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Influence of water-based exercise on energy intake, appetite, and appetite-related hormones in adults: A systematic review and meta-analysis.
Grigg, MJ, Thake, CD, Allgrove, JE, King, JA, Thackray, AE, Stensel, DJ, Owen, A, Broom, DR
Appetite. 2023;180:106375
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Exercise is an effective way to improve mental and physical health and can influence weight management due to the energy expenditure. Energy balance is influenced by day-to-day variations in energy intake and expenditure. The aim of this study was to address whether water-based exercise influences energy intake, appetite, and appetite related hormones differently to land based exercise in adults. This study is a systematic review and meta-analysis of nine studies which include randomised crossover ( 7 trials), semi-random (1 trial) (water-trial was required prior to iso-energetically matched water trial) and independent group (1 trial) (used in the 12-week study) designs. Results show that post-exercise energy intake is higher after water-based exercise versus a resting control. However, there wasn’t any difference in energy intake when water-based exercise was compared with land-based exercise. Furthermore, when different water temperatures were analysed, post-exercise energy intake was higher in cold water versus neutral water. Additionally, cycling and swimming did not alter fasting plasma concentrations of appetite regulating hormones (ghrelin and leptin), insulin or total peptide YY [gut hormone] but contributed to body mass loss. Authors conclude that if body mass management is a person’s primary focus, it is important to be mindful of the tendency to eat more in the subsequent hours after water-based exercise, as energy intake may be increased when compared to a no exercise control.
Expert Review
Conflicts of interest:
None
Take Home Message:
- The only type of exercise reporting an increase in energy intake was in water-based activities, where the temperature was between 18-20• C. However, this was only when explored in comparison to a resting control. No difference was reported in energy intake when water-based exercise was compared with land-based exercise.
- Any form of exercise, whether land or water-based should be considered where appropriate to reduce the risks of sedentary behaviour.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction:
Exercise is effective for weight-management alongside other physical and mental health benefits. Changes in appetite-regulating hormones may affect energy balance, e.g. some exercise may suppress appetite, known as exercise-induced anorexia. This review evaluated differences in energy intake, appetite and appetite-related hormones in land-based versus water-based exercise.
Methods:
The meta-analysis followed PRISMA guidelines and was registered on PROSPERO. Literature searching resulted in eight studies published between 1991 and 2021, which met the inclusion criteria (water v control), 5 studies (water v land) and 2 studies (water at different temperatures). Risk of Bias was assessed using Cochrane’s Risk of Bias for randomised trials.
Results:
Data were analysed in RevMan 5.4.1 using fixed effects, generic inverse variance method on energy intake. High heterogeneity prevented analysis on appetite and appetite-related hormones. Standard deviation was inputted based on estimated values for missing data. Heterogeneity was calculated using the I2 index. Sensitivity analyses were conducted. Statistical significance was set at p<0.05 and analyses based on two-tailed Z tests.
All participants had a healthy BMI, were aged 19-39 and ranged from well-trained to non-exercisers. A single bout of water-based exercise increased ad-libitum energy intake compared to a non-exercise control (mean difference [95% CI]: 330 [118, 542] kJ, P = 0.002) but no difference was identified between water and land-based exercise (78 [-176, 334] kJ, P = 0.55). Cold water exercise (18–20 •C) increased energy intake more than neutral water (27–33 •C) temperature (719 [222, 1215] kJ; P < 0.005). One 12-week study reported cycling and swimming did not alter fasting plasma concentrations of total ghrelin, insulin, leptin or total PYY but contributed to body mass loss 87.3 (5.2) to 85.9 (5.0) kg and 88.9 (4.9) to 86.4 (4.5) kg (P < 0.05) respectively.
Conclusion:
Despite limitations, this review may provide preliminary evidence on energy intake and appetite for water-based activities. If weight management is a primary focus, then water temperature needs to be considered, particularly if sub 20•C .
Clinical practice applications:
Although this study suggests cold water exercise may cause an increase in energy intake, 95% confidence intervals for individual studies are very large so results should be interpreted cautiously. Those preferring exercise in cold water, should be encouraged, providing they are mindful of the tendency to eat more post-exercise.
It is not possible to draw any robust conclusions about the ratings of hunger in response to different types of exercise due to limited data. However, according to the review, five studies demonstrated that hunger was suppressed more than control prior at the start of water-based exercise, and during and immediately after exercise.
