5if 3pmf pg &

대한비만학회 2014년 제41차 추계학술대회
5IF 3PMF PG &YFSDJTF BOE %JFU PO 8FJHIU -PTT
BOE .FUBCPMJD 1SPGJMFT
Justin Y. Jeon
Department of Sport and Leisure Studis, Yonsei University
MEMO
I
Adipocytokines and insulin resistance
in obese children: Vaspin, PTX-3 and
Chemerin
Pentraxin-3
Pentraxin-3 (PTX-3) is a member of the pentraxin super
family, which is rapidly produced and released by several
cell types, mononuclear phagocytes, dendritic cells,
smooth muscle cells, fibroblasts, endothelial cells in
response to primary inflammatory signals (toll-like receptor,
TNF-alpha, IL-1beta)
PTX-3 behave as an acute response protein and increase
rapidly during endotoxic shock, sepsis, cardiac events.
Some studies reported that PTX-3 is associated with BMI
and metabolic syndrome, however, its association with
insulin resistance is not clear.
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전용관: The Role of Exercise and Diet on Weight Loss and Metabolic Profiles
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Pentraxin-3 is important marker which is associated with
insulin resistance and may be an important factor for
exercise associated insulin resistance change.
Chemerin
Chemerin is a 14 kDa protein secreted in an inactive form as
prochemerin and is activated through cleavage of the Cterminus by inflammatory and coagulation serine proteases.
In humans, chemerin mRNA is highly expressed in
white adipose tissue, liver and lung while its receptor, CMKLR1 is
predominantly expressed in immune cells as well as adipose
tissue. Because of its role in adipocyte differentiation and
glucose uptake, chemerin is classified as an adipokine.
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Chemerin was found to stimulate chemotaxis of dendritic cells and
macrophages to the site of inflammation. In humans, chemerin mRNA is
highly expressed in white adipose tissue, liver and lung while its receptor,
CMKLR1 is predominantly expressed in immune cells as well as adipose
tissue. Because of its role in adipocyte differentiation and glucose uptake,
chemerin is classified as an adipokine.
Home- based intervention:
10,000 steps per day
(30% as exercise, heart rate>65% max)
Participants were asked to perform
Home-based resistance exercise using
their own body weight (material
provided)
Participants were asked to reduce their
calorie intake to 1200kcal/day: Rice bowl
that hold only 200 kcal were provided.
Education sessions on exercise and diet
were provided twice (0 and 4 week)
Exercise and dietary journal were kept
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Symposium 10. Exercise Metabolism and Obesity
Home-based lifestyle modification program significantly
improved body weight, abdominal adiposity and
improved insulin resistance
Effects of 8 week weight reduction program via
physical activity on circulating chemerin levels
Delta Chemerin was
associated with delta
insulin and HOMA-IR levels
after the weight loss
Delta chemerin was a predictor
for change in HOMA-IR even
when other confounding factors
were controlled for.
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전용관: The Role of Exercise and Diet on Weight Loss and Metabolic Profiles
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Intervention program
Program
Supervised Exercise
Unsupervised Exercise
Type
Core Exercise
Circuit Exercise
Aerobic Exercise
Period
12 weeks
12 weeks
Frequency
3 times/week
2-3 times/week
Intensity
50%10RM, 15~20 repetition,
3 sets
60% of VO2max
Duration
45 min to 60 min
30~40 min (10000 steps)
The goal of intervention was to achieve and maintain 7% weight loss
14 Dietary education sessions with a registered dietitian. Participants were
recommended to decrease their previous calorie intake by 500 kcal per day.
