Improvements In Cardiometabolic Risk Factors Research Articles

Abstract 129: My Unlimited Potential: Multidimensional Workplace Life Style Modification Program Associated With Reduction in Cardiovascular Disease Risk Among Employees With Type 2 Diabetes

Background: Diabetes mellitus is one of the leading conditions resulting in high health costs and lost productivity. In recent year there is a growing interest for managing these chronic conditions through engagement of workplace wellness programs. In this study we examined the short and long term effects of an ongoing multicomponent lifestyle intervention improvement program (My Unlimited Potential (MyUP), among employees of Baptist Health South Florida (BHSF), a large not-for-profit health care system. Method: The present analysis focuses on the efficacy of an intensive lifestyle workplace intervention among individuals presenting with diabetes mellitus. The intervention provided tools to improve physical activity, stress and dietary habits. A multi-disciplinary team made up of an advanced nurse practitioner (ARNP), registered dietician (RD), exercise physiologist (EP), certified diabetic educator (CDE), and registered nurse (RN) met with participants to provide one-on-one counseling and training. Results: The current study assessed 33 (58 years +/- 8.8, 67% female) employees with diabetes mellitus enrolled in the MyUp wellness program who completed baseline, 12-weeks, 6 months and 1 year assessments. Significant short and long term improvements in cardio-metabolic risk factors were observed (Table1). Positive change in distribution of cardiovascular risk factors was noticed at 3, 6 and 12 months (Fig1). Conclusion: These results suggest that a multi component workplace lifestyle modification program results in both short and long term improvement in cardiovascular disease risk among employees with diabetes mellitus. Further large studies are needed to confirm our study findings.

Efficacy and safety of beloranib for weight loss in obese adults: a randomized controlled trial

To assess the efficacy, safety and tolerability of beloranib treatment for obesity. This phase II, double-blind, randomized study investigated the effects of beloranib suspension (0.6, 1.2 and 2.4 mg) or placebo, administered subcutaneously, for 12 weeks in 147 participants (primarily white women) with obesity. No diet or exercise advice was administered. At week 12, beloranib resulted in dose-dependent progressive weight loss of -5.5 ± 0.5, -6.9 ± 0.6 and -10.9 ± 1.1 kg for the 0.6, 1.2 and 2.4 mg beloranib doses, respectively, compared with -0.4 ± 0.4 kg with placebo (all p < 0.0001 vs placebo). Weight loss with beloranib was associated with corresponding reductions in waist circumference and body fat mass, as well as improvements in lipids, high-sensitivity C-reactive protein and blood pressure. Sleep disturbance and gastrointestinal adverse events were more common with beloranib than with placebo; these were generally mild to moderate, transient and dose-related, and led to more early study withdrawals in participants in the group with the highest dose of beloranib. In this 12-week phase II study, beloranib produced clinically and statistically significant weight loss and corresponding improvements in cardiometabolic risk factors. Beloranib appeared safe, and the 0.6 and 1.2 mg doses were generally well tolerated. The 2.4 mg dose was associated with increased sleep latency and mild to moderate gastrointestinal adverse events over the first month of treatment. These findings represent a novel mechanism for producing clinically meaningful weight loss.

Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the Diabetes Prevention Program.

This study examined specific measures of weight loss in relation to incident diabetes and improvement in cardiometabolic risk factors. This prospective, observational study analyzed nine weight measures, characterizing baseline weight, short- versus long-term weight loss, short- versus long-term weight regain, and weight cycling, within the Diabetes Prevention Program (DPP) lifestyle intervention arm (n = 1,000) for predictors of incident diabetes and improvement in cardiometabolic risk factors over 2 years. Although weight loss in the first 6 months was protective of diabetes (hazard ratio [HR] 0.94 per kg, 95% CI 0.90, 0.98; P < 0.01) and cardiometabolic risk factors (P < 0.01), weight loss from 0 to 2 years was the strongest predictor of reduced diabetes incidence (HR 0.90 per kg, 95% CI 0.87, 0.93; P < 0.01) and cardiometabolic risk factor improvement (e.g., fasting glucose: β = -0.57 mg/dL per kg, 95% CI -0.66, -0.48; P < 0.01). Weight cycling (defined as number of 5-lb [2.25-kg] weight cycles) ranged 0-6 times per participant and was positively associated with incident diabetes (HR 1.33, 95% CI 1.12, 1.58; P < 0.01), fasting glucose (β = 0.91 mg/dL per cycle; P = 0.02), HOMA-IR (β = 0.25 units per cycle; P = 0.04), and systolic blood pressure (β = 0.94 mmHg per cycle; P = 0.01). After adjustment for baseline weight, the effect of weight cycling remained statistically significant for diabetes risk (HR 1.22, 95% CI 1.02, 1.47; P = 0.03) but not for cardiometabolic traits. Two-year weight loss was the strongest predictor of reduced diabetes risk and improvements in cardiometabolic traits.

