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Smith K, Taylor GS, Walker M, Brunsgaard LH, Bowden Davies KA, Stevenson EJ, West DJ. Pre-Meal Whey Protein Alters Postprandial Insulinemia by Enhancing β-Cell Function and Reducing Insulin Clearance in T2D. J Clin Endocrinol Metab 2023; 108:e603-e612. [PMID: 36734166 PMCID: PMC10807909 DOI: 10.1210/clinem/dgad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Abstract
CONTEXT Treatments that reduce postprandial glycemia (PPG) independent of stimulating insulin secretion are appealing for the management of type 2 diabetes (T2D). Consuming pre-meal whey protein (WP) reduces PPG by delaying gastric emptying and increasing plasma insulin concentrations. However, its effects on β-cell function and insulin kinetics remains unclear. OBJECTIVE To examine the PPG-regulatory effects of pre-meal WP by modeling insulin secretion rates (ISR), insulin clearance, and β-cell function. METHODS This was a single-blind, randomized, placebo-controlled, crossover design study in 18 adults with T2D (HbA1c, 56.7 ± 8.8 mmol/mol) who underwent 2 240-minute mixed-meal tolerance tests. Participants consumed WP (15 g protein) or placebo (0 g protein) 10 minutes before a mixed-macronutrient breakfast meal. PPG, pancreatic islet, and incretin hormones were measured throughout. ISR was calculated by C-peptide deconvolution. Estimates of insulin clearance and β-cell function were modeled from glucose, insulin, and ISR. Changes in PPG incremental area under the curve (iAUC; prespecified) and insulin clearance (post hoc) were measured. RESULTS β-cell function was 40% greater after WP (P = .001) and was accompanied with a -22% reduction in postprandial insulin clearance vs placebo (P < .0001). Both the peak change and PPG iAUC were reduced by WP (-1.5 mmol/L and -16%, respectively; both P < .05). Pre-meal WP augmented a 5.9-fold increase in glucagon and glucagon-like peptide 1 iAUC (both P < .0001), and a 1.5-fold increase in insulin iAUC (P < .001). Although the plasma insulin response was greater following WP, ISR was unaffected (P = .133). CONCLUSION In adults with T2D, pre-meal WP reduced PPG by coordinating an enhancement in β-cell function with a reduction in insulin clearance. This enabled an efficient postprandial insulinemic profile to be achieved without requiring further β-cell stimulation.Trial registry ISRCTN ID: ISRCTN17563146 Website link: www.isrctn.com/ISRCTN17563146.
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Affiliation(s)
- Kieran Smith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Human Nutrition and Exercise Research Centre, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Guy S Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Human Nutrition and Exercise Research Centre, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Mark Walker
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Lise H Brunsgaard
- Health and Performance Nutrition, Arla Foods Ingredients Group P/S, Viby J 8260, Denmark
| | - Kelly A Bowden Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Emma J Stevenson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Human Nutrition and Exercise Research Centre, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Daniel J West
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Human Nutrition and Exercise Research Centre, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Heald AH, Jenkins DA, Williams R, Mudaliar RN, Naseem A, Davies KAB, Gibson JM, Peng Y, Ollier W. COVID-19 Vaccination and Diabetes Mellitus: How Much Has It Made a Difference to Outcomes Following Confirmed COVID-19 Infection? Diabetes Ther 2023; 14:193-204. [PMID: 36478309 PMCID: PMC9734409 DOI: 10.1007/s13300-022-01338-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus (COVID-19), its successive variants and the associated pandemic caused. We have previously shown that for people living with type 2 diabetes (T2DM), the risk of being admitted to hospital or dying following a COVID-19 infection progressively decreased through the first months of 2021. In this subsequent analysis we have examined how the UK COVID-19 vaccination programme impacted differentially on COVID-19 outcomes in people with T1DM or T2DM compared to appropriate controls. METHODS T1DM and T2DM affected individuals were compared with their matched controls on 3:1 ratio basis. A 28-day hospital admission or mortality was used as the binary outcome variable with diabetes status and vaccination for COVID-19 as the main exposure variables. RESULTS A higher proportion of T1DM individuals vs their controls was found to be vaccinated at the point of their first recorded positive COVID-19 test when compared to T2DM individuals vs their controls. Regarding the 28-day hospital admission rate, there was a greater and increasing protective effect of subsequent vaccination dosage (one, two or three) in mitigating the effects of COVID-19 infection versus no vaccination in T1DM than in T2DM individuals when compared with matched controls. Similar effects were observed in T2DM for death. Across both diabetes and non-diabetes individuals, those at greater socio-economic disadvantage were more likely to test positive for COVID-19 in the early phase of the pandemic. For T2DM individuals socio-economic disadvantage was associated with a greater likelihood of hospital admission and death, independent of vaccination status. Age and male sex were also independently associated with 28-day hospital admission in T2DM and to 28-day mortality, independent of vaccination status. African ethnicity was also an additional factor for hospital admission in people with T2DM. CONCLUSION A beneficial effect of COVID-19 vaccination was seen in mitigating the harmful effects of COVID-19 infection; this was manifest in reduced hospital admission rate in T1DM individuals with a lesser effect in T2DM when compared with matched controls, regarding both hospital admission and mortality. Socio-economic disadvantage influenced likelihood of COVID-19 confirmed infection and the likelihood of hospital admission/death independent of the number of vaccinations given in T2DM.
