Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
Phys Sportsmed. 2011 May;39(2):27-40. doi: 10.3810/psm.2011.05.1893.
To determine whether sedentary obese women with elevated levels of homeostatic model assessment (HOMA) insulin resistance (ie, > 3.5) experience greater benefits from an exercise + higher-carbohydrate (HC) or carbohydrate-restricted weight loss program than women with lower HOMA levels.
221 women (age, 46.5 ± 12 years; body weight, 90.3 ± 16 kg; body mass index, 33.8 ± 5 kg/m(2)) participated in a 10-week supervised exercise and weight loss program. The fitness program involved 30 minutes of circuit-style resistance training 3 days per week. Subjects were prescribed low-fat (30%) isoenergetic diets that consisted of 1200 kcals per day for 1 week (phase 1) and 1600 kcals per day for 9 weeks (phase 2) with HC or higher protein (HP). Fasting blood samples, body composition, anthropometry, resting energy expenditure, and fitness measurements were obtained at 0 and 10 weeks. Subjects were retrospectively stratified into lower (LH) or higher (HH) than 3.5 HOMA groups. Data were analyzed by multivariate analysis of variance with repeated measures and are presented as mean ± standard deviation changes from baseline.
Baseline HOMA levels in the LH group were significantly lower than those in the HH group (LH, 0.6 ± 0.7; HH, 6.3 ± 3.4; P = 0.001). Diet and training significantly decreased body weight (-3.5 ± 3 kg), fat mass (-2.7 ± 3 kg), blood glucose (-3%), total cholesterol (-4.5%), low-density lipoproteins (-5%), triglycerides (-5.9%), systolic blood pressure (-2.6%), and waist circumference (-3.7%), while increasing peak aerobic capacity (7.3%). Subjects in the HP group experienced greater weight loss (-4.4 ± 3.6 kg vs -2.6 ± 2.9 kg), fat loss (-3.4 ± 2.7 kg vs -1.7 ± 2.0 kg), reductions in serum glucose (3% vs 2%), and decreases in serum leptin levels (-30.8% vs -10.8%) than those in the HC group. Participants in the HH (-14.1%) and HP-HH (-21.6%) groups observed the greatest reduction in serum blood glucose.
A carbohydrate-restricted diet promoted more favorable changes in weight loss, fat loss, and markers of health in obese women who initiated an exercise program compared with a diet higher in carbohydrate. Additionally, obese women who initiated training and dieting with higher HOMA levels experienced greater reductions in blood glucose following an HP diet.
确定静息肥胖女性中，胰岛素抵抗的稳态模型评估（HOMA）水平升高（即>3.5）者，通过运动+高碳水化合物（HC）或限制碳水化合物的减肥方案，是否比 HOMA 水平较低者获益更多。
221 名女性（年龄 46.5±12 岁；体重 90.3±16kg；体重指数 33.8±5kg/m²）参加了为期 10 周的监督运动和减肥计划。健身方案包括每周 3 天、每次 30 分钟的循环式阻力训练。研究对象被规定摄入低脂肪（30%）等热量饮食，第 1 周每天 1200 千卡（第 1 阶段），第 9 周每天 1600 千卡（第 2 阶段），饮食方案包含 HC 或高蛋白（HP）。于 0 周和 10 周时获取空腹血样、身体成分、人体测量学、静息能量消耗和健身测量值。根据 HOMA 水平，将受试者分为较低（LH）或较高（HH）组。通过重复测量的多元方差分析进行数据分析，并以基线时的均值±标准差变化表示。
LH 组的 HOMA 基线水平显著低于 HH 组（LH，0.6±0.7；HH，6.3±3.4；P=0.001）。饮食和训练显著降低体重（-3.5±3kg）、体脂（-2.7±3kg）、血糖（-3%）、总胆固醇（-4.5%）、低密度脂蛋白（-5%）、甘油三酯（-5.9%）、收缩压（-2.6%）和腰围（-3.7%），同时提高峰值有氧能力（7.3%）。HP 组的减重更多（-4.4±3.6kg 比-2.6±2.9kg）、体脂减少更多（-3.4±2.7kg 比-1.7±2.0kg）、血糖降低更多（3%比 2%）、瘦素水平降低更多（-30.8%比-10.8%），与 HC 组相比。与 HC 组相比，HOMA 水平较高的 HH（-14.1%）和 HP-HH（-21.6%）组的血糖降低更为显著。
与高碳水化合物饮食相比，起始运动计划的肥胖女性采用限制碳水化合物的饮食，在减重、减脂和健康标志物方面的改善更为显著。此外，起始时 HOMA 水平较高并采用高蛋白质和限制碳水化合物饮食的肥胖女性，在摄入 HP 饮食后，血糖降低更为显著。
