Circulating chemerin decreases in response to a combined strength and endurance training.

Chemerin is an adipokine that may mediate the link between obesity, inflammation, insulin resistance, type 2 diabetes mellitus, and cardiovascular disease. In this study, we examined the association between chemerin and various cardiometabolic risk factors in cross-sectional setting and tested the hypothesis that a 6-month combined exercise program decreases serum chemerin in overweight or obese, non-diabetic individuals. Serum chemerin concentration was measured in a cross-sectional analysis including 98 individuals with a wide range of age and body mass index (BMI). In addition, chemerin was measured in 79 sedentary, overweight or obese, non-diabetic individuals who completed a 6-month combined endurance and resistance exercise program (CEP, n = 51) or served as controls (C, n = 28). Chemerin was significantly associated with total cholesterol (p = 0.04), triglycerides (p < 0.001), fasting insulin (p < 0.001), homeostasis model assessment of insulin resistance (HOMA-IR, p < 0.001), systolic blood pressure (p = 0.04), highly sensitive C-reactive protein (p = 0.03), leucocytes count (p = 0.047), and leptin (p = 0.008) independently of age and BMI. In multiple regression analysis, chemerin was an independent determinant of HOMA-IR. As a result of the 6-month training program, serum chemerin decreased significantly in CEP group (-13.8 ± 13.2 ng/ml, p < 0.001). A significant association between the changes in chemerin and improved HOMA-IR were found even after adjustment for changes in waist circumference. Among non-diabetic individuals serum chemerin was associated with various cardiometabolic risk factors independently of BMI. In addition, the 6-month combined strength and endurance training program led to a significant reduction in circulating chemerin levels in overweight or obese individuals.

Physical activity is strongly inversely related to post-challenge plasma glucose and glycemic spikes in a risk population for type 2 diabetes.

AIM: To examine the relationship between physical activity (PA) and various cardiometabolic risk factors during an oral glucose tolerance test (OGTT), including glycemic spikes (PGS) in individuals at risk for type 2 diabetes. SUBJECTS AND METHODS: A total of 949 middle-aged subjects from the Risk factors in Impaired Glucose Tolerance for Atherosclerosis and Diabetes (RIAD) trial aged 40-70 years were included in the present cross-sectional analysis. Standard 75 g OGTT was performed and blood was collected every 30 min for 2 hours for measurements of plasma glucose (PG) and other cardiometabolic risk factors. PA was assessed using interviewer-administered questionnaire. RESULTS: Post-challenge PGS and maximal PG (PGmax) during OGTT were significantly lower in individuals with high PA vs. individuals with low PA even after body mass index (BMI) adjustment (p = 0.026 and p = 0.035, respectively). In univariate analysis post-challenge PG 30, 60, 90, and 120 minutes, PGS and PGmax during OGTT were significantly inversely correlated to PA. This correlation was attenuated but remained significant after adjustment for BMI. Fasting PG and glycosylated hemoglobin were not correlated to PA. Significantly higher fasting and post-challenge insulin levels were found among subjects with low vs. subjects with medium (p < 0.05) and high PA (p < 0.05). Post-challenge C-peptide and proinsulin levels were significantly lower in participants with high vs. participants with low PA (p < 0.05 for all). The relationship between 2-h PG and PA was observed also in lean subjects and in subjects with normal fasting glucose. In multivariate analysis PA was a significant independent determinant of 2-h PG. CONCLUSION: We found a strong inverse relationship between PA and various post-challenge cardiometabolic parameters during OGTT, including glycemic spikes, in a population at risk for diabetes. This relationship was only partially dependent on BMI.

Effects of supervised vs non-supervised combined aerobic and resistance exercise programme on cardiometabolic risk factors.

OBJECTIVE: We examined the effect of a 6-month combined aerobic and resistance training programme on cardiometabolic risk factors in nondiabetic subjects and compared its effectiveness when executed under strict professional supervision or without direct supervision. METHODS: Eighty-five sedentary, non-diabetic subjects (27 men and 58 women), mean age 47.5 +/- 0.6 years, mean body mass index (BMI, 33.8 +/- 0.6 kg/m2) participated in a combined exercise programme assigned to supervised (S, n = 31), non-supervised (NS, n = 24) or control group (C, n = 30). Cardiometabolic risk parameters were assessed at baseline and after the 6-month training. RESULTS: In both the S and NS group there was a significant decrease in BMI (-1.6 +/- 0.3, p < 0.001 and -1.0 +/- 0.3 kg/m2, p = 0.004), waist circumference (-10.1 +/- 1.1 cm, p < 0.001 and -7.8 +/- 0.8 cm, p < 0.001), fat mass (-1.8 +/- 0.4%, p < 0.001 and -2.1 +/- 0.6%, p = 0.003), and a significant increase in fat-free mass (+1.7 +/- 0.4%, p < 0.001 and +2.0 +/- 0.7%, p = 0.008), and aerobic capacity (+6.9 +/- 1.1, p < 0.001 and +6.9 +/- 0.8 ml/kg per min, p = 0.008). Fasting glucose did not change in S and NS, but increased in C (p = 0.048). In the S group a significant decrease in fasting insulin (p < 0.001), homeostasis model assessment of insulin resistance (p < 0.001), highly sensitive C-reactive protein (p = 0.004), leucocytes count (p = 0.04), systolic high (p < 0.001) and diastolic (p = 0.009) blood pressure was found. Comparable significant decreases in total and low-density lipoprotein cholesterol were observed in all study groups. CONCLUSIONS: A 6-month combined exercise programme led to substantial improvement of various cardiometabolic risk factors. This programme was effective even when executed without direct supervision, although the effects were more pronounced in the supervised group. Our findings suggest that non-supervised exercise programmes may be a valuable, cost-effective tool to translate the current physical activity guidelines in a real-life setting.

