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McGee JE, Early KS, Huff AC, Clunan MC, Hursey NR, Osborne B, Bucher C, Tanner C, Brewer SB, Brophy PM, Clark A, Pories WJ, Matarese LE, Houmard JA, Collier D, May LE, McClung JM, Earnest CP, Swift DL. Effects of weight loss and weight loss maintenance on cardiac autonomic function in obesity: a randomized controlled trial. Appl Physiol Nutr Metab 2023; 48:678-691. [PMID: 37229779 PMCID: PMC11042485 DOI: 10.1139/apnm-2023-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
NOVELTY Caloric restriction and exercise exert significant improvements in cardiac autonomic function as measured by HRV in overweight and obesity. Aerobic exercise training, within recommended guidelines coupled with weight loss maintenance, retains cardiac autonomic function benefits from weight loss in previously obese individuals.
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Affiliation(s)
- Joshua E. McGee
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Kate S. Early
- Department of Health, Columbus State University, Columbus, GA, 31907, USA
| | - Anna C. Huff
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Marie C. Clunan
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Nicole R. Hursey
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | | | | | - Charles Tanner
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Savanna B. Brewer
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Patricia M. Brophy
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Angela Clark
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC 27858, USA
| | - Laura E. Matarese
- Department of Internal Medicine, East Carolina University, Greenville, NC 27858, USA
| | - Joseph A. Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - David Collier
- Department of Pediatrics, East Carolina University, Greenville, NC 27858, USA
| | - Linda E. May
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Joseph M. McClung
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
- Department of Physiology, East Carolina University, Greenville, NC 27858, USA
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 27858, USA
| | - Conrad P. Earnest
- Texas A&M University, Department of Health and Kinesiology, College Station, TX 79016, USA
| | - Damon L. Swift
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
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2
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Ishikawa Y, Laing EM, Anderson AK, Zhang D, Kindler JM, Trivedi-Kapoor R, Sattler ELP. Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with low levels of insulin resistance among heart failure patients. Nutr Metab Cardiovasc Dis 2022; 32:1841-1850. [PMID: 35637084 DOI: 10.1016/j.numecd.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) patients are at risk of developing type 2 diabetes. This study examined the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and insulin resistance among U.S. adults with HF. METHODS AND RESULTS Using data from National Health and Nutrition Examination Survey 1999-2016 cycles, we included 348 individuals aged 20+ years with HF and no history of diabetes. DASH diet adherence index quartile 1 indicated the lowest and quartile 4 indicated the highest adherence. The highest level of insulin resistance was defined by the upper tertile of the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Associations between level of insulin resistance and DASH diet adherence and its linear trends were examined using logistic regressions. Trend analyses showed that participants in upper DASH diet adherence index quartiles were more likely older, female, non-Hispanic White, of normal weight, and had lower levels of fasting insulin than those in lower quartiles. Median values of HOMA-IR from lowest to highest DASH diet adherence index quartiles were 3.1 (interquartile range, 1.8-5.5), 2.9 (1.7-5.6), 2.1 (1.1-3.7), and 2.1 (1.3-3.5). Multivariable logistic analyses indicated that participants with the highest compared to the lowest DASH adherence showed 77.1% lower odds of having the highest level of insulin resistance (0.229, 95% confidence interval: 0.073-0.716; p = 0.017 for linear trend). CONCLUSION Good adherence to the DASH diet was associated with lower insulin resistance among community-dwelling HF patients. Heart healthy dietary patterns likely protect HF patients from developing type 2 diabetes.
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Affiliation(s)
- Yuta Ishikawa
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Emma M Laing
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Alex K Anderson
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, GA, USA; Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, NY, USA
| | - Joseph M Kindler
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Rupal Trivedi-Kapoor
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, GA, USA
| | - Elisabeth L P Sattler
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA; Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, GA, USA.
