Metabolic Unit, Department of Medicine, University of Padua, via Giustiniani 2, 35128, Padua, Italy.
Geriatrics Division, Department of Medicine, University of Padua, via Giustiniani 2, 35128, Padua, Italy.
J Endocrinol Invest. 2019 Dec;42(12):1497-1507. doi: 10.1007/s40618-019-01090-x. Epub 2019 Jul 29.
The effect of combined lifestyle interventions (LSI) including dietary and physical activity on metabolic health, energy metabolism and VOmax in diabetic patients has provided mixed results. We evaluated the impact of 1-year caloric restriction (CR), and 12-week supervised structured exercise training (SSET) on metabolic health, RMR and VOmax in obese adults with type 2 diabetes.
After 1-month education for LSI, 33 participants had anthropometric, biochemical and metabolic assessments. They then started CR based on RMR, and 3-month SSET during the months 1-3 (Early-SSET) or 4-6 (Late-SSET). Reassessments were planned after 3, 6 and 12 months. Using a per-protocol analysis, we evaluated parameter changes from baseline and their associations for the 23 participants (11 Early-SSET, 12 Late-SSET) who completed the study. RMR was adjusted (adjRMR) for age, sex, fat-free mass (FFM) and fat mass (FM).
Compared with baseline, after 6 months we found significant increases in VOmax (+ 14%) and HDL-cholesterol (+ 13%), and reduction in body mass index (- 3%), FM (- 8%) and glycated hemoglobin (HbA1c, - 7%). Training-related caloric expenditure negatively correlated with changes in body weight (p < 0.001), FM (p < 0.001) and HbA1c (p = 0.006). These results were confirmed at the 12-month follow-up. Pooling together all follow-up data, adjRMR changes correlated with changes in glycemia (r = 0.29, p = 0.02), total-cholesterol (r = 0.29, p = 0.02) and VOmax (r = - 0.26,p = 0.02). No significant differences emerged between the Early- and Late-SSET groups.
Combined intervention with SSET and CR improved metabolic control. Changes in metabolic health and fitness correlated with changes of adjRMR, which was reduced improving fitness, glycemia and cholesterolemia.
Trial registration number: NCT03785379. URL of registration: http://clinicaltrials.gov .
联合生活方式干预（LSI），包括饮食和体育活动，对糖尿病患者的代谢健康、能量代谢和最大摄氧量（VOmax）的影响结果不一。我们评估了为期 1 年的热量限制（CR）和 12 周监督结构化运动训练（SSET）对肥胖 2 型糖尿病患者代谢健康、静息代谢率（RMR）和 VOmax 的影响。
在接受 1 个月的 LSI 教育后，33 名参与者接受了人体测量、生化和代谢评估。然后，他们根据 RMR 开始进行 CR，并在第 1-3 个月（早期 SSET）或第 4-6 个月（晚期 SSET）进行 3 个月的 SSET。在 3、6 和 12 个月后进行重新评估。通过方案分析，我们评估了完成研究的 23 名参与者（11 名早期 SSET，12 名晚期 SSET）的基线参数变化及其相关性。RMR 为年龄、性别、去脂体重（FFM）和脂肪量（FM）进行了调整（adjRMR）。
与基线相比，6 个月后我们发现 VOmax（+14%）和高密度脂蛋白胆固醇（+13%）显著增加，体重指数（BMI）（-3%）、FM（-8%）和糖化血红蛋白（HbA1c，-7%）降低。与训练相关的热量消耗与体重（p<0.001）、FM（p<0.001）和 HbA1c（p=0.006）的变化呈负相关。这些结果在 12 个月的随访中得到了证实。汇总所有随访数据，adjRMR 的变化与血糖（r=0.29，p=0.02）、总胆固醇（r=0.29，p=0.02）和 VOmax（r=-0.26，p=0.02）的变化相关。早期 SSET 和晚期 SSET 组之间没有出现显著差异。
SSET 和 CR 的联合干预改善了代谢控制。代谢健康和体能的变化与 adjRMR 的变化相关，而 adjRMR 的减少改善了体能、血糖和胆固醇水平。
临床试验注册号：NCT03785379。注册网址：http://clinicaltrials.gov。
