A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes

Impaired skeletal muscle regeneration in diabetes: From cellular and molecular mechanisms to novel treatments

Diabetes represents a major public health concern with a considerable impact on human life and healthcare expenditures. It is now well established that diabetes is characterized by a severe skeletal muscle pathology that limits functional capacity and quality of life. Increasing evidence indicates that diabetes is also one of the most prevalent disorders characterized by impaired skeletal muscle regeneration, yet underlying mechanisms and therapeutic treatments remain poorly established. In this review, we describe the cellular and molecular alterations currently known to occur during skeletal muscle regeneration in people with diabetes and animal models of diabetes, including its associated comorbidities, e.g., obesity, hyperinsulinemia, and insulin resistance. We describe the role of myogenic and non-myogenic cell types on muscle regeneration in conditions with or without diabetes. Therapies for skeletal muscle regeneration and gaps in our knowledge are also discussed, while proposing future directions for the field.

Menus prescribed for diabetes management by Malawian referral hospitals are loaded with calories from carbohydrates and may worsen diabetes condition

Background: Management of diabetes demands reduction of carbohydrates and moderation of total calories, fats and protein to promote weight loss while controlling postprandial blood glucose. Hospitals prescribe menus to diabetic patients to achieve these reasons. Whether these menus provide meals that help improve diabetes outcome remains unknown. Aim: Therefore, this study assessed six menus from six different referral hospitals in Malawi. Method: We formulated three separate diets (n = 3) encompassing breakfast, 10 am snack, lunch, 3 pm snack and super that a diabetic person would consume in a day as prescribed by each menu. We developed nutritionally adequate meals based on foods listed on the menu. We calculated, using the Malawi Food Composition Table (MFCT), total available carbohydrates, energy, protein, total fats, SAFA, MUFA and PUFA that each diet provides. We averaged the nutrient content from the three diets. Results: Menus from QECH and ST Joseph Mission Hospital provide significantly higher total carbohydrates (p = 0.001), total energy (p = 0.000) and fats (p = 0.01) but contain similar proteins (p = 0.761). The proportion of energy from carbohydrates for all the menus is very high and ranges from 68-81% while protein and fat proportions are lower and range from 7-16% and 7-20%, respectively. Conclusion: These menus have high propensity to increase postprandial blood glucose and promote weight gain that could be harmful to a diabetic person. All the menus deviate from a somehow recommended energy contribution of approximately 50:25:25 from carbohydrates, fat and protein, respectively.

Delivery of a telehealth supported home exercise program with dietary advice to increase plant-based protein intake in people with non-alcoholic fatty liver disease: a 12-week randomised controlled feasibility trial

This study evaluated the feasibility and safety of a telehealth delivered exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). This was a 12-week, randomised controlled feasibility trial including twenty-eight adults aged > 45 years with NAFLD randomised to a home muscle strengthening program (3 d/week) with increased protein intake (target ∼1·2-1·5 g/kg/d) from predominately plant-based sources and behavioural change support (3-4 text messages/week) (Pro-Ex n 14) or usual care (UC, n 14). Feasibility was assessed via retention (≤ 10 % attrition), adherence (exercise ≥ 66 %; recommended daily protein serves ≥ 80 %) and safety (adverse events). Secondary outcomes included macronutrient intake (3 × 24-h records), weight, moderate-to-vigorous physical activity (MVPA) and 30 s sit-to-stand (STS) performance. Study retention was 89 %. Mean exercise adherence (Pro-Ex) was 52 % with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0·9 to 1·4/d) and animal protein decreased (1·5 to 1·2/d) after 12-weeks, but overall adherence (serves/day) was 32[RD1] % (plant) and 42 % (animal). Relative to UC, Pro-Ex experienced a mean 2·7 (95 % CI: 0·9, 4·4) increase in 30 s STS number, 46-minute (95 % CI: -153, 245) increase in MVPA, 1·7 kg (95 % CI: -3·5, 0·2) decrease in weight, 35·2 g (95 % CI: 11·0, 59·3) increase in protein. In adults with NAFLD a telehealth home exercise and dietary intervention was safe and improved habitual plant and animal protein intake, but overall adherence was modest suggesting more intensive healthcare support may be required.

The effects of protein intake higher than the recommended value on body composition changes after bariatric surgery: A meta-analysis of randomized controlled trials

BACKGROUND & AIMS

There is a lack of a meta-analysis to comprehensively assess the effectiveness of higher protein intake in addition to the recommended value on body composition post-bariatric surgery. We aimed to perform a meta-analysis of randomized controlled trials to determine the effects of protein intake higher than the recommended value on body composition changes after bariatric surgery.

METHODS

Electronic databases, including Scopus, PubMed/Medline, and Web of Sciences, were searched until July 2023. Studies that assessed the effect of protein intake higher than the recommended value on postoperative body composition, i.e., weight, body mass index (BMI), fat mass (FM), fat-free mass (FFM), percent fat mass (PFM), and percent total weight loss (%TWL), were eligible. For each outcome, the mean and standard deviation (for changes from baseline) were used to synthesize the data.

RESULTS

Eight trials were included in the current study. The results of the meta-analysis indicated protein intake higher than the recommended value after bariatric surgery led to more weight loss by 4.95 kg (95 % CI: -9.41 to -0.49) and FM loss by 7.64 kg (95 % CI: -14.01 to -1.28) compared with the control group. However, it had no significant effects on postoperative changes in BMI, FFM, PFM, or %TWL. There were no significant differences in body composition between protein sources obtained from diet and supplementation. When data was stratified based on the amount of added protein, we found a significant reduction in weight (MD: -7.80 kg; 95 % CI: -14.50 to -1.10) in patients who consumed protein ≥ 40 g/d in addition to the recommended value. Besides, protein intake higher than the recommended value declined FFM loss in patients who underwent laparoscopic sleeve gastrectomy (LSG) (MD: 6.52 kg; 95 % CI: 0.99 to 12.02).

CONCLUSION

The results of the current meta-analysis indicated that protein intake higher than the recommended value might cause greater weight and FM loss after bariatric surgery than a normal protein diet. However, our findings did not support the role of additional protein in the preservation of FFM, except in patients with LSG.

Low-Molecular Collagen Peptide Supplementation and Body Fat Mass in Adults Aged ≥ 50 Years: A Randomized, Double-Blind, Placebo-Controlled Trial

A randomized, double-blind, placebo-controlled trial was conducted to confirm whether collagen peptide supplementation for 12 week has a beneficial effect on body fat control in older adults at a daily physical activity level. Participants were assigned to either the collagen group (15 g/day of collagen peptide) or the placebo group (placebo drink). Body composition was measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA). In total, 74 participants (collagen group, n = 37; placebo group, n = 37) were included in the final analysis. The collagen group showed a significant reduction in total body fat mass compared with the placebo group, as evidenced by both BIA (p = 0.021) and DEXA (p = 0.041) measurements. Body fat mass and percent body fat of the whole body and trunk reduced at 12 weeks compared with baseline only in the collagen group (whole body: body fat mass, p = 0.002; percent body fat, p = 0.002; trunk: body fat mass, p = 0.001; percent body fat, p = 0.000). Total fat mass change (%) (collagen group, -0.49 ± 3.39; placebo group, 2.23 ± 4.20) showed a significant difference between the two groups (p = 0.041). Physical activity, dietary intake, and biochemical parameters showed no significant difference between the groups. The results confirmed that collagen peptide supplementation had a beneficial effect on body fat reduction in older adults aged ≥ 50 years with daily physical activity level. Thus, collagen peptide supplementation has a positive effect on age-related changes.

Dose-response relationships of resistance training in Type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Background

Globally, type 2 diabetes mellitus (T2DM) accounts for approximately 90% of diabetes cases. Resistance training (RT) is frequently employed to diminish Glycated Hemoglobin (HbA1c) and Fast Blood Glucose (FBG) levels in T2DM patients. Yet, the specific dose-response relationships between RT variables such as training duration, frequency, and intensity for T2DM remain under-researched.

Objectives

This meta-analysis aimed to elucidate the overarching effects of RT on HbA1c and FBG metrics and to provide dose-response relationships of RT variables. This was achieved by examining randomized controlled trials (RCTs) that reported reductions in HbA1c and FBG among T2DM patients.

Methods

Comprehensive literature searches were conducted up to 25th February 2023 across databases including EMBASE, Pubmed, Cochrane, CENTRAL, Web of Science, CNKI, Wanfang Data, VIP Database for Chinese Technical Periodicals, and the Chinese Biomedical Database. The Physical Therapy Evidence Database (PEDro) was leveraged to appraise the quality of selected studies based on predefined inclusion and exclusion criteria. The meta-analysis was conducted using Stata 16.

Results

26 studies that include 1336 participants met the criteria for inclusion. RT significantly reduced HbA1c and FBG levels in comparison to control groups (P<0.05). Meta-regression analyses revealed that the number of repetitions per set (p=0.034) was a significant predictor of RT's efficacy on HbA1c. Subgroup analyses indicated that the most pronounced reductions in HbA1c and FBG occurred with a training duration of 12-16 weeks, intensities of 70-80% of 1 RM, training frequencies of 2-3 times per week, 3 sets per session, 8-10 repetitions per set, and less than a 60-second rest interval.

Conclusion

The beneficial impact of RT on HbA1c and FBG in T2DM patients is affirmed by this systematic review and meta-analysis. Moreover, the critical training parameters identified in this study are pivotal in enhancing HbA1c and FBG reductions, providing a reference for clinical staff to formulate RT exercise regiments for T2DM patients.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42023414616.