Considerations for future research:
Most participants were of healthy weight and physically active, however since appetite signals may be dysregulated in obesity, including all weight categories and different activity levels may generate a more comprehensive overview.
Further research recommendations include:
- Measuring the effects of water- based activities on appetite, appetite related hormones and energy intake at different time points following exercise in order to provide recommendations for effective weight management strategies and in a range of different temperatures.
- Using a ‘no exercise’ water immersion control. Evidence suggests that immersion in cold water alone may increase energy expenditure
- Evaluating the effect of a water-based activity, such as swimming performed in a ‘fasted’ and ‘non-fasted’ state to investigate the impact on appetite, appetite related hormones and energy intake.
Abstract
Single bouts of land-based exercise suppress appetite and do not typically alter energy intake in the short-term, whereas it has been suggested that water-based exercise may evoke orexigenic effects. The primary aim was to systematically review the available literature investigating the influence of water-based exercise on energy intake in adults (PROSPERO ID number CRD42022314349). PubMed, Medline, Sport-Discus, Academic Search Complete, CINAHL and Public Health Database were searched for peer-reviewed articles published in English from 1900 to May 2022. Included studies implemented a water-based exercise intervention versus a control or comparator. Risk of bias was assessed using the revised Cochrane 'Risk of bias tool for randomised trials' (RoB 2.0). We identified eight acute (same day) exercise studies which met the inclusion criteria. Meta-analysis was performed using a fixed effects generic inverse variance method on energy intake (8 studies (water versus control), 5 studies (water versus land) and 2 studies (water at two different temperatures)). Appetite and appetite-related hormones are also examined but high heterogeneity did not allow a meta-analysis of these outcome measures. We identified one chronic exercise training study which met the inclusion criteria with findings discussed narratively. Meta-analysis revealed that a single bout of exercise in water increased ad-libitum energy intake compared to a non-exercise control (mean difference [95% CI]: 330 [118, 542] kJ, P = 0.002). No difference in ad libitum energy intake was identified between water and land-based exercise (78 [-176, 334] kJ, P = 0.55). Exercising in cold water (18-20 °C) increased energy intake to a greater extent than neutral water (27-33 °C) temperature (719 [222, 1215] kJ; P < 0.005). The one eligible 12-week study did not assess whether water-based exercise influenced energy intake but did find that cycling and swimming did not alter fasting plasma concentrations of total ghrelin, insulin, leptin or total PYY but contributed to body mass loss 87.3 (5.2) to 85.9 (5.0) kg and 88.9 (4.9) to 86.4 (4.5) kg (P < 0.05) respectively. To conclude, if body mass management is a person's primary focus, they should be mindful of the tendency to eat more in the hours after a water-based exercise session, particularly when the water temperature is cold (18-20 °C).
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Associations between circulating obesity-related biomarkers and prognosis in female breast cancer survivors: a systematic review of observational data in women enrolled in lifestyle intervention trials.
Meyer, D, Pastor-Villaescusa, B, Michel, S, Hauner, H, Hauner, D
BMC cancer. 2022;22(1):1187
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Overweight and obesity play a role in the development and potential outcomes in breast cancer. Several factors have been implicated linking cancer and obesity including hormones imbalances and inflammation, however exact links have yet to be elucidated. This systematic review of 4 randomised control trials containing 5234 women aimed to examine obesity related blood factors such as hormones, fats and sugar and their relationship with prognosis in individuals with breast cancer. The results showed that higher levels of testosterone were associated with an increased risk of recurrence of breast cancer. The female sex hormones, oestradiol and sex hormone binding globulin were not associated with breast cancer recurrence. Blood sugar levels and insulin resistance were not associated with breast cancer recurrence. There were certain growth factors, which are molecules responsible for stimulating cellular processes, that were responsible for an increased chance of recurrence of breast cancer and insulin-like growth factor and platelet derived growth factor were shown to increase risk but only when increased in combination with each other. Inconsistent results were seen with C-reactive protein, which is an inflammatory marker. It was concluded that testosterone may be associated with an increased risk of breast cancer recurrence, however the evidence from the other blood factor was unreliable due to poor quality trials. More trials are needed to investigate these factors further. This study could be used by healthcare professionals to understand that weight loss is the key to the prevention of recurrence of breast cancer in those who are overweight and that testosterone levels could be used to identify those who are at an increased risk.
