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Energy Expenditure Improved Risk Factors Associated with Renal Function Loss in NAFLD and MetS Patients.
Abbate, M, Mascaró, CM, Montemayor, S, Barbería-Latasa, M, Casares, M, Gómez, C, Angullo-Martinez, E, Tejada, S, Abete, I, Zulet, MA, et al
Nutrients. 2021;(2)
Abstract
To assess the efficacy of three lifestyle interventions on the reduction of liver fat content and metabolic syndrome (MetS), and whether such reductions would influence renal outcomes, we conducted a randomized controlled trial on 128 participants with MetS and non-alcoholic fatty liver disease (NAFLD), as well as available data on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatine ratio (UACR). Patients were randomized in 1:1:1 ratio to either Conventional Diet, Mediterranean diet (MD)-high meal frequency, and MD-physical activity groups. Each intervention aimed at reducing caloric intake by 25%-30% of baseline intake and increase energy expenditure by 400 kcal/70 kg. Patients attended regular visits and were followed-up for 6 months. Increased albuminuria was present in 13.3% of patients, while 32.8% showed hyperfiltration. UACR reduction was associated with higher levels of UACR at baseline but not with changes in liver fat. eGFR decreased in patients presenting hyperfiltration at baseline and was associated with reduction in liver fat and insulin resistance, as well as with increase in energy expenditure (R2 = 0.248, p = 0.006). No significant differences were observed between the three treatment groups. In patients with NAFLD and MetS, energy expenditure significantly reduced hepatic fat accumulation and insulin resistance, which reduced glomerular hyperfiltration. Increased albuminuria was reduced, but it was not associated with reduced liver fat.
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Metabolic and Cardiovascular Effects of Switching Thiazides to Amlodipine in Hypertensive Patients With and Without Type 2 Diabetes (the Diuretics and Diabetes Control Study).
Buscemi, S, Buscemi, C, Borzì, AM, Cosentino, L, Rosafio, G, Randazzo, C, Colomba, D, Di Raimondo, D, Pluchinotta, FR, Parrinello, G
Metabolic syndrome and related disorders. 2020;(2):110-118
Abstract
Background: Different studies have indicated that thiazide diuretics can increase the risk of developing type 2 diabetes (T2D). Therefore, in this study, we investigated whether switching from hydrochlorothiazide (HCTZ) to amlodipine resulted in ameliorating different cardiovascular and metabolic measures in hypertensive patients with or without T2D. Methods: This study [Diuretics and Diabetes Control (DiaDiC)] was a 6-week, single-blind, single-center randomized controlled trial. The first 20 normal glucose-tolerant, 20 prediabetic, and 20 T2D consecutive patients were randomized to continue the previous antihypertensive treatment with HCTZ (12.5-25 mg/day) or to switch from HCTZ to amlodipine (2.5-10 mg/day). The primary endpoints were the absolute change in 7-day continuous subcutaneous glucose monitoring (CSGM) glycemia, serum uric acid concentrations, and endothelial function [measured as flow-mediated dilation (FMD)]. Other secondary endpoints were investigated, including changes in glycated hemoglobin (HbA1c), glycemic variability from 7-day CSGM, and the estimated glomerular filtration rate (eGFR). Results: Amlodipine treatment was associated with a significant reduction in HbA1c (P = 0.03) for both 7-day CSGM glycemia (P = 0.01) and glycemic variability (coefficient of variability %: HCTZ +3%, amlodipine -2.8%), and a reduction in uric acid concentrations (P < 0.001), especially in participants with T2D or prediabetes. Following amlodipine treatment, a significant increase in both eGFR (P = 0.01) and FMD (P = 0.02) was also observed. Conclusions: This study demonstrates that the replacement of HCTZ with amlodipine has several metabolic and cardiovascular beneficial effects. However, further intervention studies are necessary to confirm the clinical effects of thiazides, especially in diabetic people and in those at risk of diabetes.
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Marital discord, past depression, and metabolic responses to high-fat meals: Interpersonal pathways to obesity.
Kiecolt-Glaser, JK, Jaremka, L, Andridge, R, Peng, J, Habash, D, Fagundes, CP, Glaser, R, Malarkey, WB, Belury, MA
Psychoneuroendocrinology. 2015;:239-50
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BACKGROUND Longitudinal studies have implicated both marital distress and depression in the development of the metabolic syndrome, a risk factor for diabetes and cardiovascular disease. This study addressed the impact of hostile marital interactions and a mood disorder history on obesity-related metabolic responses to high-fat meals. METHODS This double-blind, randomized crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, insulin, glucose, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) before and after two high-fat meals. During two separate 9.5h visits, 43 healthy married couples, ages 24-61 (mean=38.22), received either a high saturated fat meal or a high oleic sunflower oil meal, both 930kcal and 60g fat. The Structured Diagnostic Interview for DSM-IV assessed mood disorder history. Couples discussed a marital disagreement during both visits; behavioral coding of these interactions provided data on hostile marital behaviors. RESULTS Men and women who displayed more hostile behaviors and who also had a mood disorder history had significantly lower post-meal REE, higher insulin, and higher peak triglyceride responses than other participants, with nonsignificant effects for fat and carbohydrate oxidation. Participants with a mood disorder history had a steeper rise in postprandial IL-6 and glucose than those without a past history. Higher levels of hostile behaviors were associated with higher post-meal TNF-α. The two meals did not differ on any outcome assessed. CONCLUSIONS People spend about 18 of every 24h in a postprandial state, and dining with one's partner is a common daily event. Among subjects with a mood disorder history, the cumulative 6.75-h difference between high and low hostile behaviors translates into 128kcal, a difference that could add 7.6pounds/year. Our findings illustrate novel pathways through which chronic marital stress and a mood disorder history synergistically heighten the risk for obesity, metabolic syndrome, and cardiovascular disease.
