Cardiometabolic Blood Markers Research Articles

Snack quality and snack timing are associated with cardiometabolic blood markers: the ZOE PREDICT study

BackgroundSnacking is a common diet behaviour which accounts for a large proportion of daily energy intake, making it a key determinant of diet quality. However, the relationship between snacking frequency, quality and timing with cardiometabolic health remains unclear.DesignDemography, diet, health (fasting and postprandial cardiometabolic blood and anthropometrics markers) and stool metagenomics data were assessed in the UK PREDICT 1 cohort (N = 1002) (NCT03479866). Snacks (foods or drinks consumed between main meals) were self-reported (weighed records) across 2–4 days. Average snacking frequency and quality [snack diet index (SDI)] were determined (N = 854 after exclusions). Associations between snacking frequency, quality and timing with cardiometabolic blood and anthropometric markers were assessed using regression models (adjusted for age, sex, BMI, education, physical activity level and main meal quality).ResultsParticipants were aged (mean, SD) 46.1 ± 11.9 years, had a mean BMI of 25.6 ± 4.88 kg/m2 and were predominantly female (73%). 95% of participants were snackers (≥ 1 snack/day; n = 813); mean daily snack intake was 2.28 snacks/day (24 ± 16% of daily calories; 203 ± 170 kcal); and 44% of participants were discordant for meal and snack quality. In snackers, overall snacking frequency and quantity of snack energy were not associated with cardiometabolic risk markers. However, lower snack quality (SDI range 1–11) was associated with higher blood markers, including elevated fasting triglycerides (TG (mmol/L) β; – 0.02, P = 0.02), postprandial TGs (6hiAUC (mmol/L.s); β; – 400, P = 0.01), fasting insulin (mIU/L) (β; – 0.15, P = 0.04), insulin resistance (HOMA-IR; β; – 0.04, P = 0.04) and hunger (scale 0–100) (β; – 0.52, P = 0.02) (P values non-significant after multiple testing adjustments). Late-evening snacking (≥ 9 pm; 31%) was associated with lower blood markers (HbA1c; 5.54 ± 0.42% vs 5.46 ± 0.28%, glucose 2hiAUC; 8212 ± 5559 vs 7321 ± 4928 mmol/L.s, P = 0.01 and TG 6hiAUC; 11,638 ± 8166 vs 9781 ± 6997 mmol/L.s, P = 0.01) compared to all other snacking times (HbA1c remained significant after multiple testing).ConclusionSnack quality and timing of consumption are simple diet features which may be targeted to improve diet quality, with potential health benefits.Clinical trial registry number and websiteNCT03479866, https://clinicaltrials.gov/ct2/show/NCT03479866?term=NCT03479866&draw=2&rank=1

The paradox of obesity with normal weight; a cross-sectional study.

To evaluate the prevalence of excessive adiposity among normal-weight individuals, and their cardiometabolic risk. This cross-sectional study included 3,001 participants (ages 20-95, 52% men, BMI 28.0 ± 5.5 kg/m2) who completed an anthropometric evaluation, dual x-ray absorptiometry (DXA) scan to measure body composition, and cardiometabolic blood markers. Excess adiposity was defined as ≥25% for men and ≥ 35% for women. Of the entire study participants, 967 were in normal BMI (18.5-24.9 kg/m2) with a wide body fat distribution (4-49%). Of them, 26% of men and 38% of women were classified with excess adiposity. As compared to normal-weight lean participants, normal-weight obese men and women had higher triglycerides (76.5 ± 37.3 vs. 101.2 ± 50.3 mg/dL, p = 0.004 and 84 ± 44.2 vs. 101.4 ± 91.1 mg/dL, p = 0.030; respectively) and elevated low-density lipoprotein cholesterol (103.3 ± 31.7 vs. 119.6 ± 45.5 mg/dL, p = 0.011) and total cholesterol (171.5 ± 40.3 vs. 190.2 ± 39 mg/dL, p = 0.007) for men only. Among NWO, abdominal circumference was prevalent in 60% of the females with NWO (≥88 cm), but only in 4% of males (≥102 cm). Higher adiposity, even within normal weight, increases cardiometabolic risk, and abdominal waist circumference misclassified obesity in normal-weight individuals. This study highlights the need for a body composition evaluation to determine cardiometabolic risk for adults with normal body weight.