Practical Application of a Comprehensive Weight Management Program in Patients with and without Metabolic Syndrome

This paper examines weight loss outcomes and their impact on risk factors associated with metabolic syndrome following participation in OPTIFAST®, a comprehensive weight-management program. A multicenter, retrospective chart review of 153 patients enrolled in the OPTIFAST program was conducted. Change in weight, body mass index, percent weight loss and cardiometabolic risk factors were compared between patients with and without metabolic syndrome. Patients with metabolic syndrome at baseline lost 21.6 ± 10.0 kg compared to 20.4 ± 9.2 kg for patients without metabolic syndrome (p > 0.05). Mean reduction in body mass index was 7.3 ± 3.1 kg/m2 and 7.1 ± 3.0 kg/ m2, and mean percent weight loss was 16.7 ± 6.9% and 17.6 ± 6.9%, respectively (p > 0.05). Metabolic syndrome patients had significantly greater reductions in triglycerides (p < 0.0001) and diastolic blood pressure (p < 0.01). The proportion of metabolic syndrome patients at program completion (41/87 (47%)) was significantly less than the proportion of metabolic syndrome patients at baseline (51/87 (59%); p < 0.0001). Patients with and without metabolic syndrome achieved significant weight loss and similar declines in body weight, body mass index and percent weight change. Significant improvements in cardiometabolic risk factors, including meaningful reductions in the prevalence of metabolic syndrome within the study population were observed.

Predictors of Improvement in Cardiometabolic Risk Factors With Weight Loss in Women

BackgroundWeight loss is associated with improvements in cardiometabolic risk factors, including serum glucose, insulin, C‐reactive protein, and blood lipids. Few studies have evaluated the long‐term (>18 months) effect of weight loss on these risk factors or sought to identify factors associated with sustained improvements in these measures.Methods and ResultsIn 417 overweight/obese women (mean [SD] age, 44 [10] years) participating in a weight loss trial, we sought to identify predictors of weight loss–associated cardiometabolic risk factors after 12 and 24 months of intervention. Total cholesterol (TC), low‐density lipoprotein (LDL)–cholesterol (LDL‐C), high‐density lipoprotein (HDL)–cholesterol, non‐HDL‐cholesterol, triglycerides (TG), insulin, glucose, C‐reactive protein (CRP), and cardiopulmonary fitness were measured at baseline and at 12 and 24 months. After 24 months, significant reductions in body weight, waist circumference, CRP, TC, HDL‐cholesterol, and non‐HDL‐cholesterol were observed (P<0.01). After 24 months, mean TC and non‐HDL‐cholesterol were reduced regardless of the amount of weight lost, whereas reductions in LDL–cholesterol, CRP, insulin, and TG were observed only in those who lost ≥10% body weight. Step‐test performance improved only in those who lost ≥10% body weight after 24 months. Change in weight demonstrated a positive predictive value for change in cholesterol, insulin, glucose, and triglycerides. Baseline level of the biomarker showed the greatest predictive value for follow‐up measures for insulin, cholesterol, glucose, and triglycerides.ConclusionsOur data extend the results from short‐term weight loss trials and suggest that the magnitude of weight loss and baseline values for risk factors are associated with improvements in cardiometabolic risk factors even after 24 months.Clinical Trials Registration InformationURL: http://www.clinicaltrials.gov/. Unique identifier: NCT00640900.