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Affiliation(s)
- Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
| | - David A Jenkins
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rajshekhar N Mudaliar
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Asma Naseem
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - J Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Witham MD, Cooper R, Bowden Davies KA, Ortega-Martorell S, Stewart CE, Sayer AA. Ageing Research Translation: a new era for UK geroscience. Nat Aging 2022; 2:867-868. [PMID: 37118281 DOI: 10.1038/s43587-022-00288-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Heald AH, Jenkins DA, Williams R, Sperrin M, Mudaliar RN, Syed A, Naseem A, Bowden Davies KA, Peng Y, Peek N, Ollier W, Anderson SG, Delanerolle G, Gibson JM. Mortality in People with Type 2 Diabetes Following SARS-CoV-2 Infection: A Population Level Analysis of Potential Risk Factors. Diabetes Ther 2022; 13:1037-1051. [PMID: 35416588 PMCID: PMC9006208 DOI: 10.1007/s13300-022-01259-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Research is ongoing to increase our understanding of how much a previous diagnosis of type 2 diabetes mellitus (T2DM) affects someone's risk of becoming seriously unwell following a COVID-19 infection. In this study we set out to determine the relative likelihood of death following COVID-19 infection in people with T2DM when compared to those without T2DM. This was conducted as an urban population study and based in the UK. METHODS Analysis of electronic health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of T2DM and subsequent COVID-19 confirmed infection. Each individual with T2DM (n = 13,807) was matched with three COVID-19-infected non-diabetes controls (n = 39,583). Data were extracted from the Greater Manchester Care Record (GMCR) database for the period 1 January 2020 to 30 June 2021. Social disadvantage was assessed through Townsend scores. Death rates were compared in people with T2DM to their respective non-diabetes controls; potential predictive factors influencing the relative likelihood of admission were ascertained using univariable and multivariable logistic regression. RESULTS For individuals with T2DM, their mortality rate after a COVID-19 positive test was 7.7% vs 6.0% in matched controls; the relative risk (RR) of death was 1.28. From univariate analysis performed within the group of individuals with T2DM, the likelihood of death following a COVID-19 recorded infection was lower in people taking metformin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i) or a glucagon-like peptide 1 (GLP-1) agonist. Estimated glomerular filtration rate (eGFR) and hypertension were associated with increased mortality and had odds ratios of 0.96 (95% confidence interval 0.96-0.97) and 1.92 (95% confidence interval 1.68-2.20), respectively. Likelihood of death following a COVID-19 infection was also higher in those people with a diagnosis of chronic obstructive pulmonary disease (COPD) or severe enduring mental illness but not with asthma, and in people taking aspirin/clopidogrel/insulin. Smoking in people with T2DM significantly increased mortality rate (odds ratio of 1.46; 95% confidence interval 1.29-1.65). In a combined analysis of patients with T2DM and controls, multiple regression modelling indicated that the factors independently relating to a higher likelihood of death (accounting for 26% of variance) were T2DM, age, male gender and social deprivation (higher Townsend score). CONCLUSION Following confirmed infection with COVID-19 a number of factors are associated with mortality in individuals with T2DM. Prescription of metformin, SGLT2is or GLP-1 agonists and non-smoking status appeared to be associated with a reduced the risk of death for people with T2DM. Age, male sex and social disadvantage are associated with an increased risk of death.