Exercise training, dietary intervention, or combined interventions and their effects on lipid profiles in adults with overweight and obesity: A systematic review and meta-analysis of randomized clinical trials

AIMS

We performed a systematic review and meta-analysis to compare the effects of Ex (exercise training) vs. DI (dietary intervention) vs. combined Ex and DI on total cholesterol (TC), low-density lipoprotein cholesterol (LDL), triglycerides (TG), and high-density lipoprotein cholesterol (HDL) in adults with overweight and obesity.

DATA SYNTHESIS

PubMed, Web of Science, and Scopus were searched to identify original articles published until March 2022, using keywords for the categories "exercise training," "dietary intervention," "overweight and obesity," and "randomized." Studies that included lipid profiles as outcomes and performed in adults with body mass indexes (BMIs) ≥ 25 kg/m2 were included. A total of 80 studies involving 4804 adult participants were included in the meta-analysis. Ex was not as effective as DI for reducing TC and TG and was less effective for reducing LDL. In addition, Ex increased HDL to a greater extent than DI. Combined interventions decreased TC, TG, and LDL but did not increase HDL more than Ex alone. Combined interventions failed to reduce TC or LDL but decreased TG and increased HDL more than DI alone.

CONCLUSIONS

Our results suggest that the combination of Ex and DI can be more effective than either Ex or DI alone in improving lipid profiles in adults with overweight and obesity.

High- and normal-protein diets improve body composition and glucose control in adults with type 2 diabetes: a randomized trial

OBJECTIVE

Weight loss of ≥10% improves glucose control and may remit type 2 diabetes (T2D). High-protein (HP) diets are commonly used for weight loss, but whether protein sources, especially red meat, impact weight loss-induced T2D management is unknown. This trial compared an HP diet including beef and a normal-protein (NP) diet without red meat for weight loss, body composition changes, and glucose control in individuals with T2D.

METHODS

A total of 106 adults (80 female) with T2D consumed an HP (40% protein) diet with ≥4 weekly servings of lean beef or an NP (21% protein) diet excluding red meat during a 52-week weight loss intervention. Body weight, body composition, and cardiometabolic parameters were measured before and after intervention.

RESULTS

Weight loss was not different between the HP (-10.2 ± 1.6 kg) and NP (-12.7 ± 4.8 kg, p = 0.336) groups. Both groups reduced fat mass and increased fat-free mass percent. Hemoglobin A1c, glucose, insulin, insulin resistance, blood pressure, and triglycerides improved, with no differences between groups.

CONCLUSIONS

The lack of observed effects of dietary protein and red meat consumption on weight loss and improved cardiometabolic health suggests that achieved weight loss, rather than diet composition, should be the principal target of dietary interventions for T2D management.

Diabetes websites lack information on dietary causes, risk factors, and preventions for type 2 diabetes

Introduction

Type 2 diabetes (T2D) is a growing public health burden throughout the world. Many people looking for information on how to prevent T2D will search on diabetes websites. Multiple dietary factors have a significant association with T2D risk, such as high intake of added sugars, refined carbohydrates, saturated fat, and red meat or processed meat; and decreased intake of dietary fiber, and fruits/vegetables. Despite this dietary information being available in the scientific literature, it is unclear whether this information is available in gray literature (websites).

Objective

In this study, we evaluate the use of specific terms from diabetes websites that are significantly associated with causes/risk factors and preventions for T2D from three term categories: (A) dietary factors, (B) nondietary nongenetic (lifestyle-associated) factors, and (C) genetic (non-modifiable) factors. We also evaluate the effect of website type (business, government, nonprofit) on term usage among websites.

Methods

We used web scraping and coding tools to quantify the use of specific terms from 73 diabetes websites. To determine the effect of term category and website type on the usage of specific terms among 73 websites, a repeated measures general linear model was performed.

Results

We found that dietary risk factors that are significantly associated with T2D (e.g., sugar, processed carbohydrates, dietary fat, fruits/vegetables, fiber, processed meat/red meat) were mentioned in significantly fewer websites than either nondietary nongenetic factors (e.g., obesity, physical activity, dyslipidemia, blood pressure) or genetic factors (age, family history, ethnicity). Among websites that provided "eat healthy" guidance, one third provided zero dietary factors associated with type 2 diabetes, and only 30% provided more than two specific dietary factors associates with type 2 diabetes. We also observed that mean percent usage of all terms associated with T2D causes/risk factors and preventions was significantly lower among government websites compared to business websites and nonprofit websites.

Conclusion

Diabetes websites need to increase their usage of dietary factors when discussing causes/risk factors and preventions for T2D; as dietary factors are modifiable and strongly associated with all nondietary nongenetic risk factors, in addition to T2D risk.

Diet, exercise, and pharmacotherapy for sarcopenia in people with diabetes

Diabetes prevalence is increasing rapidly in older people, and sarcopenia is prevalent as a novel complication, particularly in patients with type 2 diabetes mellitus (T2DM). Therefore, sarcopenia prevention and treatment in these people is necessary. Diabetes accelerates sarcopenia through several mechanisms, such as hyperglycemia, chronic inflammation and oxidative stress. The effects of diet, exercise, and pharmacotherapy on sarcopenia in patients with T2DM need to be considered. In diet, low intake of energy, protein, vitamin D, and ω-3 fatty acid are associated with sarcopenia risk. In exercises, although intervention studies in people, especially older and non-obese patients with diabetes, are few, accumulating evidence shows the usefulness of exercise, particularly resistance exercise for muscle mass and strength, and aerobic exercise for physical performance in sarcopenia. In pharmacotherapy, certain classes of anti-diabetes compounds have possibility of preventing sarcopenia. However, much data on diet, exercise, and pharmacotherapy were obtained in obese and non-elderly patients with T2DM, demanding actual clinical data on non-obese and older patients with diabetes.

Effect of resistance vs. aerobic exercise in pre-diabetes: an RCT

BACKGROUND

This study aimed to assess the different impacts of aerobic and resistance exercise intervention on pre-diabetes and its possible influencing factor (obesity) to identify which exercise intervention mode was better for pre-diabetes to control their blood glucose levels.

METHODS

Single-blind randomized controlled trial. Participants were recruited from Southwest Hospital between February 2016 and May 2017 and randomly divided into three groups using stratified randomization: aerobic exercise (A), resistance exercise (R), and control (C). The effects of each group were analyzed, and the relationship with obesity was investigated following a 12-week intervention.

RESULTS

Eighty participants were enrolled (9 were lost, and 1 was excluded). Finally, 26 participants were included in group A, 23 in group R, and 21 in group C. In groups A and R, FPG, OGTT 2-h PG, and HOMA2-IR decreased by 6.17% (P = 0.001) and 4.81% (P = 0.019), 20.39% (P < 0.001) and 16.50% (P < 0.001), and 8.34% (P = 0.026) and 18.31% (P = 0.001, superior to that in group A), respectively (all P < 0.001 compared with group C, with no significant differences between groups A and R). The ratio of reversal to euglycemia was 69.2% (P = 0.003 compared with group C) in group A and 43.5% (P = 0.213 compared with group C) in group R. The decreased ratio of GSP in group R was greater (65.2%, P = 0.008 compared with group C) compared with group A (38.5%, P = 0.355 compared with group C). Decreases in the parameters BMI (3.1 ± 3.2% P < 0.001, moderately positive correlation with the decreased FPG level, r = 0.498, P = 0.010, two-tailed) and waist circumference (3.1 ± 2.7% P < 0.001) were noted in group A, but no significant correlations were noted between other indicators in group R.

CONCLUSIONS

Both resistance and aerobic exercise can control and reverse IGR. Compared with aerobic exercise, resistance exercise may be superior in terms of GSP and IR improvement. Aerobic exercise decreases blood glucose levels through weight loss. However, the effect of resistance exercise might not be mediated via weight loss and obesity control.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000038304. Registered on September 17, 2020.

Intensity Differences of Resistance Training for Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis

Resistance training is used as adjunctive therapy for type 2 diabetes (T2DM), and the aim of this study was to investigate the differences in the treatment effects of different intensities of resistance training in terms of glycemia, lipids, blood pressure, adaptations, and body measurements. A comprehensive search was conducted in the PubMed, EMBASE (Excerpta Medica dataBASE), EBSCO (Elton B. Stephens Company) host, Cochrane Library, WOS (Web of Science), and Scopus databases with a cut-off date of April 2022, and reference lists of relevant reviews were also consulted. The literature screening and data extraction were performed independently by two researchers. RoB2 (Risk of bias 2) tools were used for the literature quality assessment, the exercise intensity was categorized as medium-low intensity and high intensity, and the meta subgroup analysis was performed using R Version. A fixed or random effects model was selected for within-group analysis based on the heterogeneity test, and a random effects model was used for the analysis of differences between subgroups. A total of 36 randomized controlled trials were included, with a total of 1491 participants. It was found that resistance training significantly improved HbA1c (glycated hemoglobin), fasting blood glucose, TG (triglycerides), TC (total cholesterol), and LDL (low-density lipoprotein cholesterol) levels in patients with T2DM and caused a significant reduction in systolic blood pressure, percent of fat mass, and HOMA-IR (homeostatic model assessment for insulin resistance) indexes. The effects of high and medium-low intensity resistance training on T2DM patients were different in terms of HOMA-IR, maximal oxygen consumption, weight, waist-to-hip ratio, and body mass indexes. Only medium-low intensity resistance training resulted in a decrease in HOMA-IR. In addition to weight (MD = 4.25, 95% CI: [0.27, 8.22], I² = 0%, p = 0.04; MD = -0.33, 95% CI: [-2.05, 1.39], I² = 0%, p = 0.76; between groups p = 0.03) and HOMA-IR (MD = 0.11, 95% CI: [-0.40, -0.63], I² = 0%, p = 0.85; MD = -1.09, 95% CI: [-1.83, -0.36], I² = 87%, p = < 0.01; between groups p = 0.0085), other indicators did not reach statistical significance in the level of difference within the two subgroups of high intensity and medium-low intensity. The treatment effects (merger effect values) of high intensity resistance training were superior to those of medium-low intensity resistance training in terms of HbA1c, TG, TC, LDL levels and diastolic blood pressure, resting heart rate, waist circumference, fat mass, and percentage of fat mass. Therefore, high intensity resistance training can be considered to be a better option to assist in the treatment of T2DM and reduce the risk of diabetic complications compared to medium-low intensity resistance training. Only one study reported an adverse event (skeletal muscle injury) associated with resistance training. Although results reflecting the difference in treatment effect between intensity levels reached no statistical significance, the practical importance of the study cannot be ignored.