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3
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Sarwar H, Rafiqi SI, Ahmad S, Jinna S, Khan SA, Karim T, Qureshi O, Zahid ZA, Elhai JD, Levine JC, Naqvi SJ, Jaume JC, Imam S. Hyperinsulinemia Associated Depression. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221090244. [PMID: 35494421 PMCID: PMC9039439 DOI: 10.1177/11795514221090244] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/16/2022] [Indexed: 12/14/2022] Open
Abstract
Hyperinsulinemia promotes fat accumulation, causing obesity. Being an inflammatory state, obesity can induce further inflammation and is a risk factor for HPA (hypothalamic pituitary axis) dysregulation through hypercortisolism-related hyperglycemia. In another hypothesis, the sympathetic nervous system (SNS) plays a significant role in the regulation of hormone secretion from the pancreas such as an increase in catecholamines and glucagon as well as a decrease in plasma insulin levels, a disruption on SNS activity increases insulin levels, and induces glycogenolysis in the liver and lipolysis in adipose tissue during hypoglycemia. Hyperglycemia-hyperinsulinemia exacerbates inflammation and increases the oxidative stress along with regulating the levels of norepinephrine in the brain sympathetic system. Increased inflammatory cytokines have also been shown to disrupt neurotransmitter metabolism and synaptic plasticity which play a role in the development of depression via inhibiting serotonin, dopamine, melatonin, and glutamate signaling. An increased level of plasma insulin over time in the absence of exercising causes accumulation of lipid droplets in hepatocytes and striated muscles thus preventing the movement of glucose transporters shown to result in an increase in insulin resistance due to obesity and further culminates into depression. Further hyperinsulinemia-hyperglycemia condition arising due to exogenous insulin supplementation for diabetes management may also lead to physiological hyperinsulinemia associated depression. Triple therapy with SSRI, bupropion, and cognitive behavioral therapy aids in improving glycemic control, lowering fasting blood glucose, decreasing the chances of relapse, as well as decreasing cortisol levels to improve cognition and the underlying depression. Restoring the gut microbiota has also been shown to restore insulin sensitivity and reduce anxiety and depression symptoms in patients.
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Affiliation(s)
- Haider Sarwar
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA.,Windsor University School of Medicine, Cayon, West Indies
| | - Shafiya Imtiaz Rafiqi
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA
| | | | - Sruthi Jinna
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Sawleha Arshi Khan
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA.,Mercy Health - St. Vincent Medical Center, Toledo, OH, USA
| | - Tamanna Karim
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA
| | - Omar Qureshi
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA.,American University of the Caribbean School of Medicine, Sint Maarten, Kingdom of the Netherlands
| | - Zeeshan A Zahid
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA
| | - Jon D Elhai
- Department of Psychology and Psychiatry, University of Toledo, Toledo, OH, USA
| | - Jason C Levine
- Department of Psychology and Psychiatry, University of Toledo, Toledo, OH, USA
| | | | - Juan C Jaume
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA
| | - Shahnawaz Imam
- Division of Endocrinology, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.,Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA
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4
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Valensi P. Autonomic nervous system activity changes in patients with hypertension and overweight: role and therapeutic implications. Cardiovasc Diabetol 2021; 20:170. [PMID: 34412646 PMCID: PMC8375121 DOI: 10.1186/s12933-021-01356-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
The incidence and prevalence of hypertension is increasing worldwide, with approximately 1.13 billion of people currently affected by the disease, often in association with other diseases such as diabetes mellitus, chronic kidney disease, dyslipidemia/hypercholesterolemia, and obesity. The autonomic nervous system has been implicated in the pathophysiology of hypertension, and treatments targeting the sympathetic nervous system (SNS), a key component of the autonomic nervous system, have been developed; however, current recommendations provide little guidance on their use. This review discusses the etiology of hypertension, and more specifically the role of the SNS in the pathophysiology of hypertension and its associated disorders. In addition, the effects of current antihypertensive management strategies, including pharmacotherapies, on the SNS are examined, with a focus on imidazoline receptor agonists.
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Affiliation(s)
- Paul Valensi
- Unit of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, CINFO, CRNH-IdF, AP-HP, Paris Nord University, Avenue du 14 Juillet, 93140, Bondy, France.