The Relationship between Circulating APOA-1 and Atherosclerosis Initiation and Progression in Psoriasis

Apolipoprotein A-1 (ApoA-1) is central to the high-density lipoprotein function of reverse cholesterol transport measured by cholesterol efflux capacity. Psoriasis is a systemic inflammatory disease associated with poor cholesterol efflux capacity and accelerated non-calcified burden (NCB) as measured by coronary computed tomographic angiography (CCTA). Here, we characterized the relationship between ApoA-1, cholesterol efflux capacity, and progression of NCB over four years. Consecutively recruited psoriasis participants underwent CCTA for NCB quantification (Medis QAngio, Netherlands) at baseline (n=310) and four years (n=124). Blood was assessed for cardiometabolic biomarkers. The lowest quartile of ApoA-1 was associated with cardiometabolic blood markers (insulin, HOMA-IR and cholesterol efflux capacity) and higher NCB (P<0.001). Over four years, the low ApoA-1 quartile had higher NCB at four years (β =-0.36, P=0.02) in fully adjusted models. Finally, a 10-unit decrease of ApoA-1 was associated with a 16% increase of NCB progression over four years (odds ratio, [95% CI], 0.83 [0.70, 0.99] P=0.04). In addition to being associated with cardiometabolic disease, low ApoA-1 was associated with more NCB over time. These findings demonstrate that low ApoA-1 is correlated with initiation and progression of coronary artery disease and may have clinical utility in identifying high risk populations for development of cardiovascular disease.

The Effects of Intermittent Fasting and Continuous Energy Restriction with Exercise on Cardiometabolic Biomarkers, Dietary Compliance, and Perceived Hunger and Mood: Secondary Outcomes of a Randomised, Controlled Trial.

(1) Background: Excess weight in the form of adiposity plays a key role in the pathogenesis of cardiometabolic diseases. Lifestyle modifications that incorporate continuous energy restriction (CER) are effective at inducing weight loss and reductions in adiposity; however, prescribing daily CER results in poor long-term adherence. Over the past decade, intermittent fasting (IF) has emerged as a promising alternative to CER that may promote increased compliance and/or improvements in cardiometabolic health parameters independent of weight loss. (2) Methods: This paper presents a secondary analysis of data from a 12-week intervention investigating the effects of a twice-weekly fast (5:2 IF; IFT group) and CER (CERT group) when combined with resistance exercise in 34 healthy participants (17 males and 17 females, mean BMI: 27.0 kg/m2, mean age: 23.9 years). Specifically, changes in cardiometabolic blood markers and ratings of hunger, mood, energy and compliance within and between groups were analysed. Dietary prescriptions were hypoenergetic and matched for energy and protein intake. (3) Results: Both dietary groups experienced reductions in total cholesterol (TC; mean reduction, 7.8%; p < 0.001), low-density lipoprotein cholesterol (LDL-C; mean reduction, 11.1%; p < 0.001) and high-density lipoprotein cholesterol (mean reduction 2.6%, p = 0.049) over the 12 weeks. Reductions in TC and LDL-C were greater in the IFT group after adjustment for baseline levels and change in weight. No significant changes in markers of glucose regulation were observed. Both groups maintained high levels of dietary compliance (~80%) and reported low levels of hunger over the course of the intervention period. (4) Conclusions: Secondary data analysis revealed that when combined with resistance training, both dietary patterns improved blood lipids, with greater reductions observed in the IFT group. High levels of compliance and low reported levels of hunger throughout the intervention period suggest both diets are well tolerated in the short-to-medium term.

Metabolic effects of high-intensity interval training and essential amino acids.