Sarcopenic obesity is associated with coffee intake in elderly Koreans

This study assessed the association between sarcopenic obesity (S+O+) and coffee intake inelderly Koreans. This study obtained data from the Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2011), a cross-sectional and nationally representative survey conducted by the Korean Centers for Disease Control and Prevention. Of the 2,661 participants included in this study, there was a significant difference between 5.861 (95% CI 2.024-16.971) in less than one cup of coffee, and 6.245 (95% CI 2.136-18.260) in one cup of coffee, and 4.323 (95% CI 1.457-12.824) in two cups of coffee compared to three or more than cups of coffee. In contrast, in the case of sarcopenia or obesity only (S+O- or S-O+), no significant difference was found in any model. The results suggest that the elderly who consume less than one cup of coffee per day had a greater risk of S+O+ than those who consume more than three cups per day. Furthermore, there was an association between coffee intake and sarcopenia but not with obesity. Therefore, coffee intake may have prevented musculoskeletal loss in these patients.

Whey protein and soy protein prevent obesity by upregulating uncoupling protein 1 to activate brown adipose tissue and promote white adipose tissue browning in high-fat diet-fed mice

There are inconsistent conclusions regarding the effect of whey protein and soy protein supplementation on obesity, and the underlying mechanisms of a high-protein diet for reducing weight gain remain to be elucidated. The aim of the present study was to investigate the preventive effect of whey protein and soy protein on obesity and its possible mechanism. Eighty-four male C57BL/6J mice were randomly divided into seven dietary groups: control group (10% fat) and 6 groups fed with a high-fat diet (HFD): 10% whey protein isolate (WPI), 20% WPI, 30% WPI, 10% soy protein isolate (SPI), 20% SPI and 30% SPI for 12 weeks. Compared with the 20% SPI group, the 20% WPI group had a significantly lower body weight, serum levels of insulin, total cholesterol and leptin, weight of inguinal white adipose tissue (iWAT), and size of adipocytes in iWAT and epididymal white adipose tissue (eWAT). The body mass index (BMI) and the Lee index were significantly lower in the WPI groups than those in the SPI groups at the same protein level. The body weight, body weight gain and BMI were significantly lower with the decreasing ratio of protein to carbohydrate (P/C). Compared with the 20% SPI group, the expressions of browning-related genes such as UCP1 (uncoupling protein 1), PGC-1α, AMPKα and Cidea and the protein expression of UCP1 were significantly higher in brown adipose tissue (BAT) and iWAT in the 20% WPI group. Moreover, the expressions of lipogenesis-related genes such as SREBP1c, PPARγ, LPL and DGAT1 in BAT, iWAT and eWAT in the 10% WPI group were significantly lower compared with the 10% SPI group. In conclusion, whey protein was more effective than soy protein in preventing obesity in mice, probably by suppressing lipogenesis in adipose tissues, activating BAT and promoting the browning of iWAT. In addition, lowering the P/C ratio was beneficial for combating obesity in the context of a HFD.

Effects of exercise training and dietary supplement on fat free mass and bone mass density during weight loss – a systematic review and meta-analysis

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM.

Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity.

Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement.

Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training.

Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Vertical Sleeve Gastrectomy Lowers SGLT2/Slc5a2 Expression in the Mouse Kidney

Bariatric surgery improves glucose homeostasis, but the underlying mechanisms are not fully elucidated. Here, we show that the expression of sodium-glucose cotransporter 2 (SGLT2/Slc5a2) is reduced in the kidney of lean and obese mice following vertical sleeve gastrectomy (VSG). Indicating an important contribution of altered cotransporter expression to the impact of surgery, inactivation of the SGLT2/Slc5a2 gene by clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 attenuated the effects of VSG, with glucose excursions following intraperitoneal injection lowered by ∼30% in wild-type mice but by ∼20% in SGLT2-null animals. The effects of the SGLT2 inhibitor dapaglifozin were similarly blunted by surgery. Unexpectedly, effects of dapaglifozin were still observed in SGLT2-null mice, consistent with the existence of metabolically beneficial off-target effects of SGLT2 inhibitors. Thus, we describe a new mechanism involved in mediating the glucose-lowering effects of bariatric surgery.

Hybrid Meat Products: Incorporation of White Bean Flour in Lean Pork Burgers

The effect of partial lean pork-meat replacement by white Phaseolus vulgaris L. flour in hybrid burgers was studied. A multivariate regression model was used to test different bean flour levels (BF: 8–15 g/100 g) and water/bean flour ratios (W/BF: 1.2, 1.6, and 1.8 g/g). Process yield, texture profile analysis, color parameters, thermal transitions, and microstructure of the systems were analyzed. Respond Surface Methodology was used to model the response behaviors and optimization. Burgers with BF showed yields higher than 88%. Hardness and cohesiveness decreased as the BF level increased, with a more noticeable effect when the W/BF ratio became larger. Regarding color, the higher the BF and the W/BF ratio in burgers, the higher the L* obtained. The desirability optimization predicted an optimum formulation consisting of 15 g BF/100 g and 1.36 g/g W/BF with similar attributes to a commercial pork burger. The thermal analysis showed an increase in the enthalpy associated with the myosin denaturation and the interactions between meat proteins and BF led to higher temperatures for the starch gelatinization and protein denaturation. The microstructure of BF burgers presented a more stable coarse gel matrix derived from coagulated meat proteins combined with the flour components. The mathematical procedure adequately predicted the hybrid burger quality attributes.

Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials

BACKGROUND

Carbohydrate restriction is effective for type 2 diabetes management.

OBJECTIVES

We aimed to evaluate the dose-dependent effect of carbohydrate restriction in patients with type 2 diabetes.

METHODS

We systematically searched PubMed, Scopus, and Web of Science to May 2021 for randomized controlled trials evaluating the effect of a carbohydrate-restricted diet (≤45% total calories) in patients with type 2 diabetes. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included fasting plasma glucose (FPG); body weight; serum total, LDL, and HDL cholesterol; triglyceride (TG); and systolic blood pressure (SBP). We performed random-effects dose-response meta-analyses to estimate mean differences (MDs) for a 10% decrease in carbohydrate intake.

RESULTS

Fifty trials with 4291 patients were identified. At 6 months, compared with a carbohydrate intake between 55%-65% and through a maximum reduction down to 10%, each 10% reduction in carbohydrate intake reduced HbA1c (MD, -0.20%; 95% CI, -0.27% to -0.13%), FPG (MD, -0.34 mmol/L; 95% CI, -0.56 to -0.12 mmol/L), and body weight (MD, -1.44 kg; 95% CI, -1.82 to -1.06 kg). There were also reductions in total cholesterol, LDL cholesterol, TG, and SBP. Levels of HbA1c, FPG, body weight, TG, and SBP decreased linearly with the decrease in carbohydrate intake from 65% to 10%. A U-shaped effect was seen for total cholesterol and LDL cholesterol, with the greatest reduction at 40%. At 12 months, a linear reduction was seen for HbA1c and TG. A U-shaped effect was seen for body weight, with the greatest reduction at 35%.

CONCLUSIONS

Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake. U-shaped effects were seen for total cholesterol and LDL cholesterol at 6 months and for body weight at 12 months.

Ketogenic diets, physical activity and body composition: a review

Obesity remains a serious relevant public health concern throughout the world despite related countermeasures being well understood (i.e. mainly physical activity and an adjusted diet). Among different nutritional approaches, there is a growing interest in ketogenic diets (KD) to manipulate body mass (BM) and to enhance fat mass loss. KD reduce the daily amount of carbohydrate intake drastically. This results in increased fatty acid utilisation, leading to an increase in blood ketone bodies (acetoacetate, 3-β-hydroxybutyrate and acetone) and therefore metabolic ketosis. For many years, nutritional intervention studies have focused on reducing dietary fat with little or conflicting positive results over the long term. Moreover, current nutritional guidelines for athletes propose carbohydrate-based diets to augment muscular adaptations. This review discusses the physiological basis of KD and their effects on BM reduction and body composition improvements in sedentary individuals combined with different types of exercise (resistance training or endurance training) in individuals with obesity and athletes. Ultimately, we discuss the strengths and the weaknesses of these nutritional interventions together with precautionary measures that should be observed in both individuals with obesity and athletic populations. A literature search from 1921 to April 2021 using Medline, Google Scholar, PubMed, Web of Science, Scopus and Sportdiscus Databases was used to identify relevant studies. In summary, based on the current evidence, KD are an efficient method to reduce BM and body fat in both individuals with obesity and athletes. However, these positive impacts are mainly because of the appetite suppressive effects of KD, which can decrease daily energy intake. Therefore, KD do not have any superior benefits to non-KD in BM and body fat loss in individuals with obesity and athletic populations in an isoenergetic situation. In sedentary individuals with obesity, it seems that fat-free mass (FFM) changes appear to be as great, if not greater, than decreases following a low-fat diet. In terms of lean mass, it seems that following a KD can cause FFM loss in resistance-trained individuals. In contrast, the FFM-preserving effects of KD are more efficient in endurance-trained compared with resistance-trained individuals.