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5
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Sato Y, Nunoi K, Kaku K, Yoshida A, Suganami H. Basal insulin secretion capacity predicts the initial response and maximum levels of beta-hydroxybutyrate during therapy with the sodium-glucose co-transporter-2 inhibitor tofogliflozin, in relation to weight loss. Diabetes Obes Metab 2020; 22:222-230. [PMID: 31608549 PMCID: PMC6973158 DOI: 10.1111/dom.13890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 01/14/2023]
Abstract
AIMS To investigate predictors of the initial response of beta-hydroxybutyrate (BHB) and maximum BHB (max-BHB) values during long-term therapy with the sodium-glucose co-transporter-2 inhibitor tofogliflozin (TOFO), and to explore the association of the initial elevation of BHB with subsequent clinical effects in people with type 2 diabetes mellitus. METHODS We analysed 774 people receiving TOFO in phase 3 trials in two groups based on measurable BHB change at week 4 (initial response): the top quartile [n = 194] and the three lower quartiles [n = 579]. Multivariate analysis was used to determine baseline predictors of inclusion in the top quartile and the max-BHB values. To investigate the association of the initial response with subsequent clinical effects, adjusted changes in variables in the two groups were compared using an analysis of covariance model. RESULTS Of the participants, 66% were men, and the mean age, glycated haemoglobin, body mass index and estimated glomerular filtration rate were 58.5 years, 8.1%, 25.6 kg/m2 and 83.9 mL/min/1.73 m2 , respectively. Median changes in BHB at week 4 in the top quartile and lower three quartiles were +246.4* and +30.8* μmol/L, respectively (*P < .001 vs baseline). Lower baseline insulin secretion capacity predicted the inclusion in the top quartile and greater max-BHB levels. The top quartile was associated with greater weight loss following greater increases in free fatty acids and greater reductions in fasting C-peptide levels compared with the lower three quartiles. CONCLUSIONS Lower basal insulin secretion capacity might predict greater initial BHB elevations and max-BHB levels during long-term TOFO therapy. Greater weight loss through lipid use might be related to high initial BHB elevations.
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Affiliation(s)
- Yuichi Sato
- Department of Diabetes and EndocrinologySt Mary's HospitalFukuokaJapan
| | - Kiyohide Nunoi
- Department of Diabetes and EndocrinologySt Mary's HospitalFukuokaJapan
| | - Kohei Kaku
- Department of Internal MedicineKawasaki Medical SchoolOkayamaJapan
| | - Akihiro Yoshida
- Cardiovascular and Diabetes Product Marketing DepartmentKowa Company, LtdTokyoJapan
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6
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Lambert GW, Schlaich MP, Eikelis N, Lambert EA. Sympathetic activity in obesity: a brief review of methods and supportive data. Ann N Y Acad Sci 2019; 1454:56-67. [PMID: 31268175 DOI: 10.1111/nyas.14140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/11/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
The increase in the prevalence of obesity and the concomitant rise in obesity-related illness have led to substantial pressure on health care systems throughout the world. While the combination of reduced exercise, increased sedentary time, poor diet, and genetic predisposition is undoubtedly pivotal in generating obesity and increasing disease risk, a large body of work indicates that the sympathetic nervous system (SNS) contributes to obesity-related disease development and progression. In obesity, sympathetic nervous activity is regionalized, with activity in some outflows being particularly sensitive to the obese state, whereas other outflows, or responses to stimuli, may be blunted, thereby making the assessment of sympathetic nervous activation in the clinical setting difficult. Isotope dilution methods and direct nerve recording techniques have been developed and utilized in clinical research, demonstrating that in obesity there is preferential activation of the muscle vasoconstrictor and renal sympathetic outflows. With weight loss, sympathetic activity is reduced. Importantly, sympathetic nervous activity is associated with end-organ dysfunction and changes in sympathetic activation that accompany weight loss are often reflected in an improvement of end-organ function. Whether targeting the SNS directly improves obesity-related illness remains unknown, but merits further attention.
