight loss strategies and as a tool to maintain a healthy weight, despite its modest effect on energy expenditure and overall body weight.

Effect of Mori ramulus on the postprandial blood glucose levels and inflammatory responses of healthy subjects subjected to an oral high-fat/sucrose challenge: A double-blind, randomized, crossover clinical trial

Blood glucose is inadequately controlled in diabetes mellitus, causing various inflammation-related complications. This study aimed to investigate responses to an oral sucrose/lipid challenge in the context of glucose metabolism after consumption of Mori ramulus (MR) extract. In this study on healthy subjects, the optimal dose and safety of MR were confirmed in a preliminary pilot trial (n = 24), meanwhile, blood glucose, insulin, and inflammatory marker levels were detected via an oral sucrose/lipid tolerance test in the main trial (n = 36). In the main study, the blood glucose response was significantly decreased after 240 min in the MR group. Compared to the placebo group, the treatment group exhibited plasma insulin levels that were significantly increased at 120 min and decreased at 240 min. In conclusion, a single MR extract dose protects against inflammation induced by high-fat/sugar to maintain normal insulin secretion and thus helps to maintain postprandial blood glucose levels via an inflammatory mechanism.

Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes

Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.

Effects of Intradialytic Exercise on Dialytic Parameters, Health-Related Quality of Life, and Depression Status in Hemodialysis Patients: A Randomized Controlled Trial

Exercise is fundamentally important in managing chronic diseases and improving health-related quality of life (HRQL). However, whether intradialytic exercise is safe through assessment of changes in dialytic parameters and has a positive impact on HRQL and depression status of hemodialysis patients requires further research with diverse racial and cultural populations to identify. This study aimed to evaluate the effects of intradialytic exercise on dialytic parameters, HRQL, and depression status in hemodialysis patients. A randomized controlled trial was conducted at a medical center in Northern Taiwan. Sixty-four hemodialysis patients were recruited using stratified random sampling. Participants were randomized into an experimental group (EG, n = 32) or a control group (CG, n = 32). The EG received a 12-week intradialytic exercise program while the CG maintained their usual lifestyles. Dialytic parameters, HRQL, and depression status were collected at baseline and at 12 weeks. The results indicated no differences in the dialytic parameters from the baseline between both groups. However, the EG had increased HRQL (ß = 22.6, p < 0.001) and reduced depression status (ß = −7.5, p = 0.02) at 12 weeks compared to the CG. Therefore, a 12-week intradialytic exercise regime is safe and effective in improving HRQL and reducing depression status for hemodialysis patients.

Current Options and Future Directions for NAFLD and NASH Treatment

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with a broad spectrum ranging from simple steatosis to advanced stage of nonalcoholic steatohepatitis (NASH). Although there are many undergoing clinical trials for NAFLD treatment, there is no currently approved treatment. NAFLD accounts as a major causing factor for the development of hepatocellular carcinoma (HCC), and its incidence rises accompanying the prevalence of obesity and diabetes. Reprogramming of antidiabetic and anti-obesity medicine is a major treatment option for NAFLD and NASH. Liver inflammation and cellular death, with or without fibrosis account for the progression of NAFLD to NASH. Therefore, molecules and signaling pathways involved in hepatic inflammation, fibrosis, and cell death are critically important targets for the therapy of NAFLD and NASH. In addition, the avoidance of aberrant infiltration of inflammatory cytokines by treating with CCR antagonists also provides a therapeutic option. Currently, there is an increasing number of pre-clinical and clinical trials undergoing to evaluate the effects of antidiabetic and anti-obesity drugs, antibiotics, pan-caspase inhibitors, CCR2/5 antagonists, and others on NAFLD, NASH, and liver fibrosis. Non-invasive serum diagnostic markers are developed for fulfilling the need of diagnostic testing in a large amount of NAFLD cases. Overall, a better understanding of the underlying mechanism of the pathogenesis of NAFLD is helpful to choose an optimized treatment.

Effect of exercise on cardiometabolic health of adults with overweight or obesity: Focus on blood pressure, insulin resistance, and intrahepatic fat-A systematic review and meta-analysis

This systematic review examined the impact of exercise intervention programs on selected cardiometabolic health indicators in adults with overweight or obesity. Three electronic databases were explored for randomized controlled trials (RCTs) that included adults with overweight or obesity and provided exercise-training interventions. Effects on blood pressure, insulin resistance (homeostasis model of insulin resistance, HOMA-IR), and magnetic resonance measures of intrahepatic fat in exercise versus control groups were analyzed using random effects meta-analyses. Fifty-four articles matched inclusion criteria. Exercise training reduced systolic and diastolic blood pressure (mean difference, MD = -2.95 mmHg [95% CI -4.22, -1.68], p < 0.00001, I²  = 63% and MD = -1.93 mmHg [95% CI -2.73, -1.13], p < 0.00001, I²  = 54%, 60 and 58 study arms, respectively). Systolic and diastolic blood pressure decreased also when considering only subjects with hypertension. Exercise training significantly decreased HOMA-IR (standardized mean difference, SMD = -0.34 [-0.49, -0.18], p < 0.0001, I²  = 48%, 37 study arms), with higher effect size in subgroup of patients with type 2 diabetes (SMD = -0.50 [95% CI: -0.83, -0.17], p = 0.003, I²  = 39%). Intrahepatic fat decreased significantly after exercise interventions (SMD = -0.59 [95% CI: -0.78, -0.41], p < 0.00001, I²  = 0%), with a larger effect size after high-intensity interval training. In conclusion, exercise training is effective in improving cardiometabolic health in adults with overweight or obesity also when living with comorbitidies.