The effectiveness of diet intervention in improving the metabolism of overweight and obese women: a systematic review and meta-analysis

OBJECTIVES

Dietary therapy may improve glucose and lipid metabolism function in women. However, there is no systematic review to investigate the association between metabolic effects and different dietary interventions in obese women. The main purpose of this study is to summarize the current literature and investigate whether different dietary interventions have an effect on glucose and metabolic indicators of overweight or obese women.

METHODS

We conducted a scoping review of randomized controlled trial (RCT) studies from 1991 to 2022 by adopting a systematic review and meta-analysis. The database includes Google Scholar, PubMed, Embase and Web of Science. Literature screening, data extraction, and quality assessment were independently completed by 2 researchers. Meta-analysis was performed with RevMan.

RESULTS

Twelve articles were extracted and the meta-analysis results showed that the mean difference of metabolic indexes of obese women before and after dietary intervention, including fasting glucose, fasting insulin, HOMA-IR (Homeostasis model assessment-insulin resistance), TG (triglyceride), TC (total cholesterol), LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol) are -0.13 [-0.15, -0.10], -2.41 [-3.44, -1.38], -0.13 [-0.15, -0.10], -21.71 [-24.19, -19.22], -21.71 [-24.19, -19.22], -13.29 [-17.86, -8.72], 3.31 [2.22, 4.40], respectively.

CONCLUSIONS

Different dietary interventions benefit glucose and lipid metabolism of overweight or obese women. Further study is needed to determine which specific dietary effects have the greatest effect on improving metabolic indicators.

Enhancement of anaerobic glycolysis - a role of PGC-1α4 in resistance exercise

Resistance exercise training (RET) is an effective countermeasure to sarcopenia, related frailty and metabolic disorders. Here, we show that an RET-induced increase in PGC-1α4 (an isoform of the transcriptional co-activator PGC-1α) expression not only promotes muscle hypertrophy but also enhances glycolysis, providing a rapid supply of ATP for muscle contractions. In human skeletal muscle, PGC-1α4 binds to the nuclear receptor PPARβ following RET, resulting in downstream effects on the expressions of key glycolytic genes. In myotubes, we show that PGC-1α4 overexpression increases anaerobic glycolysis in a PPARβ-dependent manner and promotes muscle glucose uptake and fat oxidation. In contrast, we found that an acute resistance exercise bout activates glycolysis in an AMPK-dependent manner. These results provide a mechanistic link between RET and improved glucose metabolism, offering an important therapeutic target to counteract aging and inactivity-induced metabolic diseases benefitting those who cannot exercise due to many reasons.

Effect of resistance training on HbA1c in adults with type 2 diabetes mellitus and the moderating effect of changes in muscular strength: a systematic review and meta-analysis

Type 2 diabetes mellitus (T2DM) accounts for approximately 90% of diabetes cases globally. Regular physical activity is regarded as one of the key components in T2DM management. Aerobic exercise was traditionally recommended; however, there is a growing body of research examining the independent effect of resistance training (RT) on glycemic control. This systematic review and meta-analysis aimed to conduct an update on the effects of RT on glycosylated hemoglobin (HbA1c) in adults with T2DM and examine the moderating effects of training effect (ie, muscular strength improvements), risk of bias and intervention duration. Peer-reviewed articles published in English were searched across MEDLINE, Embase, CINAHL, Scopus and SPORTDiscus from database inception until January 19, 2021. Each online database was systematically searched for randomized controlled trials reporting on the effects of RT on HbA1c in individuals with T2DM. Twenty studies (n=1172) were included in the meta-analysis. RT significantly reduced HbA1c compared with controls (weighted mean difference=-0.39, 95% CI -0.60 to -0.18, p<0.001, I²=69.20). Training effect significantly (p<0.05) moderated the results, with larger improvements in muscular strength leading to greater reductions in HbA1c (β=-0.99, CI -1.97 to -0.01). Intervention duration and risk of bias did not significantly moderate the effects. As a secondary analysis, this study found no significant differences in HbA1c when comparing RT and aerobic training (p=0.42). This study demonstrates that RT is an effective strategy to decrease HbA1c in individuals with T2DM. Importantly, RT interventions that had a larger training effect appeared more effective in reducing HbA1c, compared with interventions producing medium and small effects.PROSPERO registration number CRD42020134046.

Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk

BACKGROUND

Debates on effective and safe diets for managing obesity in adults are ongoing. Low-carbohydrate weight-reducing diets (also known as 'low-carb diets') continue to be widely promoted, marketed and commercialised as being more effective for weight loss, and healthier, than 'balanced'-carbohydrate weight-reducing diets.

OBJECTIVES

To compare the effects of low-carbohydrate weight-reducing diets to weight-reducing diets with balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults without and with type 2 diabetes mellitus (T2DM).

SEARCH METHODS

We searched MEDLINE (PubMed), Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 25 June 2021, and screened reference lists of included trials and relevant systematic reviews. Language or publication restrictions were not applied.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in adults (18 years+) who were overweight or living with obesity, without or with T2DM, and without or with cardiovascular conditions or risk factors. Trials had to compare low-carbohydrate weight-reducing diets to balanced-carbohydrate (45% to 65% of total energy (TE)) weight-reducing diets, have a weight-reducing phase of 2 weeks or longer and be explicitly implemented for the primary purpose of reducing weight, with or without advice to restrict energy intake.  DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts and full-text articles to determine eligibility; and independently extracted data, assessed risk of bias using RoB 2 and assessed the certainty of the evidence using GRADE. We stratified analyses by participants without and with T2DM, and by diets with weight-reducing phases only and those with weight-reducing phases followed by weight-maintenance phases. Primary outcomes were change in body weight (kg) and the number of participants per group with weight loss of at least 5%, assessed at short- (three months to < 12 months) and long-term (≥ 12 months) follow-up.

MAIN RESULTS

We included 61 parallel-arm RCTs that randomised 6925 participants to either low-carbohydrate or balanced-carbohydrate weight-reducing diets. All trials were conducted in high-income countries except for one in China. Most participants (n = 5118 randomised) did not have T2DM. Mean baseline weight across trials was 95 kg (range 66 to 132 kg). Participants with T2DM were older (mean 57 years, range 50 to 65) than those without T2DM (mean 45 years, range 22 to 62). Most trials included men and women (42/61; 3/19 men only; 16/19 women only), and people without baseline cardiovascular conditions, risk factors or events (36/61). Mean baseline diastolic blood pressure (DBP) and low-density lipoprotein (LDL) cholesterol across trials were within normal ranges. The longest weight-reducing phase of diets was two years in participants without and with T2DM. Evidence from studies with weight-reducing phases followed by weight-maintenance phases was limited. Most trials investigated low-carbohydrate diets (> 50 g to 150 g per day or < 45% of TE; n = 42), followed by very low (≤ 50 g per day or < 10% of TE; n = 14), and then incremental increases from very low to low (n = 5). The most common diets compared were low-carbohydrate, balanced-fat (20 to 35% of TE) and high-protein (> 20% of TE) treatment diets versus control diets balanced for the three macronutrients (24/61). In most trials (45/61) the energy prescription or approach used to restrict energy intake was similar in both groups. We assessed the overall risk of bias of outcomes across trials as predominantly high, mostly from bias due to missing outcome data. Using GRADE, we assessed the certainty of evidence as moderate to very low across outcomes.  Participants without and with T2DM lost weight when following weight-reducing phases of both diets at the short (range: 12.2 to 0.33 kg) and long term (range: 13.1 to 1.7 kg).  In overweight and obese participants without T2DM: low-carbohydrate weight-reducing diets compared to balanced-carbohydrate weight-reducing diets (weight-reducing phases only) probably result in little to no difference in change in body weight over three to 8.5 months (mean difference (MD) -1.07 kg, (95% confidence interval (CI) -1.55 to -0.59, I2 = 51%, 3286 participants, 37 RCTs, moderate-certainty evidence) and over one to two years (MD -0.93 kg, 95% CI -1.81 to -0.04, I2 = 40%, 1805 participants, 14 RCTs, moderate-certainty evidence); as well as change in DBP and LDL cholesterol over one to two years. The evidence is very uncertain about whether there is a difference in the number of participants per group with weight loss of at least 5% at one year (risk ratio (RR) 1.11, 95% CI 0.94 to 1.31, I2 = 17%, 137 participants, 2 RCTs, very low-certainty evidence).  In overweight and obese participants with T2DM: low-carbohydrate weight-reducing diets compared to balanced-carbohydrate weight-reducing diets (weight-reducing phases only) probably result in little to no difference in change in body weight over three to six months (MD -1.26 kg, 95% CI -2.44 to -0.09, I2 = 47%, 1114 participants, 14 RCTs, moderate-certainty evidence) and over one to two years (MD -0.33 kg, 95% CI -2.13 to 1.46, I2 = 10%, 813 participants, 7 RCTs, moderate-certainty evidence); as well in change in DBP, HbA1c and LDL cholesterol over 1 to 2 years. The evidence is very uncertain about whether there is a difference in the number of participants per group with weight loss of at least 5% at one to two years (RR 0.90, 95% CI 0.68 to 1.20, I2 = 0%, 106 participants, 2 RCTs, very low-certainty evidence).  Evidence on participant-reported adverse effects was limited, and we could not draw any conclusions about these.  AUTHORS' CONCLUSIONS: There is probably little to no difference in weight reduction and changes in cardiovascular risk factors up to two years' follow-up, when overweight and obese participants without and with T2DM are randomised to either low-carbohydrate or balanced-carbohydrate weight-reducing diets.