High-intensity interval training (HIIT) promotes positive cardiometabolic and body composition changes. Essential amino acids (EAA) may support changes associated with HIIT, but evaluation of potential synergistic effects is lacking. The purpose of this study was to compare independent and combined effects of HIIT and EAA on total body composition and metabolism in men and women considered overweight/obese; an exploratory aim was to evaluate the modulatory effects of sex. Sixty-six healthy adults (50% female; Age: 36.7 ± 6.0 years; BMI: 32.0 ± 4.2kg/m2) completed 8 weeks of: (1) HIIT, 2 days/weeks; (2) EAA supplementation, 3.6g twice daily; (3) HIIT + EAA; or (4) control. Body composition, resting metabolic rate (RMR), substrate metabolism (respiratory exchange ratio; RER), and cardiorespiratory fitness were measured at baseline, 4 weeks, and 8 weeks; cardiometabolic blood markers were measured at baseline and 8 weeks. Differences between groups were assessed by linear mixed models covaried for baseline values, followed by 95% confidence intervals (CI) on adjusted mean change scores. There were no significant changes in body composition (p > 0.05) for any group. Changes in RER, but not RMR, occurred with HIIT (mean change; [95% CI]: - 0.04; [- 0.07, - 0.02]) and EAA (- 0.03; [- 0.06, - 0.01]) after 8 weeks. Cardiorespiratory fitness increased following 8 weeks of HIIT (+ 5.1ml/kg/min [3.3,6.8]) and HIIT + EAA (+ 4.1ml/kg/min [1.0,6.4]). Changes with HIIT + EAA were not significantly different from HIIT. There were no changes in cardiometabolic markers (p > 0.05) and no sex interaction (p > 0.05). HIIT is efficacious for promoting positive changes in cardiorespiratory fitness and resting substrate metabolism in adults considered overweight/obese. Addition of EAA did not significantly enhance HIIT-induced adaptations. ClinicalTrials.gov ID#NCT04080102.

Does polymorphisms in PPAR and APOE genes modify associations between fatty acid desaturase (FADS), n-3 long-chain PUFA and cardiometabolic markers in 8-11-year-old Danish children?

n-3 Long-chain PUFA (LCPUFA) can improve cardiometabolic blood markers, but studies in children are limited. SNP in the FADS genes, which encode fatty acid desaturases, influence endogenous LCPUFA production. Moreover, SNP in genes that encode PPAR and apoE may modulate the effects of n-3 LCPUFA. We explored whether FADS polymorphisms were associated with blood cholesterol and TAG, insulin and glucose and whether polymorphisms in PPAR and APOE modified associations between FADS or n-3 LCPUFA status and the cardiometabolic blood markers. We measured fasting cholesterol and TAG, insulin, glucose and n-3 LCPUFA in 757 Danish 8-11-year-old children and genotyped SNP in FADS (rs1535 and rs174448), PPARG2 (rs1801282), PPARA (rs1800206) and APOE (rs7412+rs429358). Carriage of two FADS rs174448 major alleles was associated with lower TAG (P = 0·027) and higher HDL-cholesterol (P = 0·047). Blood n-3 LCPUFA was inversely associated with TAG and insulin in PPARG2 minor allele carriers and positively with LDL-cholesterol in major allele homozygotes (Pn-3 LCPUFA × rs180182 < 0·01). Associations between n-3 LCPUFA and cardiometabolic markers were not modified by APOE genotype (Pn-3 LCPUFA × APOE > 0·11), but interaction between FADS rs1535 and APOE showed that rs1535 major allele homozygotes who also carried APOE2 had higher HDL-cholesterol than all other genotype combinations (Prs1535 × APOE = 0·019, pairwise-P < 0·05). This indicates that FADS genotypes, which increase endogenous LCPUFA production, may beneficially affect children's cardiometabolic profile in a partly APOE-dependent manner. Also, the degree to which children benefit from higher n-3 LCPUFA intake may depend on their PPARG2 genotype.

The effect of low-volume high-intensity interval training on cardiometabolic health and psychological responses in overweight/obese middle-aged men

ABSTRACT High-intensity interval training (HIIT) has been proposed as a time-efficient exercise protocol to improve metabolic health, but direct comparisons with higher-volume moderate-intensity continuous training (MICT) under unsupervised settings are limited. This study compared low-volume HIIT and higher-volume MICT interventions on cardiometabolic and psychological responses in overweight/obese middle-aged men. Twenty-four participants (age: 48.1±5.2yr; BMI: 25.8±2.3kg·m−2) were randomly assigned to undertake either HIIT (10 X 1-min bouts of running at 80–90% HRmax separated by 1-min active recovery) or MICT (50-min continuous jogging/brisk walking at 65–70% HRmax) for 3 sessions/week for 8 weeks (2-week supervised + 6-week unsupervised training). Both groups showed similar cardiovascular fitness (VO2max) improvement (HIIT: 32.5±5.6 to 36.0±6.2; MICT: 34.3±6.0 to 38.2±5.1mL kg−1 min−1, p < 0.05) and %fat loss (HIIT: 24.5±3.4 to 23.2±3.5%; MICT: 23.0±4.3 to 21.5±4.1%, p< 0.05) over the 8-week intervention. Compared to baseline, MICT significantly decreased weight and waist circumference. No significant group differences were observed for blood pressure and cardiometabolic blood markers such as lipid profiles, fasting glucose and glycated haemoglobin. Both groups showed similar enjoyment levels and high unsupervised adherence rates (>90%). Our findings suggest that low-volume HIIT can elicit a similar improvement of cardiovascular fitness as traditional higher-volume MICT in overweight/obese middle-aged men.