Abstract
Obesity plays an important role in the development and progression of breast cancer via various oncogenic pathways. However, the biological mechanisms underlying this relationship are not fully understood. Moreover, it is unclear whether obesity-related and further associated biomarkers could be suitable targets for lifestyle interventions. This systematic review was conducted to examine relationships between obesity-related blood parameters and prognosis for breast cancer survivors enrolled in lifestyle intervention studies. A systematic, computerized literature search was conducted from inception through August 26th, 2020 in PubMed, EMBASE, and CENTRAL. The focus was on observational data from randomized controlled lifestyle intervention trials investigating associations between selected baseline biomarkers, measured in remission, and breast cancer recurrence, breast cancer mortality and/or all-cause mortality. Four studies with data from 5234 women met the inclusion criteria.Studies herein provide moderate evidence that bioavailable or serum testosterone may be positively linked to breast cancer recurrence and inversely linked to disease-free survival. Limited evidence suggests no associations with circulating estradiol or insulin levels on prognosis outcomes, whereas HDL cholesterol was inversely associated with breast cancer recurrence. For some other biomarkers, such as growth factors, adipokines, and CRP, the evidence for associations with disease prognosis was too weak to draw conclusions.Overall, despite potential candidates, there is insufficient evidence to confirm or refute that obesity-related biomarkers and sex hormones have a prognostic value for breast cancer survival. More longitudinal studies in breast cancer survivors to examine the clinical utility of obesity-related biomarkers are needed.
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The Effects of Intermittent Fasting and Continuous Energy Restriction with Exercise on Cardiometabolic Biomarkers, Dietary Compliance, and Perceived Hunger and Mood: Secondary Outcomes of a Randomised, Controlled Trial.
Keenan, S, Cooke, MB, Chen, WS, Wu, S, Belski, R
Nutrients. 2022;14(15)
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Obesity plays an important role in the development of cardiometabolic diseases. Excess body weight contributes to insulin resistance, unfavourable patterns of blood lipids and systemic inflammation, which are significant risk factors for cardiovascular disease and type 2 diabetes. Lifestyle modifications that restrict energy intake are an effective approach to attaining weight loss and reducing fat mass; however, continuous energy restrictions (CER) often have poor compliance in the long run. Intermittent fasting (IF) approaches present a promising alternative to CER and may promote increased compliance. The favourable changes in cardiometabolic health attained by an energy-restricted diet can be further amplified when combined with exercise. This paper is a secondary analysis from a 12-week intervention investigating the effects of a twice-weekly fast (5:2 IF; IFT group) and CER (CERT group) in 34 young, overweight but metabolically healthy participants when combined with resistance training. The analysis focused on changes in cardiometabolic blood markers, ratings of hunger, mood, energy and compliance as well as the participant's intention to continue with their prescribed diets post-intervention. Both dietary patterns improved blood lipids, namely reductions in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol over 12 weeks. Reductions in TC and LDL-C were more pronounced in the IFT group. No remarkable differences or changes in triglycerides, the inflammatory marker C-reactive Protein or markers of insulin resistance were seen in either group. Both groups reported high levels of dietary compliance and low levels of hunger, suggesting that both diets are well adhered to in the short to medium term. Some gender-specific differences were seen, but the author was unable to make conclusions due to the small study size. The analysis demonstrated that IF and CER, combined with resistance exercise, can improve some cardiometabolic risk biomarkers in overweight but metabolically healthy adults, independent of weight loss, with greater improvements with IF approaches.