Intermittent fasting and continuous energy restriction result in similar changes in body composition and muscle strength when combined with a 12 week resistance training program

Purpose

The objective of this study was to compare the effects of 12 weeks of resistance training combined with either 5:2 intermittent fasting or continuous energy restriction on body composition, muscle size and quality, and upper and lower body strength.

Methods

Untrained individuals undertook 12 weeks of resistance training plus either continuous energy restriction [20% daily energy restriction (CERT)] or 5:2 intermittent fasting [~ 70% energy restriction 2 days/week, euenergetic consumption 5 days/week (IFT)], with both groups prescribed a mean of ≥ 1.4 g of protein per kilogram of body weight per day. Participants completed 2 supervised resistance and 1 unsupervised aerobic/resistance training combination session per week. Changes in lean body mass (LBM), thigh muscle size and quality, strength and dietary intake were assessed.

Results

Thirty-four participants completed the study (CERT = 17, IFT = 17). LBM was significantly increased (+ 3.7%, p < 0.001) and body weight (− 4.6%, p < 0.001) and fat (− 24.1%, p < 0.001) were significantly reduced with no significant difference between groups, though results differed by sex. Both groups showed improvements in thigh muscle size and quality, and reduced intramuscular and subcutaneous fat assessed by ultrasonography and peripheral quantitative computed tomography (pQCT), respectively. The CERT group demonstrated a significant increase in muscle surface area assessed by pQCT compared to the IFT group. Similar gains in upper and lower body strength and muscular endurance were observed between groups.

Conclusion

When combined with resistance training and moderate protein intake, continuous energy restriction and 5:2 intermittent fasting resulted in similar improvements in body composition, muscle quality, and strength. ACTRN: ACTRN12620000920998, September 2020, retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-022-02804-3.

The Effects of Supervised Exercise Training on Weight Control and Other Metabolic Outcomes in Patients With Type 2 Diabetes: A Meta-Analysis

Few studies have investigated the dose-response relationship between exercise and weight control. This study aimed to assess the effects of different types of supervised exercise training on weight control and other metabolic outcomes in patients with type 2 diabetes mellitus and explore the dose-response relationship between exercise volume/duration and these outcomes. PubMed/MEDLINE, Embase, and Cochrane databases were searched for studies between January 1980 and June 2019. Randomized control trials in type 2 diabetes mellitus patients with supervised exercise training versus control treatment were included. The primary outcome was changes in body weight (kg). The secondary outcomes included changes in waist circumference (cm) and total body fat percentage (%). Forty-two randomized control trials, including 3,625 patients with type 2 diabetes mellitus were included. Overall, exercise treatment was associated with significant reduction in body weight (weighted mean differences, -1.10 kg; 95% CI [-1.58, -0.62], p < .01), waist circumference (weighted mean differences, -2.51 cm; 95% CI [-3.25, -1.77], p < .01), and total body fat (weighted mean differences, -1.16%; 95% CI [-1.58%, -0.75%], p < .01). The percentage of total body fat was reduced by all types of exercise, with a significant difference between aerobic exercise and resistance exercise (p = .02) and a significant difference between combined exercise and resistance exercise (p < .01). A higher volume of aerobic exercise and a higher volume of resistance exercise were superior in reducing body weight. In conclusion, supervised exercise training improved metabolic outcomes in general, while different types and volume of exercises have their own merits.

The addition of exercise to a weight loss diet on inflammatory markers: a systematic review and Meta-analysis of controlled clinical trials

This systematic review and meta-analysis of controlled clinical trials was performed to evaluate the effects of weight-loss diets plus exercise compared with weight-loss diets alone on inflammatory biomarkers in adults. PubMed, Scopus, EMBASE, Web of Science (ISI), and Google Scholar were searched up to April 2021. Overall effects were derived using a random effects model. The overall quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Twenty-nine trials were included in this systematic review and meta-analysis. The meta-analysis showed no significant difference in serum high sensitivity C-reactive protein (hs-CRP) [weighted mean difference (WMD) = -0.004 mg/l, 95% CI: -0.140, 0.132, P = 0.954], interleukin-6 (IL-6) (WMD = -0.039 pg/ml, 95% CI: -0.233 to 0.156, P = 0.696), and tumor necrosis factor-α (TNF-α) (WMD = 0.405 ng/ml, 95% CI: -1.036 to 0.226, P = 0.209) after adding exercise to a weight-loss diet compared with a weight-loss diet alone. Subgroup analysis revealed that exercise plus a weight-loss diet significantly reduced TNF-α in studies greater than 16 weeks in duration (WMD = -0.742 ng/ml, 95% CI: -1.384 to -0.1, P = 0.024). This systematic review and meta-analysis indicate that exercise in addition to a weight-loss diet does not have a significant effect on further reducing inflammatory markers compared to a weight loss diet alone.

Energy deficiency impairs resistance training gains in lean mass but not strength: A meta-analysis and meta-regression

Short-term energy deficits impair anabolic hormones and muscle protein synthesis. However, the effects of prolonged energy deficits on resistance training (RT) outcomes remain unexplored. Thus, we conducted a systematic review of PubMed and SportDiscus for randomized controlled trials performing RT in an energy deficit (RT+ED) for ≥3 weeks. We first divided the literature into studies with a parallel control group without an energy deficit (RT+CON; Analysis A) and studies without RT+CON (Analysis B). Analysis A consisted of a meta-analysis comparing gains in lean mass (LM) and strength between RT+ED and RT+CON. Studies in Analysis B were matched with separate RT+CON studies for participant and intervention characteristics, and we qualitatively compared the gains in LM and strength between RT+ED and RT+CON. Finally, Analyses A and B were pooled into a meta-regression examining the relationship between the magnitude of the energy deficit and LM. Analysis A showed LM gains were impaired in RT+ED vs RT+CON (effect size (ES) = -0.57, p = 0.02), but strength gains were comparable between conditions (ES = -0.31, p = 0.28). Analysis B supports the impairment of LM in RT+ED (ES: -0.11, p = 0.03) vs RT+CON (ES: 0.20, p < 0.001) but not strength (RT+ED ES: 0.84; RT+CON ES: 0.81). Finally, our meta-regression demonstrated that an energy deficit of ~500 kcal · day^-1 prevented gains in LM. Individuals performing RT to build LM should avoid prolonged energy deficiency, and individuals performing RT to preserve LM during weight loss should avoid energy deficits >500 kcal day^-1 .

Poor quality of dietary assessment in randomized controlled trials of nutritional interventions for type 2 diabetes may affect outcome conclusions: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to evaluate the quality of dietary assessment methods in randomized controlled trials focusing on individuals with type 2 diabetes (T2DM), and its impact on the favorability of conclusions.

METHODS

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched, from inception until September 2019 for RCTs of dietary interventions in individuals with T2DM. Investigators assessed risk of bias and quality of the dietary measurements using the Cochrane Risk of Bias Assessment Tool 2.0 and the redeveloped EURICA tool, respectively. Random-effects meta-analysis assessed mean changes in hemoglobin (Hb)A1c. The study was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-analyses. PROSPERO registration number: CRD42019146471.

RESULTS

Of 2552 records retrieved, 23 studies met the inclusion criteria. Two studies were rated as good, 6 as medium, and 15 as poor in the quality assessment of the dietary measurement tool. All eight studies with higher quality of dietary assessment were associated with favorable conclusions. Among the 15 studies with poor quality, 5 failed to draw favorable conclusions. Among studies that sought to produce a reduction in HbA1c, 3 of 6 with better dietary assessment quality produced a significant difference of -0.38% (-0.67% to -0.08%), and 4 of 12 of poorer quality produced a significant difference of -0.26% (-0.37% to -0.14%).

CONCLUSIONS

The poor quality of dietary assessment in clinical trials casts uncertainty on the dietary outcomes and the validity of possible causal mechanisms. Attention to the accuracy and reliability of dietary assessment methods is indicated.

The liver-alpha-cell axis after a mixed meal and during weight loss in type 2 diabetes

OBJECTIVE

Glucagon and amino acids may be regulated in a feedback loop called the liver-alpha-cell axis with alanine or glutamine as suggested signal molecules. We assessed this concept in individuals with type 2 diabetes in the fasting state, after ingestion of a protein-rich meal, and during weight loss. Moreover, we investigated if postprandial glucagon secretion and hepatic insulin sensitivity were related.

METHODS

This is a secondary analysis of a 12-week weight-loss trial (Paleolithic diet ± exercise) in 29 individuals with type 2 diabetes. Before and after the intervention, plasma glucagon and amino acids were measured in the fasting state and during 180 min after a protein-rich mixed meal. Hepatic insulin sensitivity was measured using the hyperinsulinemic-euglycemic clamp with [6,6-2H2]glucose as a tracer.