Neuroanatomical changes in white and grey matter after sleeve gastrectomy

BackgroundMRI studies show that obese adults have reduced grey matter (GM) and white matter (WM) tissue density as well as altered WM integrity. Bariatric surgery can lead to substantial weight loss and improvements in metabolic parameters, but it remains to be examined if it induces structural brain changes. The aim of this study was to characterize GM and WM density changes measured with MRI in a longitudinal setting following sleeve gastrectomy, and to determine whether any changes are related to inflammation and cardiometabolic blood markers. Methods29 participants with obesity (age: 45.9 ​± ​7.8 years) scheduled to undergo sleeve gastrectomy were recruited. High-resolution T1-weighted anatomical images were acquired 1 month prior to as well as 4 and 12 months after surgery. GM and WM densities were quantified using voxel-based morphometry (VBM). Circulating lipid profile, glucose, insulin and inflammatory markers (interleukin-6, C-reactive protein and lipopolysaccharide-binding protein) were measured at each time point. A linear mixed effect model was used to compare brain changes before and after SG, controlling for age, sex, initial BMI and diabetic status. To assess the associations between changes in adiposity, metabolism and inflammation and changes in GM or WM density, the mean GM and WM densities were extracted across all the participants using atlas-derived regions of interest, and linear mixed-effect models were used. ResultsAs expected, weight, BMI, waist circumference and neck circumference significantly decreased after SG compared with baseline (p ​< ​0.001 for all). A widespread increase in WM density was observed after surgery, particularly in the cerebellum, brain stem, cerebellar peduncle, cingulum, corpus callosum and corona radiata (p ​< ​0.05, after FDR correction). Significant increases in GM density were observed 4 months after SG compared to baseline in several brain regions such as the bilateral occipital cortex, temporal cortex, postcentral gyrus, cerebellum, hippocampus and insula as well as right fusiform gyrus, right parahippocampal gyrus, right lingual gyrus and right amygdala. These GM and WM increases were more pronounced and widespread after 12 months and were significantly associated with post-operative weight loss and the improvement of metabolic alterations. A linear mixed-effect model also showed associations between post-operative reductions in lipopolysaccharide-binding protein, a marker of inflammation, and increased WM density. To confirm our results, we tested whether the peak of each significant region showed BMI-related differences in an independent dataset (Human Connectome Project). We matched a group of individuals who were severely obese with a group of individuals who were lean for age, sex and ethnicity. Severe obesity was associated with reduced WM density in the brain stem and cerebellar peduncle as well as reduced GM density in cerebellum, regions that significantly changed after surgery (p ​< ​0.01 for all clusters). ConclusionsBariatric surgery-induced weight loss and improvement in metabolic alterations is associated with widespread increases in WM and GM densities. These post-operative changes overlapped with baseline brain differences between participants who were severely obese and those who were normal-weight in a separate dataset, which may suggest a recovery of WM and GM alterations after bariatric surgery.