Abstract
(1) Background: Excess weight in the form of adiposity plays a key role in the pathogenesis of cardiometabolic diseases. Lifestyle modifications that incorporate continuous energy restriction (CER) are effective at inducing weight loss and reductions in adiposity; however, prescribing daily CER results in poor long-term adherence. Over the past decade, intermittent fasting (IF) has emerged as a promising alternative to CER that may promote increased compliance and/or improvements in cardiometabolic health parameters independent of weight loss. (2) Methods: This paper presents a secondary analysis of data from a 12-week intervention investigating the effects of a twice-weekly fast (5:2 IF; IFT group) and CER (CERT group) when combined with resistance exercise in 34 healthy participants (17 males and 17 females, mean BMI: 27.0 kg/m2, mean age: 23.9 years). Specifically, changes in cardiometabolic blood markers and ratings of hunger, mood, energy and compliance within and between groups were analysed. Dietary prescriptions were hypoenergetic and matched for energy and protein intake. (3) Results: Both dietary groups experienced reductions in total cholesterol (TC; mean reduction, 7.8%; p < 0.001), low-density lipoprotein cholesterol (LDL-C; mean reduction, 11.1%; p < 0.001) and high-density lipoprotein cholesterol (mean reduction 2.6%, p = 0.049) over the 12 weeks. Reductions in TC and LDL-C were greater in the IFT group after adjustment for baseline levels and change in weight. No significant changes in markers of glucose regulation were observed. Both groups maintained high levels of dietary compliance (~80%) and reported low levels of hunger over the course of the intervention period. (4) Conclusions: Secondary data analysis revealed that when combined with resistance training, both dietary patterns improved blood lipids, with greater reductions observed in the IFT group. High levels of compliance and low reported levels of hunger throughout the intervention period suggest both diets are well tolerated in the short-to-medium term.
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Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women.
Kazemi, M, Kim, JY, Wan, C, Xiong, JD, Michalak, J, Xavier, IB, Ganga, K, Tay, CT, Grieger, JA, Parry, SA, et al
Human reproduction update. 2022;28(6):910-955
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Polycystic ovary syndrome (PCOS) is a heritable, prevalent and complex endocrine disorder. Besides reproductive manifestations of increased risk of infertility and pregnancy complications, women with PCOS often exhibit cardio-metabolic aberrations and are at risk for developing metabolic syndrome, type 2 diabetes and sleep disturbance. The aim of this study was to test the hypothesis that reproductive-aged women with PCOS would exhibit worse dietary and physical activity (PA) behaviours versus their counterparts without PCOS. This study was a systematic review and meta-analysis of 54 studies (61 publications). The studies included a total of 39,471 participants and 116 experimental arms (n = 8736 PCOS [59 arms]). Results showed that women with PCOS exhibit an overall adverse lifestyle behaviour, specifically poorer dietary intakes (lower diet quality, higher cholesterol, lower magnesium, tendency for lower zinc), and lower total PA compared to those without PCOS, despite lower alcohol intakes. Furthermore, compared to women without PCOS, the women with PCOS consumed worse or similar consumption of core food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy). Authors conclude that providing education on lifestyle modification is crucial for women with PCOS to improve their short- and long-term reproductive, metabolic, and psychological health.
Abstract
BACKGROUND Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. OBJECTIVE AND RATIONALE We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. SEARCH METHODS Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). OUTCOMES Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: -21.46, 95% CI: -41.03 to -1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: -1.08, 95% CI: -2.19 to -0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: -0.95, 95% CI: -1.67 to 0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: -0.38, 95% CI: -0.72 to 0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. WIDER IMPLICATIONS Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.
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Metabolic, hormonal and performance effects of isomaltulose ingestion before prolonged aerobic exercise: a double-blind, randomised, cross-over trial.
Notbohm, HL, Feuerbacher, JF, Papendorf, F, Friese, N, Jacobs, MW, Predel, HG, Zacher, J, Bloch, W, Schumann, M
Journal of the International Society of Sports Nutrition. 2021;18(1):38
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Isomaltulose is a low-glycaemic index carbohydrate that lowers insulin and glucose levels postprandially. The benefits of taking Isomaltulose in an exercise setting are not well studied. This double-blinded, randomised, crossover study evaluated the effects of Isomaltulose intake on metabolic responses, hormonal responses, exercise performance and gastrointestinal disturbances in runners. Twenty-one male recreational endurance runners took part in four separate experimental sessions to compare Isomaltulose to maltodextrin and glucose. Fat and carbohydrate oxidation rates were not different among groups. This might be because the lower dose of Isomaltulose (50g) was used in this trial. Compared to glucose and maltodextrin, isomaltulose lowered metabolic and hormonal responses to exercise. In the study, Isomaltulose, glucose, and maltodextrin did not differ in exercise performance or gastrointestinal disturbances. A higher dose may be needed in order to demonstrate exercise performance, but caution should be exercised since a higher dose may cause gastrointestinal upset. A robust investigation of Isomalulose dose and its effects on glucose, insulin, and glucose-dependent insulinotropic polypeptides is required to determine if exercise leads to hypoglycaemia in the clinical population. Healthcare practitioners can use the findings of this study to understand the advantageous effects of 50g Isomaltulose in regulating glucose, insulin and glucose-dependent insulinotropic polypeptide during aerobic exercise.