Effect of an 18-month physical activity and weight loss intervention on body composition in overweight and obese older adults

ObjectiveOur primary objective was to determine the long-term effects of physical activity (PA) and weight loss (WL) on body composition in overweight/obese older adults. Secondarily, we evaluated the association between change in body mass and composition on change in several cardiometabolic risk factors and mobility.Design and Methods288 older (X±SD: 67.0±4.8 years), overweight/obese (BMI 32.8±3.8 kg/m2) men and women participated in this 18 month randomized, controlled trial. Treatment groups included PA+WL (n=98), PA-only (n=97), and a successful aging (SA) health education control (n=93). DXA-acquired body composition measures (total body fat and lean mass), conventional biomarkers of cardiometabolic risk, and 400-m walk time were obtained at baseline and 18 months.ResultsFat mass was significantly reduced from (X±SE) 36.5±8.9 kg to 31.7±9.0 kg in the PA+WL group (p<0.01), but remained unchanged from baseline in the PA-only (−0.8±3.8 kg) and SA (−0.0±3.9 kg) groups. Lean mass losses were three times greater in the PA+WL group compared to PA-only or SA groups (−2.5±2.8 kg vs. −0.7±2.2 kg or −0.8±2.4 kg, respectively; p<0.01); yet due to a larger decrease in fat mass, percent lean mass was significantly increased over baseline in the PA+WL group (2.1%±2.6%; p<0.01). Fat mass loss was primarily responsible for WL-associated improvements in cardiometabolic risk factors, while reduction in body weight, regardless of compartment, was significantly associated with improved mobility.ConclusionThis 18 month PA+WL program resulted in a significant reduction in percent body fat with a concomitant increase in percent body lean mass. Shifts in body weight and composition were associated with favorable changes in clinical parameters of cardiometabolic risk and mobility. Moderate PA without WL had no effect on body composition.

Abstract P422: Dissociation between Changes in Cardiorespiratory Fitness and Cardiometabolic Risk Profile in Response to Exercise in Abdominally Obese Adults

Cardiorespiratory fitness (CRF) is a strong, independent predictor of morbidity and mortality. Although the majority of adults who increase daily physical activity experience an increase in CRF (VO2 peak), about 10-15% of participants do not increase CRF despite participating in a standardized exercise program. In this study we sought to determine whether exercise combined with a healthy diet was associated with a corresponding improvement in cardiometabolic risk factors despite the absence of change in CRF. We studied 59 sedentary, abdominally obese (waist circumference: 104.6 ± 8.5cm) adults who participated in 3 (women) or 4 (men) months of supervised aerobic exercise. CRF was measured using a standard treadmill test. Cardiometabolic risk factors included fasting triglycerides, total cholesterol, HDL-C, LDL-C, insulin, glucose, systolic and diastolic blood pressure. Participants were asked to exercise 7 days per week for the time required to expend 500 kcals per session for women, and 700 kcals for men. The intensity of exercise was self-selected and ranged between 65-90% of VO2 peak. Men and women were combined for all analyses. To examine the relationship between corresponding changes in cardiometabolic risk factors and CRF, participants were divided into tertiles based on mean change in CRF. A linear trend test was used to characterize the change in cardiometabolic risk factors across CRF change tertiles. The volume (energy expenditure (kcal)) and intensity (%VO2 peak) of exercise performed across tertiles of change in CRF was not different (P&gt;0.10). As expected a significant linear trend across tertiles was observed for change in CRF (P&lt;0.001), however, the mean change in CRF within the lowest tertile was not significant (P&gt;0.10). Without exception, no linear trend was observed for the change in cardiometabolic risk factors across tertiles of change in CRF (P&gt;0.10). This was also true for change in waist circumference and visceral fat (P&gt;0.10). Regression analysis using the total sample confirmed that, with the exception of glucose, the change score for each cardiometabolic risk factor was not related to the change in CRF (P&gt;0.10). Our findings suggest that in abdominally obese adults, improvement in cardiometabolic risk profile is not associated with change in CRF and that increasing physical activity combined with a healthful diet is associated with substantial health benefit in the absence of change in CRF.

