Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA.
Metabolism. 2012 May;61(5):672-9. doi: 10.1016/j.metabol.2011.10.001. Epub 2011 Dec 5.
The objective was to evaluate the determinants of change (Δ) in insulin sensitivity in overweight coronary artery disease male patients without diabetes after an intensive lifestyle intervention. All patients received nutritional counseling and performed 4 months of exercise training (ET) according to 1 of 2 protocols: aerobic ET (65%-70% of peak aerobic capacity [VO(2)]) 25 to 40 minutes 3 times a week (n = 30) or walking (50%-60% of peak VO(2)) 45 to 60 minutes at least 5 times a week (n = 30). Data from participants of both ET groups were pooled, and post-intensive lifestyle intervention results were compared with baseline data. The primary outcome was Δ insulin sensitivity (m-value) assessed by the criterion standard technique, the euglycemic-hyperinsulinemic clamp. Changes in weight, body mass index, total and percentage fat mass (by dual-energy x-ray absorptiometry scan), waist circumference, total abdominal and visceral fat (by computed tomographic scan), high-sensitivity C-reactive protein, peak VO(2), daily energy intake, and physical activity energy expenditure (PAEE) (by doubly labeled water technique) were also assessed. Daily energy intake decreased by 335 kcal, and PAEE increased by 482 kcal/d (all P < .0001). The mean weight loss was 6.4 kg, and the mean improvement in m-value was 1.6 mg/kg fat-free mass per minute. Univariate determinants of Δ m-value were low baseline PAEE, walking protocol, Δ weight, Δ body mass index, Δ total and percentage fat mass, Δ waist circumference, Δ total abdominal and visceral fat, and Δ PAEE (all P < .05). In multivariate analysis, the only significant determinant of Δ m-value was Δ PAEE (P < .02). In this analysis, the most powerful determinant of improved insulin sensitivity in overweight coronary artery disease patients is the change in PAEE.
目的在于评估超重的冠心病男性患者（无糖尿病）在强化生活方式干预后胰岛素敏感性变化（Δ）的决定因素。所有患者都接受了营养咨询，并根据以下两种方案之一进行了 4 个月的运动训练（ET）：有氧运动训练（65%-70%的峰值有氧能力[VO₂]），每周 3 次，每次 25 至 40 分钟（n = 30）或散步（50%-60%的峰值 VO₂），每周至少 5 次，每次 45 至 60 分钟（n = 30）。将两个 ET 组的参与者数据合并，并将强化生活方式干预后的结果与基线数据进行比较。主要结果是通过稳态胰岛素钳夹技术评估的胰岛素敏感性变化（m 值）。体重、体重指数、总脂肪量和脂肪百分比（双能 X 射线吸收法扫描）、腰围、腹部和内脏脂肪总量（计算机断层扫描）、高敏 C 反应蛋白、峰值 VO₂、每日能量摄入和体力活动能量消耗（双标记水技术）的变化也进行了评估。每日能量摄入减少了 335 千卡，PAEE 增加了 482 千卡/天（均 P <.0001）。平均体重减轻了 6.4 公斤，m 值的平均改善为 1.6 毫克/公斤无脂肪体重/分钟。m 值变化的单变量决定因素为低基线 PAEE、散步方案、体重变化、体重指数变化、总脂肪量和脂肪百分比变化、腰围变化、腹部和内脏脂肪总量变化以及 PAEE 变化（均 P <.05）。在多变量分析中，m 值变化的唯一显著决定因素是 PAEE 的变化（P <.02）。在这项分析中，改善超重冠心病患者胰岛素敏感性的最有力决定因素是 PAEE 的变化。
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