Association of physical activity with insulin resistance, subclinical inflammation, coagulation, and fibrinolytic biomarkers among population at high risk for type 2 diabetes.

OBJECTIVE: TO investigate the association of physical activity with insulin resistance and biomarkers of inflammation, coagulation, and fibrinolysis in a population at high risk for type 2 diabetes. PATIENTS AND METHODS: A total of 778 subjects from the Risk factors in Impaired Glucose Tolerance for Atherosclerosis and Diabetes (RIAD) study aged 40-70 years were included in the present cross-sectional analysis. RESULTS: Participants classified as having low physical activity (PA) were more insulin resistant in comparison to participants with medium (P = 0.042) and high PA (P = 0.015). Individuals with high physical activity had a significantly lower leucocytes count than individuals with low PA (P = 0.027) and significantly lower hs-CRP and fibrinogen concentrations than individuals with medium (P = 0.011 and P = 0.021) and low physical activity (P = 0.04 and P = 0.007). Although a trend towards a decrease in plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (tPA) levels with increasing physical activity was present, significant differences were observed only between subjects with high and medium physical activity (P = 0.045 and P = 0.033). In multivariate regression analyses physical activity was an independent determinant of insulin resistance, leucocytes count, hs-CRP, and fibrinogen concentrations. CONCLUSIONS: Physical activity was independently associated with insulin resistance and biomarkers of inflammation, whereas only a tendency towards decreased concentrations of coagulation and fibrinolytic biomarkers with increasing physical activity was observed.

Relationship of physical activity and eating behaviour with obesity and type 2 diabetes mellitus: Sofia Lifestyle (SLS) study.

OBJECTIVE: Physical inactivity and excessive food consumption play a major role in the etiology of obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the relationship of physical activity (PA) and eating behaviour with obesity and T2DM in citizens of Sofia, Bulgaria. PATIENTS AND METHODS: A total of 511 randomly chosen participants completed a validated questionnaire concerning age, body height and weight, medical history, and motivation for a lifestyle change. The Baecke PA questionnaire and the Three Factor Eating Questionnaire were also completed. RESULTS: Body mass index (BMI) was significantly higher among subjects in the lowest compared with the middle (P = 0.002) and with the highest tertile of leisure time PA (P < 0.001), also between the lowest and the highest tertile group of sport PA (P = 0.001). BMI differed significantly in the highest vs. the middle (P = 0.04), as well as vs. the lowest (P= 0.017) tertile of uncontrolled eating behaviour. The prevalence of T2DM was significantly greater in the lowest vs. the middle (P = 0.027) and the highest (P = 0.02) tertile of leisure time PA. In a multiple regression analysis both leisure time PA and uncontrolled eating were independently associated with BMI (beta = -0.13, 95% CI -1.83 to -0.11, P = 0.03 and beta = 0.32, 95% CI 0.23 to 0.44, P < 0.001). CONCLUSIONS: We found a strong inverse relationship between the level of PA during leisure time (including sport), BMI, and the prevalence of T2DM. Uncontrolled eating behaviour was also found to have a significant effect on BMI.

The metabolic syndrome in Bulgaria.

The prevalence of the metabolic syndrome (MetS), a cluster of central obesity, hyper/dyslipiemia, hyperglycemia, and hypertension is constantly increasing worldwide. Although, the exact mechanisms underlying the development of the MetS are not completely understood, modern lifestyle of physical inactivity and unhealthy nutrition, obesity, and their interaction with genetic factors are considered largely responsible. It has been convincingly demonstrated that the metabolic syndrome is associated with substantially increased risk for the development of type 2 diabetes mellitus, as well as, with increased cardiovascular disease (CVD) morbidity and mortality. The prevalence of obesity and type 2 diabetes in Bulgaria has dramatically increased in the last decades. For the same period CVD mortality in the country have also gradually increased and Bulgaria is nowadays among the countries with the highest macrovascular disease death rates in Europe. A number of epidemiological studies have demonstrated that the prevalence of the MetS and of its individual components has also increased during the last decades and is nowadays relatively high among the general population in Bulgarian and extremely high among high-risk individuals. Surprisingly, the prevalence of the MetS is also high among the low risk population in the country and most of its components that are independent predictors of CVD mortality are largely undiagnosed. Furthermore, the presence of the MetS is associated with history of myocardial infarction in the country. Although objective data is somewhat scarce, several studies have reported association of the low physical activity level and the unhealthy nutritional habits with the prevalence of cardiometabolic diseases among the Bulgarian population. Taking into account these observations it may be suggested that indeed the high metabolic syndrome prevalence that results as a consequence of unhealthy lifestyle is responsible for the extremely high CVD mortality rates in Bulgaria. Therefore, large-scale screening programmes should be undertaken within this population in combination with health prevention strategies promoting regular physical activity and improvement of nutritional habits.