Abstract
BACKGROUND Isomaltulose has been discussed as a low glycaemic carbohydrate but evidence concerning performance benefits and physiological responses has produced varying results. Therefore, we primarily aimed to investigate the effects of isomaltulose ingestion compared to glucose and maltodextrin on fat and carbohydrate oxidation rates, blood glucose levels and serum hormone concentrations of insulin and glucose-dependent insulinotropic polypeptide (GIP). As secondary aims, we assessed running performance and gastrointestinal discomfort. METHODS Twenty-one male recreational endurance runners performed a 70-min constant load trial at 70% maximal running speed (Vmax), followed by a time to exhaustion (TTE) test at 85% Vmax after ingesting either 50 g isomaltulose, maltodextrin or glucose. Fat and carbohydrate oxidation rates were calculated from spiroergometric data. Venous blood samples for measurement of GIP and insulin were drawn before, after the constant load trial and after the TTE. Capillary blood samples for glucose concentrations and subjective feeling of gastrointestinal discomfort were collected every 10 min during the constant load trial. RESULTS No between-condition differences were observed in the area under the curve analysis of fat (p = 0.576) and carbohydrate oxidation rates (p = 0.887). Isomaltulose ingestion led to lower baseline postprandial concentrations of blood glucose compared to maltodextrin (percent change [95% confidence interval], - 16.7% [- 21.8,-11.6], p < 0.001) and glucose (- 11.5% [- 17.3,-5.7], p = 0.001). Similarly, insulin and GIP concentrations were also lower following isomaltulose ingestion compared to maltodextrin (- 40.3% [- 50.5,-30.0], p = 0.001 and - 69.1% [- 74.3,-63.8], p < 0.001, respectively) and glucose (- 32.6% [- 43.9,-21.2], p = 0.012 and - 55.8% [- 70.7,-40.9], p < 0.001, respectively). Furthermore, glucose fluctuation was lower after isomaltulose ingestion compared to maltodextrin (- 26.0% [- 34.2,-17.8], p < 0.001) and glucose (- 17.4% [- 29.1,-5.6], p < 0.001). However, during and after exercise, no between-condition differences for glucose (p = 0.872), insulin (p = 0.503) and GIP (p = 0.244) were observed. No between-condition differences were found for TTE (p = 0.876) or gastrointestinal discomfort (p = 0.119). CONCLUSION Isomaltulose ingestion led to lower baseline postprandial concentrations of glucose, insulin and GIP compared to maltodextrin and glucose. Consequently, blood glucose fluctuations were lower during treadmill running after isomaltulose ingestion, while no between-condition differences were observed for CHO and fat oxidation rates, treadmill running performance and gastrointestinal discomfort. Further research is required to provide specific guidelines on supplementing isomaltulose in performance and health settings.
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Role of Minerals and Trace Elements in Diabetes and Insulin Resistance.
Dubey, P, Thakur, V, Chattopadhyay, M
Nutrients. 2020;12(6)
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Minerals and trace elements have several functions within the body and deficiencies, or excesses may contribute to disease. Type 2 diabetes mellitus (T2DM) is often associated with an imbalance of damaging oxidants within the body and deficiencies of certain minerals and trace elements which act as antioxidants may contribute to this disease. This review paper aimed to determine trace element deficiencies, which may be related to the development of type 2 diabetes. The role of selenium in the development of diabetes is difficult to determine, as studies are conflicting. Magnesium, iron, and iodine may play a role in maintaining blood sugar levels. Chromium supplementation may improve T2DM through improvements to the functioning of the hormone insulin, which acts to process sugar in the blood. Boron may indirectly impact T2DM through its ability to act as an antioxidant. Dietary intake of calcium may prevent the development of T2DM, and finally cobalt and zinc deficiency may contribute to the development of T2DM. It was concluded that trace element deficiencies are associated with oxidative stress which may eventually lead to T2DM. This study could be used by healthcare professionals to understand the importance of dietary intakes of all trace elements in order to limit oxidative stress and decrease the risk of development of T2DM.