Diabetes Prevention Program Community Outreach

The gap between what is known from clinical efficacy research and the systematic community translation of diabetes prevention programs is narrowing. During the past 5 years, numerous randomized and nonrandomized dissemination studies have evaluated the modified delivery of structured Diabetes Prevention Program (DPP) interventions in diverse real-world settings. Programs of sufficient dose and duration, implemented with fidelity, have reported weight losses in the range of 4%-7% with associated improvements in cardiometabolic risk factors at 6 and 12 months from baseline. The current article describes some of the experiences and perspectives of a team of University of Pittsburgh researchers as they have engaged in these efforts.

Erratum to: “Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo adiposity intervention study - a hospital/public health nurse combined treatment.”

Weight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results. From 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1- 0.00-0.55). 230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio. Even a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.

Weight Loss and Metabolic Improvement in Morbidly Obese Subjects Implanted for 1 Year With an Endoscopic Duodenal-Jejunal Bypass Liner

To evaluate safety, weight loss, and cardiometabolic changes in obese subjects implanted with the duodenal-jejunal bypass liner (DJBL) for 1 year. The DJBL is an endoscopic implant that mimics the duodenal-jejunal bypass component of the Roux-en-Y gastric bypass. Previous reports have shown significant weight loss and improvement in type 2 diabetes for up to 6 months. Morbidly obese subjects were enrolled in a single arm, open label, prospective trial and implanted with the DJBL. Primary endpoints included safety and weight change from baseline to week 52. Secondary endpoints included changes in waist circumference, blood pressure, lipids, glycemic control, and metabolic syndrome. The DJBL was implanted endoscopically in 39 of 42 subjects (age: 36 ± 10 years; 80% female; weight: 109 ± 18 kg; BMI: 43.7 ± 5.9 kg/m); 24 completed 52 weeks of follow-up. Three subjects could not be implanted due to short duodenal bulb. Implantation time was 24 ± 2 minutes. There were no procedure-related complications and there were 15 early endoscopic removals. In the 52-week completer population, total body weight change from baseline was -22.1 ± 2.1 kg (P < 0.0001) corresponding to 19.9 ± 1.8% of total body weight and 47.0 ± 4.4% excess of weight loss. There were also significant improvements in waist circumference, blood pressure, total and low-density lipoprotein cholesterol, triglycerides, and fasting glucose. The DJBL is safe when implanted for 1 year, and results in significant weight loss and improvements in cardiometabolic risk factors. These results suggest that this device may be suitable for the treatment of morbid obesity and its related comorbidities. This study was registered at www.clinicaltrials.gov (NCT00985491).

Effects of whole and refined grains on cardiometabolic risk factors in a controlled‐feeding, weight loss study: Preliminary findings

Making “half your grains whole” is recommended to reduce risk of chronic disease; yet, evidence from clinical trials is mixed. Our aim was to study the effects of chronic whole (WG) and refined grain (RG) intake on cardiometabolic risk factors in a controlled‐feeding setting. Overweight or obese (BMI 25–42 kg/m2) men (n=25) and women (n=25) aged 35–55 with increased waist circumference and at least 1 other Metabolic Syndrome criterion were randomized to a healthy diet containing either WG or RG. An isocaloric diet was provided for 6 weeks followed by a hypocaloric diet (~500 kcal/day) for 6 weeks. Both groups had reductions (p for time &lt;0.001) in body weight, waist circumference, abdominal % body fat, C‐reactive protein, insulin, triglycerides, HDL‐C, LDL‐C, and blood pressure, but group differences for these endpoints were not significant. Fasting plasma glucose (FPG) tended to decrease more with WG compared to RG (−1.2±0.9 vs −4.0±0.9 mg/dL, p=0.1) while controlling for baseline FBG and weight loss. In a subgroup analysis, there was a greater decrease in the number of prediabetic participants (FPG ≥100 mg/dL) from baseline to study end in the WG (10 to 1) compared to the RG group (8 to 7). In conclusion, a healthy diet led to significant improvement of cardiometabolic risk factors in an “unhealthy overweight” population while WG provided extra benefits for glycemic control, particularly in prediabetic individuals.Grant Funding Source : Bell Institute for Health and Nutrition, General Mills, Inc.; NIH Grant M01RR10732; ClinicalTrials.gov NCT00924521