RESULTS

The postprandial increase of plasma glucagon was associated with the postprandial increase of alanine and several other amino acids but not glutamine. In the fasted state and after the meal, glucagon levels were negatively correlated with hepatic insulin sensitivity (rS = -0.51/r = -0.58, respectively; both P < 0.05). Improved hepatic insulin sensitivity with weight loss was correlated with decreased postprandial glucagon response (r = -0.78; P < 0.001).

CONCLUSIONS

Several amino acids, notably alanine, but not glutamine could be key signals to the alpha cell to increase glucagon secretion. Amino acids may be part of a feedback mechanism as glucagon increases endogenous glucose production and ureagenesis in the liver. Moreover, postprandial glucagon secretion seems to be tightly related to hepatic insulin sensitivity.

Caloric Restriction per se Rather Than Dietary Macronutrient Distribution Plays a Primary Role in Metabolic Health and Body Composition Improvements in Obese Mice

Caloric restriction (CR) is of key importance in combating obesity and its associated diseases. We aimed to examine effects of dietary macronutrient distribution on weight loss and metabolic health in obese mice exposed to CR. Male C57BL/6J mice underwent diet-induced obesity for 18 weeks. Thereafter mice were exposed to a 6-week CR for up to 40% on either low-fat diet (LFD; 20, 60, 20% kcal from protein, carbohydrate, fat), low-carb diet (LCD; 20, 20, 60% kcal, respectively) or high-pro diet (HPD; 35, 35, 30% kcal, respectively) (n = 16 each). Ten mice on the obesogenic diet served as age-matched controls. Body composition was evaluated by tissue dissections. Glucose tolerance, bloods lipids and energy metabolism were measured. CR-induced weight loss was similar for LFD and LCD while HPD was associated with a greater weight loss than LCD. The diet groups did not differ from obese controls in hindlimb muscle mass, but showed a substantial decrease in body fat without differences between them. Glucose tolerance and blood total cholesterol were weight-loss dependent and mostly improved in LFD and HPD groups during CR. Blood triacylglycerol was lowered only in LCD group compared to obese controls. Thus, CR rather than macronutrient distribution in the diet plays the major role for improvements in body composition and glucose control in obese mice. Low-carbohydrate-high-fat diet more successfully reduces triacylglycerol but not cholesterol levels compared to isocaloric high-carbohydrate-low-fat weight loss diets.

Weight Loss Strategies and the Risk of Skeletal Muscle Mass Loss

With energy intake restriction and exercise remaining the key diet and lifestyle approaches to weight loss, this is not without potential negative implications for body composition, metabolic health, and quality and quantity of life. Ideally, weight loss should be derived almost exclusively from the fat mass compartment as this is the main driver of metabolic disease, however, several studies have shown that there is an accompanying loss of tissue from the fat-free compartment, especially skeletal muscle. Population groups including post-menopausal women, the elderly, those with metabolic disease and athletes may be particularly at risk of skeletal muscle loss when following a weight management programme. Research studies that have addressed this issue across a range of population groups are reviewed with a focus upon the contribution of resistance and endurance forms of exercise and a higher intake dietary protein above the current guideline of 0.8 g/kg body weight/day. While findings can be contradictory, overall, the consensus appears that fat-free and skeletal muscle masses can be preserved, albeit to varying degrees by including both forms of exercise (but especially resistance forms) in the weight management intervention. Equally, higher intakes of protein can protect loss of these body compartments, acting either separately or synergistically with exercise. Elderly individuals in particular may benefit most from this approach. Thus, the evidence supports the recommendations for intakes of protein above the current guidelines of 0.8 g/kg body weight/d for the healthy elderly population to also be incorporated into the dietary prescription for weight management in this age group.

Effects of whey protein plus vitamin D supplementation combined with progressive resistance training on glycaemic control, body composition, muscle function and cardiometabolic risk factors in middle-aged and older overweight/obese adults with type 2 diabetes: A 24-week randomized controlled trial

AIM

To determine the effect of whey protein plus vitamin D supplementation combined with progressive resistance training (PRT) on glycaemic control, body composition, muscle function and cardiometabolic risk factors in middle-aged and older adults with type 2 diabetes (T2D).

MATERIALS AND METHODS

In this 24-week, randomized controlled trial, 198 overweight/obese adults (aged 50-75 years) with T2D undertook PRT (2-3 days/week) with random allocation to whey protein (20 g each morning plus 20 g postexercise) plus vitamin D₃ (2000 IU/day) (PRT + ProD, n = 98) or no supplementation (PRT, n = 100). Primary outcomes were HbA1c and homeostatic model assessment-2 of insulin resistance (HOMA2-IR). Secondary endpoints included fasting plasma glucose (FPG), body composition, muscle strength, physical function, blood pressure, blood lipids and inflammatory markers.

RESULTS

At 24 weeks, supplementation did not enhance the effects of PRT on HbA1c (mean absolute change: PRT + ProD -0.10% [95% CI, -0.24%, 0.05%] vs. PRT -0.17% [95% CI, -0.32%, -0.03%], p = .322) or HOMA2-IR (PRT + ProD -0.12 [95% CI, -0.27, 0.03] vs. PRT -0.03 [95% CI, -0.14, 0.09], p = .370). There were also no significant between-group differences for the mean changes in the secondary outcomes, except that FPG improved in PRT versus PRT + ProD (net difference, 0.6 mmol/L [95% CI, 0.1, 1.0], P = .018), while interleukin IL-10 (61% [95% CI 31%, 92%], P < .001), tumour necrosis factor-α (16% [95% CI, 3%, 29%], p = .015) and 30-s sit-to-stand performance (number, 1.0 [95% CI, -0.05, 1.5], p = .047) increased in PRT + ProD versus PRT.

CONCLUSIONS

In older overweight/obese adults with T2D, daily whey protein plus vitamin D supplementation did not augment the effects of PRT on measures of glycaemic control, body composition, muscle strength or cardiometabolic risk factors.

Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis

We evaluated the effects of ketogenic diets (KDs) on body mass (BM), fat mass (FM), fat-free mass (FFM), body mass index (BMI), and body fat percentage (BFP) compared to non-KDs in individuals performing resistance training (RT). Online electronic databases including PubMed, the Cochrane Library, Web of Science, Embase, SCOPUS, and Ovid were searched to identify initial studies until February 2021. Data were pooled using both fixed and random-effects methods and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Out of 1372 studies, 13 randomized controlled trials (RCTs) that enrolled 244 volunteers were included. The pooled results demonstrated that KDs significantly decreased BM [(WMD = -3.67 kg; 95% CI: -4.44, -2.90, p < 0.001)], FM [(WMD = -2.21 kg; 95% CI: -3.09, -1.34, p < 0.001)], FFM [(WMD = -1.26 kg; 95% CI: -1.82, -0.70, p < 0.001)], BMI [(WMD = -1.37 kg.m^-2; 95% CI: -2.14, -0.59, p = 0.022)], and BFP [(WMD = -2.27%; 95% CI: -3.63, -0.90, p = 0.001)] compared to non-KDs. We observed beneficial effects of KDs compared to non-KDs on BM and body fat (both FM and BFP) in individuals performing RT. However, adherence to KDs may have a negative effect on FFM, which is not ameliorated by the addition of RT.

Evaluation of the impact of a community-based, pharmacist-led weight loss program focused on a high-protein diet on risk factors for cardiovascular disease

BACKGROUND

Lifestyle choices such as poor diet, physical inactivity, and smoking contribute to modifiable cardiovascular (CV) risk factors.

OBJECTIVES

To evaluate clinical outcomes (blood pressure, glycosylated hemoglobin [A1C] level, lipid profile, weight, and waist circumference) that affect CV disease and the American Heart Association (AHA) Life's Simple 7 score before and after completion of a weight loss program focusing on a high-protein, low-calorie, low-carbohydrate, and low-fat diet.

PRACTICE DESCRIPTION

Independent pharmacy in Richmond, VA.

PRACTICE INNOVATION

Pharmacist-led weight loss program focusing on a high-protein, low-calorie, low-carbohydrate, and low-fat diet.

EVALUATION METHODS

A retrospective analysis of electronic patient records was conducted to evaluate a pharmacist-led weight loss program focusing on a high-protein, low-calorie, low-carbohydrate, and low-fat diet. Baseline information included age, gender, race, height, comorbid conditions, diet, physical activity, and smoking status. Clinical CV outcomes (blood pressure, A1C level, lipid profile, weight, and waist circumference) were compared from baseline and at completion. Participants beginning calculated AHA Life's Simple 7 score was compared with the calculated score at completion. The Wilcoxon signed-rank test was used to analyze data.

RESULTS

Fourteen participants completed the program. Improvements in risk factors included systolic blood pressure (5.79 ± 5.56 mm Hg, P < 0.005), diastolic blood pressure (2.57 ± 3.37 mm Hg, P < 0.012), A1C level (0.6% ± 0.99%, P < 0.001), total cholesterol (22.21 ± 17.79 mg/dL, P < 0.001), low-density lipoprotein cholesterol (18 mg/dL, P < 0.041), weight (11.06 ± 5.65 kilograms, P < 0.001), and waist circumference (5.44 ± 4.24 centimeters, P < 0.001). The AHA Life's Simple 7 scores increased after the weight loss program (3.21 ± 0.89, P < 0.001).

CONCLUSION

A community-based, pharmacist-led weight loss program focusing on a high-protein, low-calorie, low-carbohydrate, and low-fat diet improved participants' AHA Life's Simple 7 scores and modifiable risk factors for CV disease.