Abstract
Minerals and trace elements are micronutrients that are essential to the human body but present only in traceable amounts. Nonetheless, they exhibit well-defined biochemical functions. Deficiencies in these micronutrients are related to widespread human health problems. This review article is focused on some of these minerals and trace element deficiencies and their consequences in diabetes and insulin resistance. The levels of trace elements vary considerably among different populations, contingent on the composition of the diet. In several Asian countries, large proportions of the population are affected by a number of micronutrient deficiencies. Local differences in selenium, zinc, copper, iron, chromium and iodine in the diet occur in both developed and developing countries, largely due to malnutrition and dependence on indigenous nutrition. These overall deficiencies and, in a few cases, excess of essential trace elements may lead to imbalances in glucose homeostasis and insulin resistance. The most extensive problems affecting one billion people or more worldwide are associated with inadequate supply of a number of minerals and trace elements including iodine, selenium, zinc, calcium, chromium, cobalt, iron, boron and magnesium. This review comprises various randomized controlled trials, cohort and case-controlled studies, and observational and laboratory-based studies with substantial outcomes of micronutrient deficiencies on diabetes and insulin resistance in diverse racial inhabitants from parts of Asia, Africa, and North America. Changes in these micronutrient levels in the serum and urine of subjects may indicate the trajectory toward metabolic changes, oxidative stress and provide disease-relevant information.
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Links between metabolic syndrome and the microbiome.
Gildner, TE
Evolution, medicine, and public health. 2020;2020(1):45-46
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Metabolic syndrome (MetS) is a cluster of co-occurring pathological conditions, characterised by insulin resistance, abdominal obesity, hypertension and dyslipidaemia One possible factor contributing to MetS risk is change in microbiome composition. Diets high in processed foods appear to alter microbiome composition in ways that promote higher fat mass and insulin resistance. Additionally, a sedentary lifestyle decreases microbiome diversity, elevating inflammation and metabolic disease risk. Research on how the microbiome responds to modest, attainable changes in diet and physical activity will help identify which dietary adjustments and exercise types have the greatest potential to protect patients from MetS.
Abstract
Metabolic syndrome (MetS) is a cluster of harmful conditions which occur together, such as insulin resistance, abdominal obesity, and hypertension. The global prevalence of MetS is growing rapidly, with some estimates suggesting over one billion people worldwide experience increased morality and disease rates linked with this syndrome. One possible factor contributing to MetS risk is changes in microbiome composition. Approximately 100 trillion bacteria and other microbes reside in the human intestinal tract, collectively termed the gut microbiome. Humans and microbes share a long evolutionary history, with many of these microbes influencing human health outcomes. However, environmental conditions have changed dramatically with human technological innovations; many of these changes (e.g., diets high in processed foods and sedentary lifestyles) appear to impact human-microbe relationships. In general, recent changes in diet and activity patterns have been linked to decreased microbiome diversity, elevating inflammation and metabolic disease risk and likely promoting the development of MetS. Targeting patient diet or exercise patterns may therefore help doctors better treat patients suffering from MetS. Still, additional work is needed to determine how the microbiome responds to changes in patient activity and diet patterns across culturally and biologically diverse human populations.
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Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial.
Cho, SMJ, Lee, JH, Shim, JS, Yeom, H, Lee, SJ, Jeon, YW, Kim, HC
Journal of medical Internet research. 2020;22(10):e17435
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Metabolic disorders are established precursors to cardiovascular disease. The aim of the study was to evaluate the longitudinal effect of smartphone-based health care app on metabolic parameters in a sample of the general population with moderate metabolic abnormalities. The study is a single-blind 3-arm parallel-design randomized controlled trial delivering a 6-month primary prevention program via mobile app. One hundred twenty-nine smartphone users, aged between 30-59 years with at least 2 metabolic abnormalities, have been recruited. Results showed that the simultaneous diet/exercise logging and lifestyle coaching yielded greater body weight reduction, specifically via body fat mass reduction. On the other hand, the systolic blood pressure did not change notably between the 3 groups at any follow-up examinations. Authors conclude that future studies focusing on comparative effectiveness using alternative study designs are needed to integrate these apps in everyday lives and clinic practice.