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Affiliation(s)
- Gavin W Lambert
- The Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,The School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Nina Eikelis
- The Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,The School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Elisabeth A Lambert
- The Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,The School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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7
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Viskochil R, Lyden K, Staudenmayer J, Keadle SK, Freedson PS, Braun B. Elevated insulin levels following 7 days of increased sedentary time are due to lower hepatic extraction and not higher insulin secretion. Appl Physiol Nutr Metab 2019; 44:1020-1023. [PMID: 30970217 DOI: 10.1139/apnm-2018-0802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Higher insulin following sedentary behavior may be due to increased insulin secretion (IS), decreased hepatic insulin extraction (HIE), or a combination of both. Ten healthy adults completed glucose tolerance tests following 7 days of normal activity and 7 days of increased sitting. There were no differences in IS; however, HIE at 120 min after ingestion (85.4% ± 7.2% vs. 74.6% ± 6.6%, p < 0.05) and the area under the curve (73.6% ± 9.4% vs. 67.5% ± 11.3%, p < 0.05) were reduced following 7 days of increased sedentary time.
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Affiliation(s)
- Richard Viskochil
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Kate Lyden
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA.,KAL Research and Consulting, Denver, CO 80202, USA
| | - John Staudenmayer
- Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA 01003, USA
| | - Sarah K Keadle
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA.,Department of Kinesiology and Public Health, California Polytechnic University, San Luis Obispo, CA 93407, USA
| | - Patty S Freedson
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Barry Braun
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA.,Department of Health and Exercise Science, Colorado State University, Ft. Collins, CO 80523, USA
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8
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Bissonnette S, Saint-Pierre N, Lamantia V, Leroux C, Provost V, Cyr Y, Rabasa-Lhoret R, Faraj M. High plasma apolipoprotein B identifies obese subjects who best ameliorate white adipose tissue dysfunction and glucose-induced hyperinsulinemia after a hypocaloric diet. Am J Clin Nutr 2018; 108:62-76. [PMID: 29917037 DOI: 10.1093/ajcn/nqy070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 03/21/2018] [Indexed: 11/14/2022] Open
Abstract
Background To optimize the prevention of type 2 diabetes (T2D), high-risk obese subjects with the best metabolic recovery after a hypocaloric diet should be targeted. Apolipoprotein B lipoproteins (apoB lipoproteins) induce white adipose tissue (WAT) dysfunction, which in turn promotes postprandial hypertriglyceridemia, insulin resistance (IR), and hyperinsulinemia. Objective The aim of this study was to explore whether high plasma apoB, or number of plasma apoB lipoproteins, identifies subjects who best ameliorate WAT dysfunction and related risk factors after a hypocaloric diet. Design Fifty-nine men and postmenopausal women [mean ± SD age: 58 ± 6 y; body mass index (kg/m2): 32.6 ± 4.6] completed a prospective study with a 6-mo hypocaloric diet (-500 kcal/d). Glucose-induced insulin secretion (GIIS) and insulin sensitivity (IS) were measured by 1-h intravenous glucose-tolerance test (IVGTT) followed by a 3-h hyperinsulinemic-euglycemic clamp, respectively. Ex vivo gynoid WAT function (i.e., hydrolysis and storage of 3H-triolein-labeled triglyceride-rich lipoproteins) and 6-h postprandial plasma clearance of a 13C-triolein-labeled high-fat meal were measured in a subsample (n = 25). Results Postintervention first-phase GIISIVGTT and total C-peptide secretion decreased in both sexes, whereas second-phase and total GIISIVGTT and clamp IS were ameliorated in men (P < 0.05). Baseline plasma apoB was associated with a postintervention increase in WAT function (r = 0.61) and IS (glucose infusion rate divided by steady state insulin (M/Iclamp) r = 0.30) and a decrease in first-phase, second-phase, and total GIISIVGTT (r = -0.30 to -0.35) without sex differences. The association with postintervention amelioration in WAT function and GIISIVGTT was independent of plasma cholesterol (total, LDL, and HDL), sex, and changes in body composition. Subjects with high baseline plasma apoB (1.2 ± 0.2 g/L) showed a significant increase in WAT function (+105%; P = 0.012) and a decrease in total GIISIVGTT (-34%; P ≤ 0.001), whereas sex-matched subjects with low plasma apoB (0.7 ± 0.1 g/L) did not, despite equivalent changes in body composition and energy intake and expenditure. Conclusions High plasma apoB identifies obese subjects who best ameliorate WAT dysfunction and glucose-induced hyperinsulinemia, independent of changes in adiposity after consumption of a hypocaloric diet. We propose that subjects with high plasma apoB represent an optimal target group for the primary prevention of T2D by hypocaloric diets. This trial was registered at BioMed Central as ISRCTN14476404.