Collaborative Approach to Implementing an Adapted Diabetes Prevention Program Lifestyle Intervention

This study evaluated weight loss and cardiometabolic risk reduction achieved through an adapted Diabetes Prevention Program lifestyle intervention among adults at high risk for cardiovascular disease (CVD) and diabetes. A 16-session lifestyle intervention was delivered through a partnership between a diabetes self-management education (DSME) program and the Young Men's Christian Association (YMCA). Overweight adults with ≥ 1 additional risk factors for CVD or diabetes were enrolled (n = 265). Lifestyle coaches from the DSME program coordinated intervention delivery and taught the curriculum. YMCA staff delivered the physical activity component of the intervention. Two-hundred and nineteen participants (83%) completed the program. Seventy-five percent of participants achieved the physical activity goal (≥ 150 minutes/week), 34% achieved the 7% weight loss goal, and 60% achieved weight loss ≥ 5%. There were significant improvements in cardiometabolic risk factors among participants completing the intervention. Our findings suggest that an adapted lifestyle intervention can be successfully implemented through collaboration between a DSME program and a YMCA. Implementation of effective prevention programs in multiple settings throughout the United States will be needed to ensure that the large subpopulation of adults at high risk for CVD and diabetes have access to this prevention service.

Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study - a hospital/public health nurse combined treatment

BackgroundWeight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results.MethodsFrom 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1-< 0.23, Group 3: decrease in/stable BMI z-score≥0.0-< 0.1, Group 4: increase in BMI z-score (>0.00-0.55).Results230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio.ConclusionsEven a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.

Twelve-Week Aerobic Training Decreases Chemerin Level and Improves Cardiometabolic Risk Factors in Overweight and Obese Men

The inflammatory state of adipose tissue in obese subjects may be the most important factor linking increased adipose tissue mass to insulin resistance. Chemerin is a newly discovered adipokine that plays an important role in macrophage infiltration into adipose tissue and may contribute to the development of inflammation and insulin resistance. We examined the effects of 12 weeks of aerobic training on serum chemerin levels in association with cardiovascular risk factors in overweight and obese males. Twenty-one overweight and obese subjects [44.3 (±4.1 yrs, body mass index (BMI) ≥25 kg/m(2)) were assigned to exercise training (obese EX, n= 11) and control (obese CON, n= 10) groups. The obese EX group participated in 12 weeks of progressive aerobic training 5 days a week. Serum chemerin, insulin resistance, lipid profiles, blood pressure, and body composition were all measured before and after the training. After the aerobic training, waist circumference (P=0.009), fat percent (P=0.03), visceral fat (P=0.03), subcutaneous fat (P=0.01), fasting glucose (P=0.01), insulin resistance (P=0.03), triglyceride (P=0.05), total cholesterol (P=0.04), low-density lipoprotein cholesterol (P=0.05) and systolic blood pressure (P=0.04) of participates were significantly decreased. Concurrently, serum chemerin concentrations were significantly decreased after aerobic program (P=0.02). Aerobic training caused an improvement in cardiometabolic risk factors in obese subjects, and this improvement was accompanied by decreased chemerin levels.

Effects of aerobic training on serum omentin-1 and cardiometabolic risk factors in overweight and obese men

Omentin-1 is a newly discovered protein expressed and secreted from visceral adipose tissue that increases insulin sensitivity. We examined the effects of 12 weeks of aerobic training on serum omentin-1 concentrations together with cardiovascular risk factors in overweight and obese men. Eighteen overweight and obese participants (age 43.1 ± 4.7 years, BMI ≥25 kg · m−2) were assigned to exercise training (n = 9) and control (n = 9) groups. A matched control group of normal weight participants (n = 8; age 42.2 ± 3.8 years, BMI <25 kg · m−2) were also recruited for baseline comparison. The obese exercise group participated in 12 weeks of progressive aerobic training 5 days a week. Measures of serum omentin-1, insulin resistance, lipid profiles, blood pressure, and body composition were obtained before and after the 12 weeks. At baseline, normal weight participants had significantly higher serum omentin-1 concentrations than overweight and obese participants, and there were inverse correlations between omentin-1 and each of waist circumference, fasting glucose, insulin resistance, total cholesterol, triglyceride, and systolic blood pressure (P < 0.05). After the aerobic training, waist circumference, percent body fat, fasting glucose, insulin resistance, triglyceride, total cholesterol, low-density lipoprotein cholesterol, and systolic blood pressure were all significantly decreased (P < 0.05). In contrast, serum omentin-1 concentration was significantly increased after the aerobic programme (P < 0.05), and correlated with changes in insulin resistance (r = −0.67, P = 0.04), glucose (r = −0.65, P = 0.05), waist circumference (r = −0.70, P = 0.03), and aerobic fitness r = −0.68, P = 0.04). Aerobic training resulted in an improvement in cardiometabolic risk factors in obese participants, and this improvement was accompanied by increased omentin-1 concentrations.