Abstract
BACKGROUND Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. OBJECTIVE We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. METHODS In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. RESULTS Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean -10.95, SD 2.09 mmHg; app only: mean -7.29, SD 1.83 mmHg; app with personalized coaching: mean -7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean -0.12, SD 0.30 kg; app only: mean -0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean -0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean -0.13, SD 0.34 kg; app only: mean -0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean -0.79, SD 0.38 kg; P=.08). CONCLUSIONS Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271.
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Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia.
Hall, KS, Hyde, ET, Bassett, DR, Carlson, SA, Carnethon, MR, Ekelund, U, Evenson, KR, Galuska, DA, Kraus, WE, Lee, IM, et al
The international journal of behavioral nutrition and physical activity. 2020;17(1):78
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The health benefits of physical activity for people of all ages, fitness levels, and sociodemographic backgrounds are well-documented. The main aim of this study was to provide an updated description of the association between daily step counts and subsequent cardiovascular disease (CVD) morbidity or mortality, dysglycaemia, and all-cause mortality in adults and the patterns of these associations. This study is a systemic review of 17 studies from 13 different cohorts. Participants’ mean age ranged from 49.7 to 78.9 years with samples comprised of 46.9% female participants on average. Results showed that increasing steps per day is beneficial for health: taking more steps per day was associated with lower risk of all-cause mortality, and lower risk of CVD morbidity or mortality. These associations appear to hold across age, gender, and weight status. Authors conclude that this additional evidence will help guide meaningful volume targets that can be used for health care, education, and behavioural interventions, and potentially inform the development of public health guidelines for steps and health.
Abstract
BACKGROUND Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. METHODS A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. RESULTS Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. CONCLUSIONS Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.
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Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women.
Ko, SH, Kim, HS
Nutrients. 2020;12(1)
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Menopause is the absence of menstruation due to the loss of ovarian activity with ageing. During this transition period, changes in hormones, primarily the decline in the oestrogen estradiol, give rise to altered lipid metabolism. An unfavourable lipid profile presents a risk for metabolic disorders, such as cardiovascular diseases and type 2 diabetes. Post-menopausal changes also lead to shifts in body fat and fat distribution, resulting in an increased tendency for central fat accumulation and obesity. Obesity is associated with insulin resistance. This susceptibility for weight accumulation is possibly also driven by the age-associated decline in skeletal muscle, which reduces metabolic energy expenditure. This review summarizes the physiology of menopause and postmenopause and the consequential impact on lipid metabolism. In addition, there is a discussion of dietary recommendations, nutritional and plant-derived compounds that could support the management of menopause associated changes in lipid levels, metabolic risk factors and obesity. The recommendations discussed include traditional healthy diets and low-calorie diets, with attention drawn to adequate protein intake. Furthermore, the role of probiotics, nutritional and plant-sourced constituents are considered, including Vitamin D, Omega-3 fatty acids, antioxidants like Vitamin A, β-carotene, Vitamin C and E, genistein, resveratrol, flavonoids, indoles and capsaicin. The authors advocate sourcing these compounds from a varied whole-foods diet, which would minimize nutrient interactions and absorption issues that can occur with supplementation. This review may be of interest to those supporting the nutritional needs of menopausal and post-menopausal women, that are experiencing or are at risk of experiencing metabolic disorders.
Abstract
Menopause is clinically diagnosed as a condition when a woman has not menstruated for one year. During the menopausal transition period, there is an emergence of various lipid metabolic disorders due to hormonal changes, such as decreased levels of estrogens and increased levels of circulating androgens; these may lead to the development of metabolic syndromes including cardiovascular diseases and type 2 diabetes. Dysregulation of lipid metabolism affects the body fat mass, fat-free mass, fatty acid metabolism, and various aspects of energy metabolism, such as basal metabolic ratio, adiposity, and obesity. Moreover, menopause is also associated with alterations in the levels of various lipids circulating in the blood, such as lipoproteins, apolipoproteins, low-density lipoproteins (LDLs), high-density lipoproteins (HDL) and triacylglycerol (TG). Alterations in lipid metabolism and excessive adipose tissue play a key role in the synthesis of excess fatty acids, adipocytokines, proinflammatory cytokines, and reactive oxygen species, which cause lipid peroxidation and result in the development of insulin resistance, abdominal adiposity, and dyslipidemia. This review discusses dietary recommendations and beneficial compounds, such as vitamin D, omega-3 fatty acids, antioxidants, phytochemicals-and their food sources-to aid the management of abnormal lipid metabolism in postmenopausal women.