Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Am J Prev Med. 2011 Oct;41(4):366-75. doi: 10.1016/j.amepre.2011.06.042.
Comprehensive lifestyle interventions are effective in preventing diabetes and restoring glucose regulation; however, the key stimulus for change has not been identified and effects in older individuals are not established. The aim of the study was to investigate the independent and combined effects of dietary weight loss and exercise on insulin sensitivity and restoration of normal fasting glucose in middle-aged and older women.
Four-arm RCT, conducted between 2005 and 2009 and data analyzed in 2010.
SETTING/PARTICIPANTS: 439 inactive, overweight/obese postmenopausal women.
Women were assigned to: dietary weight loss (n=118); exercise (n=117); exercise+diet (n=117); or control (n=87). The diet intervention was a group-based reduced-calorie program with a 10% weight-loss goal. The exercise intervention was 45 min/day, 5 days/week of moderate-to-vigorous intensity aerobic activity.
12-month change in serum insulin, C-peptide, fasting glucose, and whole body insulin resistance (HOMA-IR).
A significant improvement in HOMA-IR was detected in the diet (-24%, p<0.001) and exercise+ diet (-26%, p<0.001) groups but not in the exercise (-9%, p=0.22) group compared with controls (-2%); these effects were similar in middle-aged (50-60 years) and older women (aged 60-75 years). Among those with impaired fasting glucose (5.6-6.9 mmol/L) at baseline (n=143; 33%), the odds (95% CI) of regressing to normal fasting glucose after adjusting for weight loss and baseline levels were 2.5 (0.8, 8.4); 2.76 (0.8, 10.0); and 3.1 (1.0, 9.9) in the diet, exercise+diet, and exercise group, respectively, compared with controls.
Dietary weight loss, with or without exercise, significantly improved insulin resistance. Older women derived as much benefit as did the younger postmenopausal women.
This study is registered at Clinicaltrials.govNCT00470119.
综合生活方式干预措施可有效预防糖尿病并恢复血糖调节；然而，尚未确定改变的关键刺激因素，且其在老年人中的效果尚未确定。本研究旨在调查饮食减肥和运动对中年和老年女性胰岛素敏感性和空腹血糖正常化的独立和联合作用。
2005 年至 2009 年进行的四臂 RCT，2010 年进行数据分析。
地点/参与者：439 名不活跃、超重/肥胖的绝经后女性。
女性被分配到：饮食减肥（n=118）；运动（n=117）；运动+饮食（n=117）；或对照组（n=87）。饮食干预是一种基于小组的低热量计划，目标是减重 10%。运动干预是每天 45 分钟，每周 5 天进行中等至剧烈强度的有氧运动。
血清胰岛素、C 肽、空腹血糖和全身胰岛素抵抗（HOMA-IR）的 12 个月变化。
饮食组（-24%，p<0.001）和运动+饮食组（-26%，p<0.001）的 HOMA-IR 显著改善，但运动组（-9%，p=0.22）与对照组（-2%）相比没有改善；这些效果在中年（50-60 岁）和老年女性（60-75 岁）中相似。在基线时（n=143；33%）空腹血糖受损（5.6-6.9 mmol/L）的患者中，在调整体重减轻和基线水平后，饮食组、运动+饮食组和运动组恢复正常空腹血糖的几率（95%CI）分别为 2.5（0.8，8.4）；2.76（0.8，10.0）；和 3.1（1.0，9.9），与对照组相比。
饮食减肥，无论是否运动，均可显著改善胰岛素抵抗。老年女性与年轻绝经后女性一样受益。
本研究在 Clinicaltrials.gov 注册，编号为 NCT00470119。