The use of statins potentiates the insulin-sensitizing effect of exercise training in obese males with and without Type 2 diabetes

Exercise training is advocated in insulin resistance and statins are used to treat hyperlipidaemia, two cardiometabolic risk factors often presenting concurrently. Statin intake may blunt mitochondrial function and the adaptive response to exercise training. Thus combining exercise training with statin administration may have adverse effects. We examined whether improvements in cardiometabolic risk factors, insulin sensitivity and mitochondrial function mediated by progressive exercise training are affected by statin use. A group of 14 obese elderly males on statins (ST) and 22 matched control subjects (C) were examined. Results on in vivo mitochondrial function [MRS (magnetic resonance spectroscopy)], mitochondrial density (Western blotting), insulin sensitivity (clamp) and metabolic flexibility (indirect calorimetry) were compared before and after a 12-week combined progressive exercise training programme (3 x per week; 45 min per session). Except for LDL (low-density lipoprotein) cholesterol, all pre-training values were comparable between statin users and control subjects. In vivo mitochondrial function and mitochondrial density improved by training in both groups. Interestingly, blood-lipid profile, insulin sensitivity (+72%), non-oxidative and oxidative glucose disposal (+38% and +112%) and insulin-mediated suppression of fat oxidation (-62%) improved only in the ST group. We conclude that statin treatment did not impede exercise performance or tolerance, mitochondrial function or mass. In addition, training-induced improvements in glucose homoeostasis were preserved in the ST group. Strikingly, the insulin-sensitizing effect of training was more prominent in the ST group than in the C group. The combined prescription of statins along with exercise training is safe and should be considered for subjects prone to develop insulin resistance.

Effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children

Zinc, an essential trace element and a component of many enzymes, is involved in the synthesis, storage and release of insulin. The aim of the present study was to assess the effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children. This triple-masked, randomized, placebo-controlled cross-over trial was conducted among 60 obese Iranian children in 2008. Pertinent clinical findings, fasting serum glucose, insulin and lipid profile were assessed. Participants were randomly assigned to two groups of equal number; one group received 20mg elemental zinc and the other group received placebo on a regular daily basis for eight weeks. After a 4-week wash-out period, the groups were crossed over. The mean age of participants was 9.1 +/- 1.1 years. After receiving zinc, the mean fasting plasma glucose (FPG), insulin and HOMA-IR decreased significantly, while body mass index (BMI), waist circumference (WC), LDL-C and triglycerides (TG) did not significantly change. After receiving placebo, the mean FPG, insulin and HOMA-IR increased significantly, while BMI, WC, LDL-C and TG showed a non-significant increase. Besides lifestyle modification, zinc supplementation might be considered as a useful and safe additional intervention treatment for improvement of cardiometabolic risk factors related to childhood obesity.