Kim SH, Jeon JY, Nam MS et al. 2014 Clinical Endocrinology
12 week of lifestyle intervention reduced body
adiposity and improved fitness significantly
Baseline
12 weeks
Delta
%
change
p
BMI (kg/m²)
28.3±3.4
27.1±3.6
-1.3±0.9
4.57
<0.001
WC (cm)
91.3±9.7
85.3±8.9
-6.1±4.0
6.6
<0.001
Fat mass (kg)
25.2±6.5
21.5±6.5
-3.7±2.7
14.7
<0.001
Lean mass (kg)
50.4±11.6
51.1±11.7
+0.6±0.8
1.3
0.008
VFA (cm 2)
130.0±47.2
106.4±49.6
-27.4±28.2
20.5
0.001
SFA (cm 2)
207.9±64.1
173.0±69.9
-32.4±29.2
15.8
<0.001
VO2 max (ml/min/kg)
28.2±6.6
31.9±6.5
+3.7±3.9
13.1
0.002
Kim SH, Jeon JY, Nam MS et al. 2014 Clinical Endocrinology
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12 week lifestyle intervention significantly
improved glycemic control
Baseline
12 weeks
Delta
% change
p*
HbA1c
(%)
7.5±0.6
6.5±0.6
-1.0±0.5
13.3
<0.001
FPG
(mg/dl)
142.3±24.6
121.5±20.8
-20.8±28.7
14.6
0.01
PP2hr PG
(mg/dl)
277.3±59.8
222.7±81.0
-54.6±56.8
19.68
0.002
0.91
Insulin
9.8±5.3
10.0±6.2
+0.2±4.4
2
HOMA-IR
3.5±2.1
3.0±1.8
-0.5±1.6
14.28
0.30
HOMA-Beta
50.4±35.8
68.0±42.2
+17.6±40.4
34.9
0.047
Knowing that target range for type 2 diabetic is between
6.5-7.5%, the exercise program was very effective in glycemic
control.
Kim SH, Jeon JY, Nam MS et al. 2014 Clinical Endocrinology
How good was this intervention?
DPP-4 inhibitor, the hottest diabetes drug in the market,
reduced HbA1c level by 0.6-0.7%.
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The effect intermittent fasting and exercise
II
on body weight and metabolic profiles
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전용관: The Role of Exercise and Diet on Weight Loss and Metabolic Profiles
The effects of 8 weeks of interm ittent fasting diet and com bined exercise
program on body com position, and insulin resistance in Korean
overw eight and obese adults: A pilot and random ized study
MEMO
Study protocol
Exercise
Exercise
Resistance + Aerobic type exercise
40 min Progressive resistance
training
Intensity: 70-80-90-100% of 10 RM
(periodically variation)
- Time: 40 minutes
20 min Interval training type aerobic
exercise
Intermittent fasting diet
(IFD)
3 days/week fasting
Fasting day: calorie restriction
(consumed 25 % of
baseline energy needs, feeding at
12-2 pm)
Non-fasting day: consuming foods
ad libitum
IFD + Exercise
IFD protocol
With Exercise
The effect of intermittent fasting and exercise body
composition
Group
Weight (kg)
Muscle mass
(kg)
Fat mass (kg)
WC (cm)
Combination
IFD
Ex
Control
Combination
IFD
Ex
Control
Combination
IFD
Ex
Control
Combination
IFD
Ex
Control
Baseline
Week 8
p-value1
Change
80.2 ± 18.9
72.7 ± 12.4
76.2 ± 12.8
68.7 ± 9.4
29.4 ± 8.0
25.6 ± 5.6
29.6 ± 5.9
25.1 ± 4.2
27.7 ± 8.6
26.3 ± 6.0
23.1 ± 7.1
23.1 ± 6.2
94.9 ± 10.6
91.5 ± 8.8
91.6 ± 9.0
86.8 ± 6.4
75.9 ± 19.4
69.1 ± 12.2
74.6 ± 12.3
67.7 ± 9.2
28.8 ± 8.2
25.0 ± 5.4
29.5 ± 5.5