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Affiliation(s)
- Simon Bissonnette
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal (MDRC), Quebec, Canada
| | | | - Valerie Lamantia
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal (MDRC), Quebec, Canada
| | - Catherine Leroux
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada
| | - Viviane Provost
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal (MDRC), Quebec, Canada
| | - Yannick Cyr
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal (MDRC), Quebec, Canada
| | - Remi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal (MDRC), Quebec, Canada
| | - May Faraj
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal (MDRC), Quebec, Canada
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9
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Costa J, Moreira A, Moreira P, Delgado L, Silva D. Effects of weight changes in the autonomic nervous system: A systematic review and meta-analysis. Clin Nutr 2018; 38:110-126. [PMID: 29395374 DOI: 10.1016/j.clnu.2018.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity has been linked to autonomic dysfunction, which is thought to be one of the main contributors for hypertension, cardiac remodelling and death. Exercise and diet-based weight loss are the mainstay therapy for obesity, but there is a paucity of data regarding the effect of weight changes in autonomic nervous system (ANS) activity. OBJECTIVE To describe the impact of weight changes in autonomic nervous system. METHODS A systematic literature search of four biomedical databases was performed evaluating effects of weight changes, thorough diet and/or exercise-based interventions, in the following ANS outcomes: heart rate variability, namely low frequency (LF)/high frequency (HF) ratio (LF/HF ratio), normalized units of LF (LFnu) and HF (HFnu), muscle sympathetic nerve activity (MSNA), noradrenaline spillover rate (NA-SR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), baroreflex sensitivity and pupillometry. Quality appraisal was performed using the GRADE methodology and, where fitting, studies with comparable outcomes were pooled for meta-analysis. RESULTS Twenty-seven studies - 7 controlled clinical trials and 20 observational studies - were included. Weight gain was reported in 4 studies and weight loss in all the other studies. Interventions inducing weight changes included: hypocaloric or hypercaloric diets, exercise (strength, endurance or aerobic training) and hypocaloric diet coupled with exercise programs. Most studies which resulted in weight loss reported decreases in LF/HF ratio, LFnu, MSNA burst frequency and incidence, NA-SR, and an increase of baroreflex sensitivity, HF, HFnu and RMSSD, pointing to a parasympathetic nervous system activation. Meta-analysis regarding weight loss interventions showed a significant pooled effect size (95% CI) with a decreased of MSNA burst frequency -5.09 (-8.42, -1.75), MSNA incidence -6.66 (-12.40, -0.62), however this was not significant for SDNN 14.32 (-4.31, 32.96). Weight gain was associated with an increase in LF/HF, LFnu, MSNA burst frequency and incidence. The weight loss effects were potentiated by the association of hypocaloric diet with exercise. Nevertheless, weight changes effects in these outcomes were based in low or very low quality of evidence. CONCLUSIONS Diet and exercise based weight loss appears to increase parasympathetic and decrease sympathetic activity, the opposing effects being observed with weight gain. These findings are not uniformly reported in the literature, possibly due to differences in study design, methodology, characteristics of the participants and techniques used to estimate autonomic nervous activity.