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Affiliation(s)
- Adrian H Heald
- The School of Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
| | - David A Jenkins
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Rajshekhar N Mudaliar
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Akheel Syed
- The School of Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Asma Naseem
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Simon G Anderson
- University of the West Indies, Cavehill Campus, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Gayathri Delanerolle
- Nuffield Department of Primary Health Care Science, Clinical Research Facility, University of Oxford, Oxford, UK
| | - J Martin Gibson
- The School of Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
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Smith K, Taylor GS, Brunsgaard LH, Walker M, Bowden Davies KA, Stevenson EJ, West DJ. Thrice daily consumption of a novel, premeal shot containing a low dose of whey protein increases time in euglycemia during 7 days of free-living in individuals with type 2 diabetes. BMJ Open Diabetes Res Care 2022; 10:10/3/e002820. [PMID: 35618446 PMCID: PMC9137348 DOI: 10.1136/bmjdrc-2022-002820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/06/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION During acute feeding trials, consuming a large dose of whey protein (WP) before meals improves postprandial glucose regulation in people with type 2 diabetes. It is unclear if the reported benefits of premeal WP supplementation are translatable to everyday care or are associated with clinically meaningful, real-world glycemic outcomes. This study examined the application of a novel, premeal shot containing a low dose of WP on parameters of free-living glycemic control in people with type 2 diabetes. RESEARCH DESIGN AND METHODS In a randomized, placebo-controlled, single-blind crossover design, 18 insulin naive individuals with type 2 diabetes ((mean±SD) age, 50±6 years; HbA1c (glycated hemoglobin), 7.4%±0.8%; duration of diabetes, 6±5 years) consumed a ready-to-drink WP shot (15 g of protein) or a nutrient-depleted placebo beverage 10 min before breakfast, lunch, and dinner over a 7-day free-living period. Free-living glucose control was measured by blinded continuous glucose monitoring and determined by the percentage of time spent above range (>10 mmol/L), in euglycemic range (3.9-10.0 mmol/L), below range (<3.9 mmol/L) and mean glucose concentrations. RESULTS Mealtime WP supplementation reduced the prevalence of daily hyperglycemia by 8%±19% (30%±25% vs 38%±28%, p<0.05), thereby enabling a 9%±19% (~2 hours/day) increase in the time spent in euglycemia (p<0.05). Mean 24-hour blood glucose concentrations were 0.6±1.2 mmol/L lower during WP compared with placebo (p<0.05). Similar improvements in glycemic control were observed during the waken period with premeal WP supplementation (p<0.05), whereas nocturnal glycemic control was unaffected (p>0.05). Supplemental compliance/acceptance was high (>98%), and no adverse events were reported. CONCLUSIONS Consuming a novel premeal WP shot containing 15 g of protein before each main meal reduces the prevalence of daily hyperglycemia, thereby enabling a greater amount of time spent in euglycemic range per day over 7 days of free-living in people with type 2 diabetes. TRIAL REGISTRATION NUMBER ISRCTN17563146; www.isrctn.com/ISRCTN17563146.
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Affiliation(s)
- Kieran Smith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Guy S Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lise H Brunsgaard
- Health and Performance Nutrition, Arla Foods Ingredients Group P/S, Viby J, Denmark
| | - Mark Walker
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly A Bowden Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Emma J Stevenson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel J West
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Heald AH, Jenkins DA, Williams R, Sperrin M, Fachim H, Mudaliar RN, Syed A, Naseem A, Gibson JM, Bowden Davies KA, Peek N, Anderson SG, Peng Y, Ollier W. The Risk Factors Potentially Influencing Hospital Admission in People with Diabetes, Following SARS-CoV-2 Infection: A Population-Level Analysis. Diabetes Ther 2022; 13:1007-1021. [PMID: 35325361 PMCID: PMC8944405 DOI: 10.1007/s13300-022-01230-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus and the associated global pandemic (Covid-19). People with diabetes are particularly at high risk of becoming seriously unwell after contracting this virus. METHODS This population-based study included people living in the Greater Manchester conurbation who had a recorded diagnosis of type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and subsequent Covid-19 infection. Each individual with T1DM (n = 862) or T2DM (n = 13,225) was matched with three Covid-19-infected non-diabetes controls. RESULTS For individuals with T1DM, hospital admission rate in the first 28 days after a positive Covid-19 test was 10% vs 4.7% in age/gender-matched controls [relative risk (RR) 2.1]. For individuals with T2DM, hospital admission rate after a positive Covid-19 test was 16.3% vs 11.6% in age/gender-matched controls (RR 1.4). The average Townsend score was higher in T2DM (1.8) vs matched controls (0.4), with a higher proportion of people with T2DM observed in the top two quintiles of greatest disadvantage (p < 0.001). For Covid-19-infected individuals with T1DM, factors influencing admission likelihood included age, body mass index (BMI), hypertension, HbA1c, low HDL-cholesterol, lower estimated glomerular filtration rate (eGFR), chronic obstructive pulmonary disease (COPD) and being of African/mixed ethnicity. In Covid-19-infected individuals with T2DM, factors related to a higher admission rate included age, Townsend index, comorbidity with COPD/asthma and severe mental illness (SMI), lower eGFR. Metformin prescription lowered the likelihood. For multivariate analysis in combined individuals with T2DM/controls, factors relating to higher likelihood of admission were having T2DM/age/male gender/diagnosed COPD/diagnosed hypertension/social deprivation (higher Townsend index) and non-white ethnicity (all groups). CONCLUSION In a UK population we have confirmed a significantly higher likelihood of admission in people with diabetes following Covid-19 infection. A number of factors mediate that increased likelihood of hospital admission. For T2DM, the majority of factors related to increased admission rate are common to the general population but more prevalent in T2DM. There was a protective effect of metformin in people with T2DM.