Effect of an Enriched Protein Drink on Muscle Mass and Glycemic Control during Combined Lifestyle Intervention in Older Adults with Obesity and Type 2 Diabetes: A Double-Blind RCT

Background: Weight loss is key to treatment of older adults with obesity and type 2 diabetes, but also a risk for muscle mass loss. This study investigated whether a whey protein drink enriched with leucine and vitamin D could preserve muscle mass and improve glycemic control during combined lifestyle intervention in this population. Methods: 123 older adults with obesity and type 2 diabetes were randomized into a 13-week lifestyle intervention with dietary advice and exercise, receiving either the enriched protein drink (test) or an isocaloric control (control). Muscle mass was assessed with dual-energy X-ray absorptiometry and glycemic control by oral glucose tolerance test. Statistical analyses were performed using a linear mixed model. Results: There was a nonsignificant increase in leg muscle mass (+0.28 kg; 95% CI, −0.01 to 0.56) and a significant increase in appendicular muscle mass (+0.36 kg; 95% CI, 0.005 to 0.71) and total lean mass (+0.92 kg; 95% CI, 0.19 to 1.65) in test vs. control. Insulin sensitivity (Matsuda index) also increased in test vs. control (+0.52; 95% CI, 0.07 to 0.97). Conclusions: Use of an enriched protein drink during combined lifestyle intervention shows beneficial effects on muscle mass and glycemic control in older adults with obesity and type 2 diabetes.

Effects of Exercise on Inflammatory Cytokines in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

OBJECTIVE

Inflammation is involved in the pathogenesis of type 2 diabetes (T2DM) and the occurrence of insulin resistance. The purpose of this study was to investigate the effects of exercise on inflammatory factors in patients with T2DM.

METHODS

A systematic review was conducted on five databases, Cochrane, Embase, Pubmed, Web of Science, and EBSCO. All randomized controlled trials (RCTs) published between establishment of the database and November 2020 without restrictions on language were included. Studies evaluated the effects of exercise intervention on inflammatory cytokines in patients with T2DM were selected.

RESULTS

Twenty-three randomized controlled trials (1350 patients) were included in our meta-analysis. Exercise can significantly reduce the level of C-reactive protein (CRP) (MD: -0.79, 95% CI: -1.26 to -0.33, p = 0.0008), tumor necrosis factor-α (TNF-α) (MD: -2.33, 95% CI: -3.39 to -1.27, p < 0.0001), and interleukin-6 (IL-6) (MD: -0.42, 95% CI: -0.60 to -0.24, p < 0.0001) in T2DM patients.

CONCLUSION

The findings of this review suggest that exercise reduces inflammatory cytokines (CRP, TNF-α, and IL-6) in T2DM patients. More studies with high methodological qualities and large sample sizes need to be done to confirm which forms of exercise are most effective.

Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss

The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.

Effectiveness of an mHealth Intervention Combining a Smartphone App and Smart Band on Body Composition in an Overweight and Obese Population: Randomized Controlled Trial (EVIDENT 3 Study)

Background

Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear.

Objective

This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese.

Methods

A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire.

Results

The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m², 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m² (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m² (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m² (95% CI –0.83 to –0.19).

Conclusions

The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m² and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect.

Trial Registration

Clinicaltrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614.

International Registered Report Identifier (IRRID)

RR2-10.1097/MD.0000000000009633

Low-carbohydrate diets and type 2 diabetes treatment: a meta-analysis of randomized controlled trials

AIM

To assess whether LC diets are associated with long-term improvement in glycemic control and weight loss in people with T2DM, and their cardiovascular and renal safety.

METHODS

Meta-analysis of randomized controlled trials lasting more than 3 months, retrieved through extensive search on PubMed, Embase, ClinicalTrial.gov, Cochrane databases up to March 1st, comparing LC diets and balanced carbohydrate diets in people with T2DM.

RESULTS

We retrieved 37 trials, including 3301 patients. Average carbohydrate intake in LC diets was 36% of total energy. LC diets were associated with significant reduction of HbA1c at 3 months (MD - 0.17%, 95% CI - 0.27, - 0.07), no difference at 6 and 12 months, and significant increase at 24 months (MD 0.23%, 95% CI MD 0.02, 0.44). VLC diets were associated with significant HbA1c reduction at 3 and 6 months (MD - 0.43% - 0.60, - 0.26%, and MD - 0.40% 95% CI - 0.59, - 0.22, respectively), but not at 12 and 24 months. LC diets were associated with significant BMI reduction at 6 months (- 1.35 kg/m² 95% CI, - 2.18, - 0.52), but not at other time points. Only a minority of trials reported data on renal function, so renal safety could not be assessed. No significant differences in body weight, lipid profile, or blood pressure were found in the long term.

CONCLUSION

LC diets may produce small short-term improvements in HbA1c and weight, which are not maintained in the long term. Data on their renal safety are insufficient.

Effect of Aging Time on Meat Quality of Longissimus Dorsi from Yunling Cattle: A New Hybrid Beef Cattle

Simple Summary

Beef is in great demand in many countries. Consumers are more inclined to buy beef with good tenderness, color, flavor, and healthy fatty acid composition. Beef that has been aged is often more suitable for cooking and processing. A research gap exists regarding the analysis of meat quality during the aging process in Yunling cattle, a new hybrid beef cattle bred by Chinese researchers. This study measured a set of indicators of Yunling beef and other two breeds as controls (Simmental cattle, an excellent beef cattle breed used around the world, and Wenshan cattle, a local beef cattle breed in southern China), including the pH, water loss rate, cooking loss, Warner-Bratzler shear force, myofibrillar fragmentation index, inosine 5′-monophosphate, color, and fatty acid profiles. In addition, some growth performance and carcass characteristics were determined. The results showed that the pH, water holding capacity, growth performance, and carcass traits of Yunling and Simmental cattle were basically the same and better, respectively, than those of Wenshan cattle. Aging time had no effect on beef fatty acid composition, with Yunling beef showing a healthier fatty acid profile versus the other two breeds. With increased aging time, the tenderness and color of Yunling beef became more suitable for cooking and sensory characteristics. Therefore, this study suggests that Yunling beef should be used for cooking and processing after aging.

Abstract

The beef aging process is essential for compliance with certain major requisites, such as sensory characteristics for cooking and meat processing. Meat quality analysis of Yunling cattle, a new hybrid beef cattle bred by Chinese researchers, during the aging process, represents a major research gap. To explore Yunling beef initially, indicators associated with meat quality during the aging process of Yunling, Simmental, and Wenshan cattle were measured. In addition, some important economic traits were detected in the three breeds, including growth performance and carcass characteristics. The results showed that the growth performance, carcass traits, pH, and water holding capacity of Yunling and Simmental cattle were basically the same and better, respectively, than those of Wenshan cattle. The proportions of individual fatty acids in Yunling beef were healthier than in the other two breeds. Aging time did not affect the fatty acid profiles of the beef (p > 0.05). The contents of certain fatty acids in the three beef types displayed some differences in terms of days of aging (p < 0.05). The tenderness and meat color were better in the Yunling beef as the aging time increased, indicating that Yunling beef aged for 7 days was more suitable for cooking, exhibiting better sensory characteristics. Thus, a 7-day short-term aging process is very effective in improving the quality of Yunling beef. Our study attempted to fill a gap in the Yunling beef quality analysis during aging, providing further evidence for Yunling beef improvement.

Impact of Physical Training Programs on Physical Fitness in People With Class II and III Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease.

PURPOSE

The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity.

DATA SOURCES

Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017.

STUDY SELECTION

This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article.

DATA EXTRACTION

Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached.

DATA SYNTHESIS

Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias.

LIMITATIONS

The large variability of outcomes and interventions made comparisons difficult.

CONCLUSIONS

A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.

Predictive associations between lifestyle behaviours and dairy consumption: The IDEFICS study

BACKGROUND AND AIM

Physical activity (PA) and sedentary behaviours (SB) are related to obesity and cardiometabolic risk; however, the literature is controversial regarding the effect of dairy consumption on the development of cardiovascular disease (CVD) risk factors. The aim of this study was to assess longitudinally the relationship between specific lifestyle behaviours (PA and SB) and dairy consumption in a sample of European children and adolescents.

METHODS AND RESULTS

Children from the IDEFICS study were included in the analyses. Two measurements, with 2 years' interval, were conducted. A total of 1688 (50.8% boys) children provided information regarding diet, measured by a 24-h dietary recall, PA measured by accelerometers and parent-reported sedentary screen time (SST) at both time points. Different combinations of these behaviours, at each survey and over time, were derived applying specific recommendations. Multilevel ordinal logistic regression and analysis of covariance were used to assess their association with dairy consumption, adjusted for potential confounders. Differences by gender were found regarding dairy product consumption and also adherence to SB and PA recommendations at T0 and T1. Children meeting both lifestyle recommendations, at the two measurement points, had higher probability to consume more milk and yogurt and less cheese than the rest of combinations.

CONCLUSIONS

These results suggest that European children with a healthy lifestyle, especially regarding PA and SB over time, consumed more milk and yogurt. This study suggests that the protective effect of specific dairy products found in literature could be partially due to the association of their consumption with specific healthy lifestyles.

An Approach to Obesity Management for Gastroenterologists and Hepatologists

PURPOSE OF REVIEW

Obesity is associated with multiple gastrointestinal and liver diseases such as gastroesophageal reflux disease, Barrett's esophagus, esophageal adenocarcinoma, cholelithiasis, colon polyps, and fatty liver disease. To effectively manage obesity, it is imperative to understand current and emerging therapies and procedures.