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Energy metabolism and the metabolic syndrome: does a lower basal metabolic rate signal recovery following weight loss?
Soares, MJ, Cummings, NK, Ping-Delfos, WL
Diabetes & metabolic syndrome. 2011;(2):98-101
Abstract
AIM: To determine whether basal metabolic rate (BMR) was causally related to MetS, and to study the role of gender in this relationship. METHODS Seventy-two Caucasian subjects (43 women, 29 men) had changes in basal metabolic rate (BMR), carbohydrate oxidation rate (COR), fat oxidation rate (FOR) and prevalence of the metabolic syndrome (MetS) assessed in response to weight loss. RESULTS There was a significant gender×MetS interaction in BMR at the start. Women with MetS had higher adjusted BMR, whilst men with MetS had lower adjusted BMR than their respective counterparts. Weight loss resulted in a significant decrease in fat mass (-5.2±0.31 kg, p=0.001), fat free mass (-2.3±0.27 kg, p=0.001), BMR (-549±58 kJ/d, p=0.001) and a decreased proportion of MetS (22/72, χ(2)=0.005). Subjects who recovered from MetS after weight loss (RMS) had ∼250 kJ/d significantly lower adjusted BMR compared to those who were never MetS (NMS, p=0.046) and those who still had MetS (MetS+, p=0.047). Regression analysis showed that change (Δ) in BMR was best determined by Δglucose×gender interaction (r(2)=23%), ΔFOR (r(2)=20.3%), ΔCOR (r(2)=19.4%) and Δtriglycerides (r(2)=7.8%). CONCLUSIONS There is a sexual dimorphism of BMR in MetS. Overall, the data support the notion that alterations in BMR may be central to the etiopathogenesis of MetS.
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High-calorie-expenditure exercise: a new approach to cardiac rehabilitation for overweight coronary patients.
Ades, PA, Savage, PD, Toth, MJ, Harvey-Berino, J, Schneider, DJ, Bunn, JY, Audelin, MC, Ludlow, M
Circulation. 2009;(20):2671-8
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BACKGROUND More than 80% of patients entering cardiac rehabilitation (CR) are overweight, and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change. METHODS AND RESULTS We performed a randomized controlled clinical trial to evaluate the effect of high-calorie-expenditure exercise (3000- to 3500-kcal/wk exercise-related energy expenditure) compared with standard CR exercise (7 to 800 kcal/wk) on weight loss and risk factors in 74 overweight patients with coronary heart disease. Both groups were counseled for weight loss and taking evidence-based preventive medications. High-calorie-expenditure exercise resulted in double the weight loss (8.2+/-4 versus 3.7+/-5 kg; P<0.001) and fat mass loss (5.9+/-4 versus 2.8+/-3 kg; P<0.001) and a greater waist reduction (-7+/-5 versus -5+/-5 cm; P=0.02) than standard CR exercise at 5 months. High-calorie-expenditure exercise reduced insulin resistance, measured with the euglycemic hyperinsulinemic clamp, along with the ratio of total to high-density lipoprotein cholesterol and components of the metabolic syndrome, more than standard CR exercise (each P<0.01). Overall, fat mass loss best predicted improved metabolic risk, and the prevalence of metabolic syndrome decreased from 59% to 31%. Changes in cardiac risk factors included decreased insulin resistance, increased high-density lipoprotein cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to high-density lipoprotein cholesterol (each P<0.05). Significant weight loss was maintained at 1 year. CONCLUSIONS High-calorie-expenditure exercise promotes greater weight loss and more favorable cardiometabolic risk profiles than standard CR for overweight coronary patients.
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Creatine has no beneficial effect on skeletal muscle energy metabolism in patients with single mitochondrial DNA deletions: a placebo-controlled, double-blind 31P-MRS crossover study.
Kornblum, C, Schröder, R, Müller, K, Vorgerd, M, Eggers, J, Bogdanow, M, Papassotiropoulos, A, Fabian, K, Klockgether, T, Zange, J
European journal of neurology. 2005;(4):300-9
Abstract
The purpose of our randomized, double-blind, placebo-controlled crossover study in 15 patients with chronic progressive external ophthalmoplegia (CPEO) or Kearns-Sayre syndrome (KSS) because of single large-scale mitochondrial (mt) DNA deletions was to determine whether oral creatine (Cr) monohydrate can improve skeletal muscle energy metabolism in vivo. Each treatment phase with Cr in a dosage of 150 mg/kg body weight/day or placebo lasted 6 weeks. The effect of Cr was estimated by phosphorus-31 magnetic resonance spectroscopy ((31)P-MRS), clinical and laboratory tests. (31)P-MRS analysis prior to treatment showed clear evidence of severe mitochondrial dysfunction. However, there were no relevant changes in (31)P-MRS parameters under Cr. In particular, phosphocreatine (PCr)/ATP at rest did not increase, and there was no facilitation of post-exercise PCr recovery. Clinical scores and laboratory tests did not alter significantly under Cr, which was tolerated without major side-effects in all patients. Cr supplementation did not improve skeletal muscle oxidative phosphorylation in our series of patients. However, one explanation for our negative findings may be the short study duration or the limited number of patients included.