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Affiliation(s)
- Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
| | - David A Jenkins
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Helene Fachim
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Rajshekhar N Mudaliar
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Akheel Syed
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Asma Naseem
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - J Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Simon G Anderson
- University of the West Indies, Cavehill Campus, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Bowden Davies KA, Norman JA, Thompson A, Mitchell KL, Harrold JA, Halford JCG, Wilding JPH, Kemp GJ, Cuthbertson DJ, Sprung VS. Short-Term Physical Inactivity Induces Endothelial Dysfunction. Front Physiol 2021; 12:659834. [PMID: 33897466 PMCID: PMC8064120 DOI: 10.3389/fphys.2021.659834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective This study examined the effects of a short-term reduction in physical activity, and subsequent resumption, on metabolic profiles, body composition and cardiovascular (endothelial) function. Design Twenty-eight habitually active (≥10,000 steps/day) participants (18 female, 10 male; age 32 ± 11 years; BMI 24.3 ± 2.5 kg/m2) were assessed at baseline, following 14 days of step-reduction and 14 days after resuming habitual activity. Methods Physical activity was monitored throughout (SenseWear Armband). Endothelial function (flow mediated dilation; FMD), cardiorespiratory fitness ( V . O 2 peak) and body composition including liver fat (dual-energy x-ray absorptiometry and magnetic resonance spectroscopy) were determined at each assessment. Statistical analysis was performed using one-way within subject's ANOVA; data presented as mean (95% CI). Results Participants decreased their step count from baseline by 10,111 steps/day (8949, 11,274; P < 0.001), increasing sedentary time by 103 min/day (29, 177; P < 0.001). Following 14 days of step-reduction, endothelial function was reduced by a 1.8% (0.4, 3.3; P = 0.01) decrease in FMD. Following resumption of habitual activity, FMD increased by 1.4%, comparable to the baseline level 0.4% (-1.8, 2.6; P = 1.00). Total body fat, waist circumference, liver fat, whole body insulin sensitivity and cardiorespiratory fitness were all adversely affected by 14 days step-reduction (P < 0.05) but returned to baseline levels following resumption of activity. Conclusion This data shows for the first time that whilst a decline in endothelial function is observed following short-term physical inactivity, this is reversed on resumption of habitual activity. The findings highlight the need for public health interventions that focus on minimizing time spent in sedentary behavior.
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Affiliation(s)
- Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Juliette A Norman
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Thompson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Katie L Mitchell
- Institute of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanne A Harrold
- Institute of Public Health, University of Liverpool, Liverpool, United Kingdom
| | | | - John P H Wilding
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Graham J Kemp
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Magnetic Resonance Imaging Centre, University of Liverpool, Liverpool, United Kingdom
| | - Daniel J Cuthbertson
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Victoria S Sprung
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Clifford T, Acton JP, Cocksedge SP, Davies KAB, Bailey SJ. The effect of dietary phytochemicals on nuclear factor erythroid 2-related factor 2 (Nrf2) activation: a systematic review of human intervention trials. Mol Biol Rep 2021; 48:1745-1761. [PMID: 33515348 PMCID: PMC7925463 DOI: 10.1007/s11033-020-06041-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/28/2020] [Indexed: 01/06/2023]
Abstract
We conducted a systematic review of human trials examining the effects of dietary phytochemicals on Nrf2 activation. In accordance with the PRISMA guidelines, Medline, Embase and CAB abstracts were searched for articles from inception until March 2020. Studies in adult humans that measured Nrf2 activation (gene or protein expression changes) following ingestion of a phytochemical, either alone or in combination were included. The study was pre-registered on the Prospero database (Registration Number: CRD42020176121). Twenty-nine full-texts were retrieved and reviewed for analysis; of these, eighteen were included in the systematic review. Most of the included participants were healthy, obese or type 2 diabetics. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Twelve different compounds were examined in the included studies: curcumin, resveratrol and sulforaphane were the most common (n = 3 each). Approximately half of the studies reported increases in Nrf2 activation (n = 10); however, many were of poor quality and had an unclear or high risk of bias. There is currently limited evidence that phytochemicals activate Nrf2 in humans. Well controlled human intervention trials are needed to corroborate the findings from in vitro and animal studies.