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Affiliation(s)
- João Costa
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, Universidade do Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
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10
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Christou GA, Kiortsis DN. The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope. Obes Rev 2017; 18:370-379. [PMID: 28112481 DOI: 10.1111/obr.12501] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 12/16/2022]
Abstract
Orthostatic intolerance (OI) is frequently the mechanism underlying the occurrence of noncardiac syncope (NCS) and is associated with substantial risk for injury. Body weight status appears to be a modifier of orthostatic responses and possibly influences the propensity to NCS. The majority of cross-sectional studies have found that the lower the body mass index (BMI) the greater the predisposition to OI is, accompanied with both down-regulation of sympathetic nervous system activity and up-regulation of parasympathetic nervous system activity. These changes appear to occur across the whole spectrum of BMI values from underweight to obesity, while they may be associated more strongly with central body fat than total body fat. Weight loss following bariatric surgery has been consistently found to increase OI, attributed first to the effects of weight loss per se, second to the specific type of surgical procedure and third to the potential postoperative autonomic neuropathy due to vitamin deficiency. The increased OI following bariatric surgery renders this intervention not easily tolerable for the affected individuals, mandating increased fluid and salt intake, pharmacological measures or surgical adjustments to attenuate OI. All future studies investigating orthostatic responses and NCS should implement a matching of the population arms for BMI and ideally for body fat.
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Affiliation(s)
- G A Christou
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - D N Kiortsis
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
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11
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Hua S, Loehr LR, Tanaka H, Heiss G, Coresh J, Selvin E, Matsushita K. Ankle-brachial index and incident diabetes mellitus: the atherosclerosis risk in communities (ARIC) study. Cardiovasc Diabetol 2016; 15:163. [PMID: 27923363 PMCID: PMC5142100 DOI: 10.1186/s12933-016-0476-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Individuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Although diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. Methods We examined the association of ABI with incident diabetes using Cox proportional hazards models in the ARIC Study. ABI was measured in 12,247 black and white participants without prevalent diabetes at baseline (1987–1989). Incident diabetes cases were identified by blood glucose levels at three subsequent visits (1990–92, 1993–95, and 1996–98) or self-reported physician diagnosis or medication use at those visits or during annual phone interview afterward through 2011. Results A total of 3305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91–1.00) ABI had 30–40% higher risk of future diabetes as compared to those with ABI of 1.10–1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.91–1.00 (HR = 1.17, 95% CI 1.04–1.31) and marginally significant for ABI ≤ 0.90 (HR = 1.19, 0.99–1.43). Although the association was largely consistent across subgroups, a stronger association was seen in participants without hypertension, those with normal fasting glucose, and those with a history of stroke compared to their counterparts. Conclusions Low ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI but without diabetes. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0476-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simin Hua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA
| | - Laura R Loehr
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, 137 East Franklin Street, Suite 306, Chapel Hill, NC, 27514, USA
| | - Hirofumi Tanaka
- Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX, 78712-1415, USA
| | - Gerardo Heiss
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, 137 East Franklin Street, Suite 306, Chapel Hill, NC, 27514, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA.
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12
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Pournaras DJ, Nygren J, Hagström-Toft E, Arner P, le Roux CW, Thorell A. Improved glucose metabolism after gastric bypass: evolution of the paradigm. Surg Obes Relat Dis 2016; 12:1457-1465. [PMID: 27387696 DOI: 10.1016/j.soard.2016.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). OBJECTIVES To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. SETTING University Hospital. METHODS Fifteen diabetic patients, (47±9 yr, body mass index 41.3±4.2 kg/m2) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. RESULTS In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9±1.3 to 4.2±1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7±1.7 versus 4.2±1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P<.05) and even more 2 weeks after RYGB (P<.05) with no further change after 1 year. CONCLUSION Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes.
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Affiliation(s)
- Dimitri J Pournaras
- The Norfolk and Norwich Oesophagogastric Cancer Centre, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.
| | - Jonas Nygren
- Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Eva Hagström-Toft
- Department of Medicine, H7, Karolinska Institutet, Stockholm, Sweden
| | - Peter Arner
- Department of Medicine, H7, Karolinska Institutet, Stockholm, Sweden
| | - Carel W le Roux
- Diabetes Complication Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Investigative Science, Imperial College London, London, UK
| | - Anders Thorell
- Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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