FINDINGS

Obesity is becoming increasingly prevalent and is associated with a growing monetary health care burden. Cardiac disease, cerebrovascular disease, and diabetes are among the leading causes of preventable and premature death of Americans related to obesity. In addition to behavioral modification (diet and exercise) and bariatric surgery, multiple pharmacotherapies and endoscopic procedures are newly approved and available for the management of obesity. This paper reviews the current literature on the treatments available for the management of obesity including behavior modification, pharmacotherapy, endoscopic weight loss procedures (endobariatrics), and bariatric surgery.

Nutritional Strategies to Combat Type 2 Diabetes in Aging Adults: The Importance of Protein

The prevalence of pre-diabetes (PD) and type II diabetes (T2D) has risen dramatically in recent years affecting an estimated 422 million adults worldwide. The risk of T2D increases with age, with the sharpest rise in diagnosis occurring after age 40. With age, there is also a progressive decline in muscle mass starting after the age of 30. The decline in muscle mass and function due to aging is termed sarcopenia and immediately precedes the sharp rise in T2D. The purpose of the current review is to discuss the role of protein to attenuate declines in muscle mass and insulin sensitivity to prevent T2D and sarcopenia in aging adults. The current recommended dietary allowance for protein consumption is set at 0.8 g/kg/day and is based on dated studies on young healthy men and may not be sufficient for older adults. Protein consumption upwards of 1.0-1.5 g/kg/day in older adults is able to induce improvements in glycemic control and muscle mass. Obesity, particularly central or visceral obesity is a major risk factor in the development of PD and T2D. However, the tissue composition of weight loss in older adults includes both lean body mass and fat mass and therefore may have adverse metabolic consequences in older adults who are already at a high risk of lean body mass loss. High protein diets have the ability to increase weight loss while preserving lean body mass therefore inducing "high-quality weight loss," which provides favorable metabolic changes in older adults. High protein diets also induce beneficial outcomes on glycemic markers due to satiety, lowered post-prandial glucose response, increased thermogenesis, and the ability to decrease rates of muscle protein breakdown (MPB). The consumption of dairy specific protein consumption has also been shown to improve insulin sensitivity by improving body composition, enhancing insulin release, accelerating fat oxidation, and stimulating rates of muscle protein synthesis (MPS) in older adults. Exercise, specifically resistance training, also works synergistically to attenuate the progression of PD and T2D by further stimulating rates of MPS thereby increasing muscle mass and inducing favorable changes in glycemic control independent of lean body mass increases.

Effects of Whole-Body Electromyostimulation on the Energy-Restriction-Induced Reduction of Muscle Mass During Intended Weight Loss

Purpose: Overweight and obesity are an increasing problem worldwide. However, most studies that focus on weight reduction by energy restriction and/or aerobic exercise reported considerable loss of muscle mass as well. Increased protein intake and/or resistance exercise might inhibit this detrimental effect during a negative energy balance. Whole-body electromyostimulation (WB-EMS), a time effective, joint-friendly, and highly customizable training technology, showed similar hypertrophic effects compared with high-intensity resistance training. The aim of this study is to evaluate the effect of WB-EMS on body composition during negative energy balance with maintained/increased protein intake in overweight premenopausal women.

Patients and Methods: Ninety premenopausal, 25–50-year-old, overweight women were randomly assigned to three groups (n = 30 each). (1) Negative energy balance (−500 kcal/day) by energy restriction with compensatory protein intake (CG). (2) Negative energy balance (−500 kcal/day) by energy restriction (−250 kcal/day) and increased physical activity (−250 kcal/day) with increased protein intake (PA). (3) Negative energy balance (−500 kcal/day) due to energy restriction and increased physical activity with increased protein intake plus WB-EMS. The duration of the intervention was 16 weeks. Participants underwent restrictions in kcal per days and supplementation of protein (CG: 1.2 or PA/WB-EMS: 1.7 g/kg body mass/day) where needed. Bipolar WB-EMS was applied 1.5× week for 20 min (85 Hz; 350 μs; intermittent 6 s impulse, 4 s rest; rectangular). The primary study endpoint “lean body mass” (LBM) and secondary endpoint body fat mass (BFM) were assessed by bio-impedance analysis (BIA).

Results: LBM decreased in the CG and PA group (CG: −113 ± 1,872 g; PA: −391 ± 1,832 g) but increased in the WB-EMS group (387 ± 1,769 g). However, changes were not significant (p > 0.05). Comparing the groups by ANOVA, no significant differences were observed (p = 0.070). However, pairwise adjusted comparisons determined significant differences between WB-EMS and PA (p = 0.049). BFM decreased significantly (p < 0.001) in all groups (CG: −2,174 ± 4,331 g; PA: −3,743 ± 4,237 g; WB-EMS: −3,278 ± 4,023 g) without any significant difference between the groups (ANOVA: p = 0.131).

Conclusion: WB-EMS is an efficient, joint-friendly, and highly customizable training technology for maintaining muscle mass during energy restriction and can thus be considered as an alternative to more demanding resistance exercise protocols.

Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

The aim of this study was to assess the effects of different dietary approaches on low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride (TG) levels in patients with type 2 diabetes (T2D) by applying network meta-analysis (NMA). Systematic electronic and hand searches were conducted until January 2018. Randomized controlled trials (RCTs) with an intervention period of ≥ 12 weeks, focussing on adults with T2D, and comparing dietary approaches regarding LDL, HDL or TGs, were included. For each outcome measure, random effects NMA was performed in order to determine the effect of each dietary approach compared to every other dietary intervention. Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated, and for the ranking, the surface under the cumulative ranking curves (SUCRA) was determined. Additionally, the credibility of evidence was evaluated. 52 RCTs (44 for LDL, 48 for HDL and 52 for TGs) comparing nine dietary approaches (low fat, vegetarian, Mediterranean, high protein, moderate carbohydrate, low carbohydrate, control, low glycaemic index/glycaemic load and Palaeolithic diet) enrolling 5360 T2D patients were included. The vegetarian diet most effectively reduced LDL levels [MD (95% CI): - 0.33 (- 0.55, - 0.12) mmol/L; compared to the control diet]. The Mediterranean diet beneficially raised HDL [MD (95% CI): 0.09 (0.04, 0.15) mmol/L] and decreased TG levels [MD (95% CI): - 0.41 (- 0.72, - 0.10) mmol/L] compared to the control diet. The Mediterranean diet was the most effective dietary approach to manage diabetic dyslipidaemia altogether (SUCRA: 79%). The overall findings are mainly limited by low credibility of evidence.

The Association of Maternal Protein Intake during Pregnancy in Humans with Maternal and Offspring Insulin Sensitivity Measures

The purpose of this review is to critically evaluate the studies assessing the relations between protein intake during human pregnancy and insulin sensitivity measures in the mother and offspring, and to get a better understanding of the knowledge gaps that still exist. Overall, there is insufficient evidence to conclude about implications of higher amounts of protein intake during pregnancy on maternal or offspring insulin sensitivity. However, studies show a relation between protein quality and insulin sensitivity, such that animal protein may be associated with negative outcomes and plant protein may be associated with positive insulin sensitivity outcomes. There is an urgent need for standardized studies using comparable terminology to evaluate any potential relations between insulin sensitivity in mothers and offspring and truly low and high maternal protein intake while maintaining eucaloric balance to better inform about optimal protein dosage and quality during this period.

Molecular and cellular bases of diabetes: Focus on type 2 diabetes mouse model-TallyHo

Diabetes is a chronic lifestyle disorder that affects millions of people worldwide. Diabetes is a condition where the body does not produce sufficient insulin or does not use it efficiently. Insulin resistance in diabetes or obesity causes the pancreatic β-cells to increase the insulin output. Diabetes occurs in multiple forms, including type 1, type 2, type 3 and gestational. Type 2 diabetes accounts for ∼90-95% of total affected population and is associated with both impaired insulin production by the β-cells of the pancreas and impaired insulin release in response to high blood glucose levels. Diabetes is tightly linked with genetic mutations and genetic and lifestyle activities, including diet and exercise. Recent epidemiological studies established a close link between the diabetes and progression to Alzheimer's disease. This article summarizes various molecular mechanisms involved in the developments of diabetes, including biochemical characteristics, genetic and molecular links with Alzheimer's disease, β-cell function, and factors associated with diabetes. This will help us in the development of novel therapeutic strategies targeting AD in future.

Effects of low-intensity resistance training on muscular function and glycemic control in older adults with type 2 diabetes

AIMS/INTRODUCTION

The present study aimed to investigate the effects of low-intensity resistance training with slow movement and tonic force generation (LST) on muscular function and glucose metabolism in older patients with type 2 diabetes.

MATERIALS AND METHODS

A total of 10 patients with type 2 diabetes (age 68.2 ± 9.7 years) engaged in LST training twice a week for 16 weeks. Before the long-term intervention, they were subjected to the measurement of acute changes in blood factors relating to glycemic control as a result of a bout of LST. Body composition, muscular size and strength, and glycated hemoglobin were measured before and after the intervention.

RESULTS

The magnitudes of the acute changes in the blood factors were all small and were not considered harmful for glucose metabolism. The 16-week LST training caused significant increases in thigh muscle thickness and strength, and decreases in body fat mass and glycated hemoglobin. The change in glycated hemoglobin showed a significant negative correlation with the change in the isokinetic knee extension peak torque measured at a high angular velocity (180°/s).

CONCLUSIONS

The LST training was shown to be effective for gaining muscular size and strength, and improving glycemic control in older patients with type 2 diabetes. The mechanisms underlying this effect might involve the improvement of contractile function in fast glycolytic fibers.