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Affiliation(s)
- Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Jarred P Acton
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Stuart P Cocksedge
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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9
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Smith K, Taylor GS, Allerton DM, Brunsgaard LH, Bowden Davies KA, Stevenson EJ, West DJ. The Postprandial Glycaemic and Hormonal Responses Following the Ingestion of a Novel, Ready-to-Drink Shot Containing a Low Dose of Whey Protein in Centrally Obese and Lean Adult Males: A Randomised Controlled Trial. Front Endocrinol (Lausanne) 2021; 12:696977. [PMID: 34220720 PMCID: PMC8253223 DOI: 10.3389/fendo.2021.696977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Elevated postprandial glycaemia [PPG] increases the risk of cardiometabolic complications in insulin-resistant, centrally obese individuals. Therefore, strategies that improve PPG are of importance for this population. Consuming large doses of whey protein [WP] before meals reduces PPG by delaying gastric emptying and stimulating the secretion of the incretin peptides, glucose-dependent insulinotropic polypeptide [GIP] and glucagon-like peptide 1 [GLP-1]. It is unclear if these effects are observed after smaller amounts of WP and what impact central adiposity has on these gastrointestinal processes. METHODS In a randomised-crossover design, 12 lean and 12 centrally obese adult males performed two 240 min mixed-meal tests, ~5-10 d apart. After an overnight fast, participants consumed a novel, ready-to-drink WP shot (15 g) or volume-matched water (100 ml; PLA) 10 min before a mixed-nutrient meal. Gastric emptying was estimated by oral acetaminophen absorbance. Interval blood samples were collected to measure glucose, insulin, GIP, GLP-1, and acetaminophen. RESULTS WP reduced PPG area under the curve [AUC0-60] by 13 and 18.2% in the centrally obese and lean cohorts, respectively (both p <0.001). In both groups, the reduction in PPG was accompanied by a two-three-fold increase in GLP-1 and delayed gastric emptying. Despite similar GLP-1 responses during PLA, GLP-1 secretion during the WP trial was ~27% lower in centrally obese individuals compared to lean (p = 0.001). In lean participants, WP increased the GLP-1ACTIVE/TOTAL ratio comparative to PLA (p = 0.004), indicative of reduced GLP-1 degradation. Conversely, no treatment effects for GLP-1ACTIVE/TOTAL were seen in obese subjects. CONCLUSION Pre-meal ingestion of a novel, ready-to-drink WP shot containing just 15 g of dietary protein reduced PPG in lean and centrally obese males. However, an attenuated GLP-1 response to mealtime WP and increased incretin degradation might impact the efficacy of nutritional strategies utilising the actions of GLP-1 to regulate PPG in centrally obese populations. Whether these defects are caused by an individual's insulin resistance, their obese state, or other obesity-related ailments needs further investigation. CLINICAL TRIAL REGISTRATION ISRCTN.com, identifier [ISRCTN95281775]. https://www.isrctn.com/.
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Affiliation(s)
- Kieran Smith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Guy S. Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dean M. Allerton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lise Hoej Brunsgaard
- Health and Performance Nutrition, Arla Foods Ingredients Group P/S, Viby J., Denmark
| | - Kelly A. Bowden Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- School of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Emma J. Stevenson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel J. West
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- *Correspondence: Daniel J. West,
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10
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Smith K, Bowden Davies KA, Stevenson EJ, West DJ. The Clinical Application of Mealtime Whey Protein for the Treatment of Postprandial Hyperglycaemia for People With Type 2 Diabetes: A Long Whey to Go. Front Nutr 2020; 7:587843. [PMID: 33195375 PMCID: PMC7607659 DOI: 10.3389/fnut.2020.587843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Mitigating postprandial hyperglycaemic excursions may be effective in not only enhancing glycaemic control for people with type 2 diabetes but also reducing the onset of diabetes-related complications. However, there are growing concerns over the long-term efficacy of anti-hyperglycaemic pharmacotherapies, which coupled with their rising financial costs, underlines the need for further non-pharmaceutical treatments to regulate postprandial glycaemic excursions. One promising strategy that acutely improves postprandial glycaemia for people with type 2 diabetes is through the provision of mealtime whey protein, owing to the slowing of gastric emptying and increased secretion of insulin and the incretin peptides. The magnitude of this effect appears greater when whey protein is consumed before, rather than with, a meal. Herein, this dietary tool may offer a simple and inexpensive strategy in the management of postprandial hyperglycaemia for people with type 2 diabetes. However, there are insufficient long-term studies that have investigated the use of mealtime whey protein as a treatment option for individuals with type 2 diabetes. The methodological approaches applied in acute studies and outcomes reported may also not portray what is achievable long-term in practice. Therefore, studies are needed to refine the application of this mealtime strategy to maximize its clinical potential to treat hyperglycaemia and to apply these long-term to address key components of successful diabetes care. This review discusses evidence surrounding the provision of mealtime whey protein to treat postprandial hyperglycaemia in individuals with type 2 diabetes and highlights areas to help facilitate its clinical application.
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Affiliation(s)
- Kieran Smith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kelly A Bowden Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Emma J Stevenson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel J West
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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11
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Clifford T, Hayes EJ, Scragg JH, Taylor G, Smith K, Bowden Davies KA, Stevenson EJ. The Effects of a High-Protein Diet on Markers of Muscle Damage Following Exercise in Active Older Adults: A Randomized, Controlled Trial. Int J Sport Nutr Exerc Metab 2020; 30:323-329. [PMID: 32698121 DOI: 10.1123/ijsnem.2020-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE This study examined whether a higher protein diet following strenuous exercise can alter markers of muscle damage and inflammation in older adults. METHODS Using a double-blind, independent group design, 10 males and eight females (age 57 ± 4 years; mass 72.3 ± 5.6 kg; height 1.7 ± 6.5 m) were supplied with a higher protein (2.50 g·kg-1·day-1) or moderate protein (1.25 g·kg-1·day-1) diet for 48 hr after 140 squats with 25% of their body mass. Maximal isometric voluntary contractions, muscle soreness, creatine kinase, Brief Assessment of Mood Adapted, and inflammatory markers were measured preexercise, and 24 hr and 48 hr postexercise. RESULTS The maximal isometric voluntary contractions decreased postexercise (p = .001, ηp2=.421), but did not differ between groups (p = .822, ηp2=.012). Muscle soreness peaked at 24 hr post in moderate protein (44 ± 30 mm) and 48 hr post in higher protein (70 ± 46 mm; p = .005; ηp2=.282); however, no group differences were found (p = .585; ηp2=.083). Monocytes and lymphocytes significantly decreased postexercise, and eosinophils increased 24 hr postexercise (p < 0.05), but neutrophils, creatine kinase, interleukin-6, C-reactive protein, monocyte chemotactic protein-1, and Brief Assessment of Mood Adapted were unchanged by exercise or the intervention (p > .05). CONCLUSION In conclusion, 2.50 g·kg-1·day-1 of protein is not more effective than 1.25 g·kg-1·day-1 for attenuating indirect markers of muscle damage and inflammation following strenuous exercise in older adults.
