基于行为的减肥干预对乳腺癌幸存者胰岛素抵抗参数的影响。
Impact of a behaviorally-based weight loss intervention on parameters of insulin resistance in breast cancer survivors.
机构信息
Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, 05405, USA.
Department of Nutrition and Food Sciences, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, 05405, USA.
出版信息
BMC Cancer. 2018 Mar 27;18(1):351. doi: 10.1186/s12885-018-4272-2.
BACKGROUND
Breast cancer survivors with excess weight are more likely to have negative breast cancer outcomes. Biomarkers related to insulin resistance may help explain this negative association. Weight loss is associated with improvements in insulin sensitivity. Our goal was to identify the impact of a behaviorally based weight loss intervention on indices of insulin resistance.
METHODS
Overweight, early stage breast cancer survivors who completed initial cancer therapy were enrolled in a 6 month behaviorally based weight loss intervention that included calorie reduction, exercise and behavior modification. Biomarkers related to insulin resistance were obtained at baseline and after the intervention. Results from participants who achieved ≥5% weight loss were compared to those who lost less weight.
RESULTS
Despite not having diabetes as a preexisting diagnosis prior to the study, 69% of all participants were considered to have pre-diabetes or diabetes at baseline based on American Diabetes Association definitions. Participants who achieved ≥5% weight loss had significantly lower fasting insulin, AUC insulin, and insulin resistance as measured by HOMA-IR. Beta cell function decreased as anticipated when insulin resistance improved. Additionally, leptin levels declined.
CONCLUSIONS
Breast cancer survivors who achieved ≥5% weight loss demonstrated significant improvements in indices of insulin resistance. Despite an exclusion criteria of diabetes at the time of enrolment, a high proportion met criteria for pre-diabetes or diabetes at baseline. Pre-diabetes appears to be under recognized in overweight breast cancer survivors. Behaviorally based weight loss interventions can result in weight loss and improvements in biomarkers related to breast cancer outcomes and additionally may decrease the chance of developing diabetes.
TRIAL REGISTRATION
NCT01482702 4/12/2010 (retrospectively registered). https://clinicaltrials.gov/ct2/show/NCT01482702?term=Dittus&rank=4.
背景
超重的乳腺癌幸存者更有可能出现负面的乳腺癌结果。与胰岛素抵抗相关的生物标志物可能有助于解释这种负面关联。体重减轻与胰岛素敏感性的提高有关。我们的目标是确定基于行为的减肥干预对胰岛素抵抗指数的影响。
方法
完成初始癌症治疗的超重、早期乳腺癌幸存者参加了一项为期 6 个月的基于行为的减肥干预，包括减少卡路里、锻炼和行为改变。在基线和干预后获得与胰岛素抵抗相关的生物标志物。将体重减轻≥5%的参与者的结果与体重减轻较少的参与者进行比较。
结果
尽管在研究前没有糖尿病的既往诊断，但根据美国糖尿病协会的定义，所有参与者中有 69%在基线时被认为患有前驱糖尿病或糖尿病。体重减轻≥5%的参与者空腹胰岛素、AUC 胰岛素和 HOMA-IR 测量的胰岛素抵抗显著降低。随着胰岛素抵抗的改善，β细胞功能如预期下降。此外，瘦素水平下降。
结论
体重减轻≥5%的乳腺癌幸存者胰岛素抵抗指数显著改善。尽管在入组时排除了糖尿病的标准，但仍有很大一部分人在基线时符合前驱糖尿病或糖尿病的标准。前驱糖尿病在超重的乳腺癌幸存者中似乎未被充分认识。基于行为的减肥干预可以导致体重减轻和与乳腺癌结果相关的生物标志物的改善，此外还可能降低患糖尿病的机会。
试验注册
NCT01482702 4/12/2010（回顾性注册）。https://clinicaltrials.gov/ct2/show/NCT01482702?term=Dittus&rank=4。
Zotero 插件