Plain language summary
Obesity management is beneficial in the treatment of type 2 diabetes (T2D) however, weight reduction is often accompanied by loss of muscle mass. Also, T2D is independently associated with excessive loss of muscle mass in older adults, increasing the risk for sarcopenia. To address these challenges, combined lifestyle interventions that include resistance exercise can preserve muscle mass during weight loss. The study aimed to investigate whether a 13-week combined lifestyle intervention, with or without a protein drink, could impact chronic low-grade inflammatory profile (CLIP) in older adults with T2D. This study was a post-hoc analysis of the PROBE study based on 114 participants with inflammatory biomarkers available at baseline or week 13 and without indication of acute inflammation. Participants either received a protein or isocaloric control drink for 13 weeks. Results showed that: - both intervention groups showed reduced circulating adipokines and anti-inflammatory cytokine interleukin-1 receptor antagonist (IL-1RA). - inflammatory ratios tumor necrosis factor α (TNF-α) / interleukin-10 (IL-10) and TNF-α/IL-1RA increased. - C-reactive protein increased in low-to-average CLIP participants and decreased in high CLIP participants. Authors concluded that 13 weeks of hypocaloric diet in combination with resistance exercise and high-intensity interval training, either with or without protein drink, led to differential effects on inflammatory profile in older adults with obesity and type 2 diabetes.
Abstract
BACKGROUND Chronic low-grade inflammatory profile (CLIP) is one of the pathways involved in type 2 diabetes (T2D). Currently, there is limited evidence for ameliorating effects of combined lifestyle interventions on CLIP in type 2 diabetes. We investigated whether a 13-week combined lifestyle intervention, using hypocaloric diet and resistance exercise plus high-intensity interval training with or without consumption of a protein drink, affected CLIP in older adults with T2D. METHODS In this post-hoc analysis of the PROBE study 114 adults (≥55 years) with obesity and type 2 (pre-)diabetes had measurements of C-reactive protein (CRP), pro-inflammatory cytokines interleukin (IL)-6, tumor-necrosis-factor (TNF)-α, and monocyte chemoattractant protein (MCP)-1, anti-inflammatory cytokines IL-10, IL-1 receptor antagonist (RA), and soluble tumor-necrosis-factor receptor (sTNFR)1, adipokines leptin and adiponectin, and glycation biomarkers carboxymethyl-lysine (CML) and soluble receptor for advanced glycation end products (sRAGE) from fasting blood samples. A linear mixed model was used to evaluate change in inflammatory biomarkers after lifestyle intervention and effect of the protein drink. Linear regression analysis was performed with parameters of body composition (by dual-energy X-ray absorptiometry) and parameters of insulin resistance (by oral glucose tolerance test). RESULTS There were no significant differences in CLIP responses between the protein and the control groups. For all participants combined, IL-1RA, leptin and adiponectin decreased after 13 weeks (p = 0.002, p < 0.001 and p < 0.001), while ratios TNF-α/IL-10 and TNF-α/IL-1RA increased (p = 0.003 and p = 0.035). CRP increased by 12 % in participants with low to average CLIP (pre 1.91 ± 0.39 mg/L, post 2.13 ± 1.16 mg/L, p = 0.006) and decreased by 36 % in those with high CLIP (pre 5.14 mg/L ± 1.20, post 3.30 ± 2.29 mg/L, p < 0.001). Change in leptin and IL-1RA was positively associated with change in fat mass (β = 0.133, p < 0.001; β = 0.017, p < 0.001) and insulin resistance (β = 0.095, p = 0.024; β = 0.020, p = 0.001). Change in lean mass was not associated with any of the biomarkers. CONCLUSION 13 weeks of combined lifestyle intervention, either with or without protein drink, reduced circulating adipokines and anti-inflammatory cytokine IL-1RA, and increased inflammatory ratios TNF-α/IL-10 and TNF-α/IL-1RA in older adults with obesity and T2D. Effect on CLIP was inversely related to baseline inflammatory status.
Methodological quality
Jadad score
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3
Allocation concealment
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Yes