Exenatide Use in the Management of Metabolic Syndrome: A Retrospective Database Study

To evaluate the effect of exenatide therapy on cardiometabolic risk factors and anthropometric parameters in patients with metabolic syndrome. From June 2005 to June 2007, we performed a retrospective analysis of data extracted from the records of adult patients with metabolic syndrome being treated with exenatide. Diagnosis of any type of diabetes mellitus was exclusionary. Patients were initiated on exenatide therapy, 5 mcg, 1 hour before their morning and evening meals for the first month and were instructed to titrate up to 10 mcg. Cardiometabolic risk factors (total cholesterol, high-density lipoprotein cholesterol, triglycerides, calculated low-density lipoprotein cholesterol, and blood pressure) and anthropometric parameters (absolute body weight, body mass index, and abdominal girth) were measured at baseline and at 16 +/- 4 weeks after initiating exenatide therapy. Data collected also included age, sex, metabolic syndrome diagnosis, and other concomitant medication used in the management of endocrine disorders. The study population consisted of 299 patients (259 women, 40 men) with an age range of 18 to 74 years. Exenatide treatment was associated with significant reductions in mean body weight (P<.001) and body mass index (P<.001). Weight loss in 76.6% of patients was concomitant with a significant reduction in mean abdominal girth (P<.001). Further analysis revealed significant decreases in mean triglycerides (P<.001), total cholesterol (P<.01), and both systolic (P<.01) and diastolic blood pressure (P<.03). Approximately 60.2% of patients used metformin concomitantly, and half either decreased or discontinued metformin therapy. This is the first report examining the effect of exenatide on patients with metabolic syndrome. We observed a significant improvement in cardiometabolic risk factors and anthropometric parameters as a result of exenatide over the treatment interval.

Long-term effect of CB1 blockade with rimonabant on cardiometabolic risk factors: two year results from the RIO-Europe Study †

Rimonabant, the first selective cannabinoid type 1 receptor blocker, has been shown to produce weight loss and improvements in several cardiometabolic risk factors over 1 year. We report the 2 year efficacy and tolerability data of rimonabant. Patients with a body mass index > or =30 or >27 kg/m(2) with treated/untreated hypertension, dyslipidaemia, or both, were randomized to double-blind treatment with placebo, rimonabant 5 or 20 mg once daily plus a calorie-restricted diet for 2 years. Weight loss from baseline to 2 years in the intention-to-treat population was significantly greater with rimonabant 20 mg (mean +/- SD: -5.5 +/- 7.7 kg; P < 0.001) and 5 mg (-2.9 +/- 6.5 kg; P = 0.002) than placebo (-1.2 +/- 6.8 kg). Rimonabant 20 mg produced significantly greater improvements than placebo in waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose and insulin levels, insulin resistance, and metabolic syndrome prevalence. Rimonabant 20 mg produced clinically meaningful improvements in all Impact of Weight on Quality of Life-Lite questionnaire domain scores at 2 years. Rimonabant was generally well tolerated and rates of adverse events, including depressed mood disorders and disturbances were similar to placebo during year 2. Proportions of patients with clinically significant depression (Hospital Anxiety and Depression Scale score >11) were similar in all treatment groups. Rimonabant 20 mg over 2 years promoted clinically relevant and durable weight loss and improvements in cardiometabolic risk factors.

Consequences of Change in Waist Circumference on Cardiometabolic Risk Factors Over 9 Years

Obesity and abdominal adiposity have been shown in prospective studies to be risk factors for cardiovascular disease and particularly for diabetes (1–8). In cross-sectional studies, both are related with risk factors for these diseases (9–12), but there are few publications on the effects of changes in abdominal adiposity (13). We characterized men and women who gained and lost abdominal adiposity over 9 years and describe the incidence and the improvement in cardiometabolic risk factors according to changes in waist circumference. From the Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) cohort (9,14,15), 1,868 men and 1,939 women aged 30–64 years at baseline were followed over 9 years. The 73% of the baseline cohort that we studied were older, less frequently abdominally obese, hypertriglyceridemic, hyperinsulinemic, smokers, and fewer had metabolic syndrome. Cardiometabolic abnormalities and the metabolic syndrome were defined according to the National Cholesterol Education Program (NCEP) criteria (16), except high blood pressure, which included antihypertensive treatment (Table 1); hyperinsulinemia was defined by upper quartiles of fasting insulin ≥57.3 pmol/l for men and ≥52.8 pmol/l. The incidence and improvement of cardiometabolic risk factors were studied by age-adjusted logistic regression, according to waist change: ≤ −3.0 cm, −2.9 to +2.9 cm, 3.0–6.9 cm, and ≥7.0 cm. Statistical significance was defined as P < 0.05. The median increase in waist circumference was 3 cm in men and …