Low-volume High-intensity Interval Training On Cardio-metabolic Health And Adherence-related Psycho-perceptual Responses In Overweight/obese Middle-aged Adults

High-intensity interval training (HIIT) has been proposed as a time-efficient protocol to improve metabolic health. However, its practical efficacy in terms of cardio-metabolic and adherence compared with higher-volume moderate-intensity continuous exercise (MICE) remains unclear. PURPOSE: To compare the training effects between low-volume HIIT and higher-volume MICE on cardio-metabolic and psycho-perceptual responses in overweight/obese middle-aged men. METHODS: Twenty overweight/obese men (mean age: 48.0 ± 5.7 years) were randomly assigned to undertake either HIIT (n=10) or MICE (n=10) training for 8 weeks (3 sessions/week). HIIT sessions consisted of ten 1-minute intervals of exercise at 80-90% HRmax separated by 1-minute active recovery. MICE sessions involved 50-minute continuous exercise at 65-70% HRmax. Health-related variables including cardiovascular fitness (VO2max), body composition and cardio-metabolic blood markers were assessed before and after the intervention. Adherence-related psycho-perceptual variables including enjoyment and self-efficacy were also assessed after the intervention. Paired-sample t-tests were used to compare changes within a group before and after the intervention. Analyses of Covariance were used to compare the group difference in outcome variables after controlling for baseline values. RESULTS: Both groups showed similar VO2max increase over the 8-week intervention (HIIT: 32.5 ± 5.6 to 36.0 ± 6.2 ; MICE: 36.3 ± 6.0 to 21.5 ± 40.2 ± 5.1 mL kg-1min-1, both p < 0.05). Both groups had significant fat% loss (HIIT: 24.5 ± 3.4 to 23.2 ± 3.5; MICE: 23.0 ± 4.3 to 21.5 ± 4.1, both ps < 0.05) and there was a trend favoring MICE (p = 0.054). Compared to the baseline, MICE group significantly decreased weight, body mass index (BMI), waist circumference and glycated hemoglobin whereas HIIT increased high-desity lipoprotiein after the intervention. However, these variables did not differ significantly upon group comparison. The self-efficacy and enjoyment responses were found similar between HIIT and MICE (both ps > 0.05). CONCLUSIONS: Our findings suggest that low-volume HIIT elicits a similar improvement of cardiovascular fitness and adherence-related psycho-perceptual responses as traditional higher-volume MICE in overweight/obese middle-aged men.

Relationship between After-School Physical Activity and Dietary Habits with Cardio-metabolic Risk in Low-income Children

Childhood obesity is a major focus of public health. The purpose of this study was to determine whether after-school physical activity and dietary habits predict cardio-metabolic risk in a sample of ethnic minority elementary school-aged children from low-income schools. Participants were a convenience sample of 92 children (3rd-6th grades) recruited from four Title I schools located in a metropolitan area from the Mountain West region of the United States. Children completed portions of the After School Student Questionnaire (ASSQ) and Physical Activity Questionnaire for Children (PAQ-C) to measure after-school physical activity and nutrition, respectively. Blood pressure, waist circumference and cardio-metabolic blood markers were collected in a fasted state to calculate a continuous metabolic syndrome (MetS) composite score. Predictive relationships were analyzed using a multiple linear regression model. Neither physical activity or nutrition scores were predictive of a MetS score. However, there was a linear, positive, and moderate correlation between physical activity and nutrition scores (r = 0.29, p < 0.05). The findings indicate that cardio-metabolic health cannot be predicted based on self-reported after-school physical activity and nutrition habits. There are many challenges that arise when analyzing cardio-metabolic health in children; however, this is an area of research that needs further analysis. A clearer understanding of these relationships can aid in identifying risk factors for disease at an earlier age and aid in future intervention development.

Waist-to-Height Ratio, Aerobic Fitness, and Cardiometabolic Risk in Hispanic Children From Low-Income U.S. Schools.

The purpose of this study was to examine the relationships among waist-to-height ratio (WHtR), aerobic fitness, and cardio-metabolic risk factors in Hispanic children from low-income U.S. schools. Participants were 198 Hispanic children from low-income schools (Mean age = 10.3 ± 0.5 years; 119 girls, 79 boys). Waist circumference, height, and cardio-metabolic blood markers were collected in a fasted state. Estimated VO2 Peak scores were also collected. Multilevel generalized mixed effects models were employed to examine the independent effect of WHtR and aerobic fitness classification on a child meeting recommended levels for each cardio-metabolic blood marker. A child having a WHtR < 0.5 related to meeting recommended levels for HDL cholesterol (OR = 3.25, p < .01), triglycerides (OR = 2.94, p < .01), glucose (OR = 3.42, p < .01), and related to a lower continuous Mean Arterial Pressure (MAP) score (β = -8.5 mmHg, p < .01). Aerobic fitness classification only independently related to meeting recommended levels for HDL cholesterol (OR = 2.94, p = .010). Having a WHtR < 0.5 independently associated with favorable cardio-metabolic blood markers and thus serves as an effective screening tool for cardio-metabolic risk in Hispanic children from low-income schools.