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12
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Sprung VS, Bowden Davies KA, Norman JA, Thompson A, Mitchell KL, Wilding JPH, Kemp GJ, Cuthbertson DJ. Metabolic syndrome is associated with reduced flow mediated dilation independent of obesity status. Eur J Endocrinol 2020; 183:211-220. [PMID: 32460236 DOI: 10.1530/eje-20-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/26/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data suggest that metabolic health status, incorporating components of metabolic syndrome (MetS), predicts cardiovascular disease (CVD) risk better than BMI. This study explored the association of MetS and obesity with endothelial function, a prognostic risk factor for incident CVD. METHODS Forty-four participants were phenotyped according to BMI as non-obese vs obese (<30 or >30 kg/m2) and according to the International Diabetes Federation criteria of MetS: ≤2 criteria MetS (MetS-) vs ≥3 criteria MetS (MetS+); (1.)non-obese MetS- vs (2.) non-obese MetS+ and (3.) obese MetS- vs (4.) obese MetS+. Flow-mediated dilation (FMD), body composition including liver fat (MRI and spectroscopy), dietary intake, intensities of habitual physical activity and cardio-respiratory fitness were determined. Variables were analysed using a one-factor between-groups ANOVA and linear regression; mean (95% CI) are presented. RESULTS Individuals with MetS+ displayed lower FMD than those with MetS-. For non-obese individuals mean difference between MetS+ and MetS- was 4.1% ((1.0, 7.3); P = 0.004) and obese individuals had a mean difference between MetS+ and MetS- of 6.2% ((3.1, 9.2); P < 0.001). Although there was no association between BMI and FMD (P = 0.27), an increased number of MetS components was associated with a lower FMD (P = 0.005), and after adjustment for age and sex, 19.7% of the variance of FMD was explained by MetS, whereas only 1.1% was explained by BMI. CONCLUSIONS In this study cohort, components of MetS, rather than obesity per se, contribute to reduced FMD, which suggests a reduced bioavailability of nitric oxide and thus increased risk of CVD.
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Affiliation(s)
- Victoria S Sprung
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Obesity and Endocrinology Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Kelly A Bowden Davies
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Juliette A Norman
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Andrew Thompson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Katie L Mitchell
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Graham J Kemp
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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13
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Clifford T, Jeffries O, Stevenson EJ, Davies KAB. The effects of vitamin C and E on exercise-induced physiological adaptations: a systematic review and Meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2019; 60:3669-3679. [PMID: 31851538 DOI: 10.1080/10408398.2019.1703642] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials examining the effect of vitamin C and/or E on exercise-induced training adaptations. Medline, Embase and SPORTDiscus databases were searched for articles from inception until June 2019. Inclusion criteria was studies in adult humans where vitamin C and/or E had to be consumed alongside a supervised exercise training program of ≥4 weeks. Nine trials were included in the analysis of aerobic exercise adaptations and nine for resistance training (RT) adaptations. Vitamin C and/or E did not attenuate aerobic exercise induced improvements in maximal aerobic capacity (V ̇ O2max) (SMD -0.14, 95% CI: -0.43 to 0.15, P = 0.35) or endurance performance (SMD -0.01, 95% CI: -0.38 to 0.36, P = 0.97). There were also no effects of these supplements on lean mass and muscle strength following RT (SMD -0.07, 95% CI: -0.36 to 0.23, P = 0.67) and (SMD -0.15, 95% CI: -0.16 to 0.46, P = 0.35), respectively. There was also no influence of age on any of these outcomes (P > 0.05). These findings suggest that vitamin C and/or E does not inhibit exercise-induced changes in physiological function. Studies with larger sample sizes and adequate power are still required.