25.0 ± 4.6
24.2 ± 8.9
23.6 ± 6.7
21.7 ± 6.8
22.1 ± 5.7
89.0 ± 11.7
88.6 ± 8.7
88.4 ± 7.5
85.4 ± 7.4
<0.001
<0.001
0.006
0.108
0.002
0.043
0.422
0.554
<0.001
0.001
0.007
0.118
<0.001
0.026
0.014
0.196
-4.3 ± 2.4
-3.6 ± 2.7
-1.6 ± 1.9*
-1.1 ± 2.1*
-0.6 ± 0.6
-0.5 ± 0.8
-0.2 ± 0.8
-0.1 ± 0.8
-3.5 ± 2.1
-2.8 ± 2.2
-1.4 ± 1.7*
-0.9 ± 1.9*
-6.4 ± 3.9
-3.1 ± 3.8
-3.5 ± 3.3
-1.2 ± 3.6*
p-value2
.001
.290
.003
.004
Note: data are presented in mean ± SD; BMI, Body mass index; WC, Waist circumference
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Group
Combination
IFD
Insulin (uIU/ml)
Ex
Control
Combination
IFD
Glucose
(mg/dl)
Ex
Control
Combination
IFD
HOMA-IR
Ex
Control
Combination
IFD
TG (mg/dl)
Ex
Control
Combination
IFD
TC (mg/dl)
Ex
Control
Combination
IFD
HDL-C (mg/dl)
Ex
Control
Baseline
10.3 ± 3.1
9.3 ± 5.0
7.0 ± 3.9
6.5 ± 3.4
93.4 ± 16.7
92.8 ± 8.2
90.6 ± 8.7
88.0 ± 8.6
2.4 ± 1.1
2.1 ± 1.2
1.5 ± 0.8
1.4 ± 0.7
118.9 ± 49.2
108.2 ± 48.4
179.5 ± 127.9
99.6 ± 52.7
184.1 ± 27.1
194.8 ± 24.8
178.4 ± 29.1
175.8 ± 35.3
47.6 ± 10.6
54.9 ± 13.8
46.0 ± 14.5
54.3 ± 12.5
Week 8
7.1 ± 3.1
10.7 ± 13.3
6.6 ± 3.7
9.1 ± 6.2
83.3 ± 11.6
86.9 ± 9.6
91.7 ± 8.3
85.3 ± 6.2
1.5 ± 0.8
2.5 ± 3.4
1.5 ± 0.8
1.9 ± 1.3
81.0 ± 34.9
115.2 ± 82.3
112.3 ± 50.5
123.7 ± 69.1
197.6 ± 25.1
193.9 ± 24.7
189.9 ± 30.3
190.4 ± 28.6
52.1 ± 10.7
57.5 ± 14.9
53.3 ± 10.3
57.2 ± 13.9
p-value
0.006
0.684
0.691
0.042
0.015
0.053
0.647
0.161
0.006
0.703
0.722
0.052
0.002
0.671
0.048
0.017
0.029
0.924
0.063
0.055
0.057
0.305
0.009
0.259
Change
-3.1 ± 3.9
1.4 ± 12.2
-0.4 ± 3.9
2.6 ± 3.9
-10.1 ± 14.6
-5.9 ± 10.0
1.1 ± 8.8
-2.8 ± 6.3
-0.9 ± 1.2
0.3 ± 3.0
-0.1 ± 0.8
0.5 ± 0.9
-37.9 ± 40.9
7.0 ± 57.9
-67.3 ± 120.1#
24.1 ± 29.7^
13.5 ± 22.3
-0.9 ± 34.3
11.5 ± 22.1
14.6 ± 23.6
4.4 ± 8.6
2.6 ± 8.6
7.3 ± 9.3
2.9 ± 8.4
p-value2
.137
.039
.103
.007
.392
.466
Note: data are presented in mean ± SD; BMI, Body mass index; WC, Waist circumference; SBP, Systolic blood pressure; DBP, Diastolic
blood pressure; HR, Heart rate; HOMA-IR, Homeostasis model assessment-insulin resistance; TG, Triglycerides; TC, Total cholesterol;
HDL-C, High-density lipoprotein cholesterol; p-value1, significantly different between at baseline and at week 8; change, post-pre value;
p-value2, significant group difference by ANOVA analysis; post-hoc: Tukey test; *, significantly different with Combination group; #,
significantly different with IFD group; ^, significantly different with Exercise.
9 All three intervention groups showed significant reduction in body weight , but
combined IFD and exercise group showed most reduction in body weight and fat
mass.
9 Only combined IFD and exercise group showed significant reduction in fasting insulin
and insulin resistance.
9 Significant improvement in HDL-C was observed in exercise group only.
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