The association among skeletal muscle phosphocreatine recovery, adiposity, and insulin resistance in children.

Obesity is associated with cardiometabolic disturbances, which may have significant implications for musculoskeletal health and exercise tolerance. We sought to determine the association between muscle structure, function, and metabolism in adolescents across the weight spectrum. This cross-sectional case-control study included overweight and obese participants (n = 24) 8-18 years of age with a body mass index (BMI) ≥ 85th percentile for age and gender, and non-obese participants (n = 24) with a BMI < 85th percentile. Body composition, physical activity, peak aerobic capacity, cardiometabolic blood markers and insulin resistance (measured by the homeostatic model assessment of insulin resistance, HOMA-IR), skeletal muscle mitochondrial oxidative capacity (via 31 Phosphorous-Magnetic Resonance Spectroscopy, 31 P-MRS, to assess phosphocreatine (PCr) recovery after exercise), and extramyocellular and intramyocellular lipid (IMCL) levels (via 1 Hydrogen-MRS) were assessed. Stepwise regression was performed to examine the factors associated with oxidative capacity. bese and overweight patients had similar age, height, and physical activity to non-obese controls, but obese and overweight participants exhibited higher insulin resistance. Obese and overweight participants had longer PCr recovery than non-obese controls following 5x30s of moderate-intensity exercise (51.2 ± 20.1 s vs. 23.9 ± 7.5 s, p = 0.004). In univariate correlation analysis, impaired PCr recovery was associated with a higher BMI z-score (rs = 0.51, p < 0.001), circulating triglycerides (rs = 0.41, p = 0.005), and HOMA-IR (rs = 0.46, p = 0.001). In stepwise multivariate regression analysis, impaired PCr recovery was associated with a higher BMI z-score (β = 0.47, p = 0.002), but not insulin resistance (β = 0.07, p = 0.07) or circulating triglycerides (β = 0.16 p = 0.33). A slower phosphocreatine recovery following aerobic exercise is strongly associated with increasing adiposity. A slower metabolic recovery following aerobic exercise stress suggests that endurance exercise training in obese adolescents may be an optimal strategy to target exercise intolerance in this cohort.

Associations between Health-Related Fitness and Cardio-Metabolic Blood Profiles in Low-Income Children

Children from low-income families have a higher incidence for developing early onset cardio-metabolic disease risk factors. Optimal levels of health-related fitness may attenuate risk, but little research has examined its relationships with individual cardio-metabolic blood markers in low-income children. The purpose of this study was to examine the prevalence and correlates of unfavorable cardio-metabolic blood profiles in children from low-income families. Data were collected and analyzed on 124 children (mean age = 10.4 ± 0.9 years; 57 girls, 67 boys; 97% Hispanic) recruited from three urban Title I schools from the state of Utah in the US Health-related fitness. Measures were collected using the validated FITNESSGRAM fitness test battery. The Cholestech LDX system was used to analyze students’ total cholesterol (TC), LDL cholesterol, HDL cholesterol, triglycerides (TRI), and blood glucose (BG). Capillary blood samples via finger sticks were collected while each student was in a fasted state before school hours. Unfavorable measurements were defined as TC ≥ 200 mg/dL, LDL ≥ 130 mg/dL, HDL 150 mg/dL, and BG ≥ 100 mg/dL (pre-diabetes). Approximately 5.3% of the total sample had unfavorable TC, 16.7% had unfavorable HDL, 16.0% had unfavorable LDL, 15.2% had unfavorable TRI, and 25.4% had unfavorable BG (pre-diabetes). Pearson’s chi-square tests revealed no significant differences between sexes on any unfavorable classification after alpha level adjustment (p > 0.01). When all parameters were analyzed as continuous variables, Spearman’s rank correlation revealed a statistically significant linear relationship between aerobic fitness and LDL in boys (rs = - 0.65, p - 0.46, p < 0.01), and between BMI and BG in girls (rs = 0.56, p < 0.01). Aerobic fitness relates to LDL cholesterol in low-income boys and BMI relates to HDL cholesterol and BG in low-income girls.