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Affiliation(s)
- Tom Clifford
- Institute of Cellular Medicine, Newcastle University, Newcastle on Tyne, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Owen Jeffries
- Institute of Cellular Medicine, Newcastle University, Newcastle on Tyne, UK
| | - Emma J Stevenson
- Institute of Cellular Medicine, Newcastle University, Newcastle on Tyne, UK
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14
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Bowden Davies KA, Sprung VS, Norman JA, Thompson A, Mitchell KL, Harrold JOA, Finlayson G, Gibbons C, Wilding JPH, Kemp GJ, Hamer M, Cuthbertson DJ. Physical Activity and Sedentary Time: Association with Metabolic Health and Liver Fat. Med Sci Sports Exerc 2019; 51:1169-1177. [PMID: 30694971 PMCID: PMC6542688 DOI: 10.1249/mss.0000000000001901] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction/Purpose To investigate whether (a) lower levels of daily physical activity (PA) and greater sedentary time accounted for contrasting metabolic phenotypes (higher liver fat/presence of metabolic syndrome [METS+] vs lower liver fat/absence of metabolic syndrome [METS−]) in individuals of similar body mass index and (b) the association of sedentary time on metabolic health and liver fat. Methods Ninety-eight habitually active participants (53 female, 45 male; age, 39 ± 13 yr; body mass index 26.9 ± 5.1 kg·m−2), underwent assessments of PA (SenseWear armband; wear time ~98%), cardiorespiratory fitness (V˙O2 peak), body composition (magnetic resonance imaging and magnetic resonance spectroscopy) and multiorgan insulin sensitivity (oral glucose tolerance test). We undertook a) cross-sectional analysis comparing four groups: nonobese or obese, with and without metabolic syndrome (METS+ vs METS−) and b) univariate and multivariate regression for sedentary time and other levels of PA in relation to liver fat. Results Light, moderate, and vigorous PA did not account for differences in metabolic health between individuals, whether nonobese or obese, although METS+ individuals were more sedentary, with a higher number, and prolonged bouts (~1–2 h). Overall, sedentary time, average daily METS and V˙O2 peak were each independently associated with liver fat percentage. Each additional hour of daily sedentary time was associated with a 1.15% (95% confidence interval, 1.14%–1.50%) higher liver fat content. Conclusions Greater sedentary time, independent of other levels of PA, is associated with being metabolically unhealthy; even in habitually active people, lesser sedentary time, and higher cardiorespiratory fitness and average daily METS is associated with lower liver fat.
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Affiliation(s)
- Kelly A Bowden Davies
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM.,School of Biomedical Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UNITED KINGDOM
| | - Victoria S Sprung
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UNITED KINGDOM.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UNITED KINGDOM
| | - Juliette A Norman
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UNITED KINGDOM
| | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, Liverpool, UNITED KINGDOM
| | - Katie L Mitchell
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UNITED KINGDOM
| | - J O A Harrold
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Graham Finlayson
- Appetite Control and Energy Balance Research, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UNITED KINGDOM
| | - Catherine Gibbons
- Appetite Control and Energy Balance Research, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UNITED KINGDOM
| | - John P H Wilding
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UNITED KINGDOM
| | - Graham J Kemp
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM.,Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UNITED KINGDOM
| | - Mark Hamer
- School Sport, Exercise Health Sciences, National Centre for Sport and Exercise Medicine-East Midlands, Loughborough University, Loughborough, UNITED KINGDOM
| | - Daniel J Cuthbertson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM.,Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UNITED KINGDOM
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15
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Bowden Davies KA, Pickles S, Sprung VS, Kemp GJ, Alam U, Moore DR, Tahrani AA, Cuthbertson DJ. Reduced physical activity in young and older adults: metabolic and musculoskeletal implications. Ther Adv Endocrinol Metab 2019; 10:2042018819888824. [PMID: 31803464 PMCID: PMC6878603 DOI: 10.1177/2042018819888824] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although the health benefits of regular physical activity and exercise are well established and have been incorporated into national public health recommendations, there is a relative lack of understanding pertaining to the harmful effects of physical inactivity. Experimental paradigms including complete immobilization and bed rest are not physiologically representative of sedentary living. A useful 'real-world' approach to contextualize the physiology of societal downward shifts in physical activity patterns is that of short-term daily step reduction. RESULTS Step-reduction studies have largely focused on musculoskeletal and metabolic health parameters, providing relevant disease models for metabolic syndrome, type 2 diabetes (T2D), nonalcoholic fatty liver disease (NAFLD), sarcopenia and osteopenia/osteoporosis. In untrained individuals, even a short-term reduction in physical activity has a significant impact on skeletal muscle protein and carbohydrate metabolism, causing anabolic resistance and peripheral insulin resistance, respectively. From a metabolic perspective, short-term inactivity-induced peripheral insulin resistance in skeletal muscle and adipose tissue, with consequent liver triglyceride accumulation, leads to hepatic insulin resistance and a characteristic dyslipidaemia. Concomitantly, various inactivity-related factors contribute to a decline in function; a reduction in cardiorespiratory fitness, muscle mass and muscle strength. CONCLUSIONS Physical inactivity maybe particularly deleterious in certain patient populations, such as those at high risk of T2D or in the elderly, considering concomitant sarcopenia or osteoporosis. The effects of short-term physical inactivity (with step reduction) are reversible on resumption of habitual physical activity in younger people, but less so in older adults. Nutritional interventions and resistance training offer potential strategies to prevent these deleterious metabolic and musculoskeletal effects. IMPACT Individuals at high risk of/with cardiometabolic disease and older adults may be more prone to these acute periods of inactivity due to acute illness or hospitalization. Understanding the risks is paramount to implementing countermeasures.
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Affiliation(s)
| | - Samuel Pickles
- Institute of Ageing and Chronic Disease,
University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group,
Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Victoria S. Sprung
- Research Institute for Sport and Exercise
Science, Liverpool John Moores University, Liverpool, UK
- Institute of Ageing and Chronic Disease,
University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group,
Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Graham J. Kemp
- Institute of Ageing and Chronic Disease,
University of Liverpool, Liverpool, UK
- Liverpool Magnetic Resonance Imaging Centre
(LiMRIC), University of Liverpool, Liverpool, UK
| | - Uazman Alam
- Institute of Ageing and Chronic Disease,
University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group,
Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Pain Research Institute, University of
Liverpool, Liverpool, UK
- Division of Endocrinology, Diabetes and
Gastroenterology, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Royal
Liverpool and Broadgreen University NHS Hospitals Trust, Liverpool, UK
| | - Daniel R. Moore
- Faculty of Kinesiology and Physical Education,
University of Toronto, Toronto, ON, Canada
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research,
College of Medical and Dental Sciences, University of Birmingham,
Birmingham, UK
- Centre of Endocrinology, Diabetes and
Metabolism (CEDAM), Birmingham Health Partners, Birmingham UK
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Daniel J. Cuthbertson
- Institute of Ageing and Chronic Disease,
University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group,
Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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16
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Bowden Davies KA, Sprung VS, Norman JA, Thompson A, Mitchell KL, Halford JCG, Harrold JA, Wilding JPH, Kemp GJ, Cuthbertson DJ. Short-term decreased physical activity with increased sedentary behaviour causes metabolic derangements and altered body composition: effects in individuals with and without a first-degree relative with type 2 diabetes. Diabetologia 2018; 61:1282-1294. [PMID: 29671031 DOI: 10.1007/s00125-018-4603-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/02/2018] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Low physical activity levels and sedentary behaviour are associated with obesity, insulin resistance and type 2 diabetes. We investigated the effects of a short-term reduction in physical activity with increased sedentary behaviour on metabolic profiles and body composition, comparing the effects in individuals with first-degree relatives with type 2 diabetes (FDR+ve) vs those without (FDR-ve). METHODS Forty-five habitually active participants (16 FDR+ve [10 female, 6 male] and 29 FDR-ve [18 female, 11 male]; age 36 ± 14 years) were assessed at baseline, after 14 days of step reduction and 14 days after resuming normal activity. We determined physical activity (using a SenseWear armband), cardiorespiratory fitness ([Formula: see text]), body composition (dual-energy x-ray absorptiometry/magnetic resonance spectroscopy) and multi-organ insulin sensitivity (OGTT) at each time point. Statistical analysis was performed using a two-factor between-groups ANCOVA, with data presented as mean ± SD or (95% CI). RESULTS There were no significant between-group differences in physical activity either at baseline or following step reduction. During the step-reduction phase, average daily step count decreased by 10,285 steps (95% CI 9389, 11,182; p < 0.001), a reduction of 81 ± 8%, increasing sedentary time by 223 min/day (151, 295; p < 0.001). Pooling data from both groups, following step reduction there was a significant decrease in whole-body insulin sensitivity (Matsuda index) (p < 0.001), muscle insulin sensitivity index (p < 0.001), cardiorespiratory fitness (p = 0.002) and lower limb lean mass (p = 0.004). Further, there was a significant increase in total body fat (p < 0.001), liver fat (p = 0.001) and LDL-cholesterol (p = 0.013), with a borderline significant increase in NEFA AUC during the OGTT (p = 0.050). Four significant between-group differences were apparent: following step reduction, FDR+ve participants accumulated 1.5% more android fat (0.4, 2.6; p = 0.008) and increased triacylglycerol by 0.3 mmol/l (0.1, 0.6; p = 0.044). After resuming normal activity, FDR+ve participants engaged in lower amounts of vigorous activity (p = 0.006) and had lower muscle insulin sensitivity (p = 0.023). All other changes were reversed with no significant between-group differences. CONCLUSIONS/INTERPRETATION A short-term reduction in physical activity with increased sedentary behaviour leads to a reversible reduction in multi-organ insulin sensitivity and cardiorespiratory fitness, with concomitant increases in central and liver fat and dyslipidaemia. The effects are broadly similar in FDR+ve and FDR-ve individuals. Public health recommendations promoting physical activity should incorporate advice to avoid periods of sedentary behaviour.
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Affiliation(s)
- Kelly A Bowden Davies
- Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.
- Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, L9 7AL, UK.
| | - Victoria S Sprung
- Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Juliette A Norman
- Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Katie L Mitchell
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jason C G Halford
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo A Harrold
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
- Eye and Vision Science, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
| | - Graham J Kemp
- Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
- Obesity and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, L9 7AL, UK
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