K Kantartzis1, J Machann, F Schick, K Rittig, F Machicao, A Fritsche, H-U Häring, N Stefan. 1. Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University of Tübingen, Member of the Deutsches Zentrum für Diabetesforschung, Otfried-Müller-Str 10, D-72076 Tübingen, Germany.
Abstract
AIMS/HYPOTHESIS: We and others recently characterised metabolically benign or healthy obesity (MHO). In the present study we investigated whether a lifestyle intervention is sufficient to place obese insulin-resistant (OIR) individuals in a position where the possible metabolic consequences are similar to those for MHO individuals. METHODS: A total of 262 non-diabetic individuals participated in a 9 month lifestyle intervention programme. Obese individuals (BMI ≥ 30.0 kg/m(2)) were stratified, based on their insulin sensitivity (IS) estimated from an OGTT, into MHO (IS in the upper quartile, n = 26) and OIR (IS in the lower three quartiles, n = 77). Total body and visceral fat were measured by magnetic resonance (MR) tomography and liver fat by (1)H-MR spectroscopy. RESULTS: During the intervention, visceral fat decreased significantly in both groups (both p ≤ 0.009), whereas total body and liver fat decreased only in the OIR group (p < 0.0001; MHO p = 0.12 for total body fat and p = 0.47 for liver fat). IS improved in the OIR group (p < 0.0001), but remained essentially unchanged in the MHO group (p = 0.30). However, despite the significant increase in the OIR group, IS at follow-up barely exceeded 50% of the IS of the MHO group (OIR 9.30 ± 0.53 arbitrary units [AU]; MHO 16.41 ± 1.05 AU; p < 0.0001). CONCLUSIONS/ INTERPRETATION: IS improves during the lifestyle intervention in OIR individuals. However, it does not reach a level where adequate protection from type 2 diabetes and cardiovascular disease is expected. Thus, stratification of obese individuals based on their metabolic phenotype is important to identify those who are likely to need early pharmacological treatment in addition to the lifestyle intervention.
AIMS/HYPOTHESIS: We and others recently characterised metabolically benign or healthy obesity (MHO). In the present study we investigated whether a lifestyle intervention is sufficient to place obese insulin-resistant (OIR) individuals in a position where the possible metabolic consequences are similar to those for MHO individuals. METHODS: A total of 262 non-diabetic individuals participated in a 9 month lifestyle intervention programme. Obese individuals (BMI ≥ 30.0 kg/m(2)) were stratified, based on their insulin sensitivity (IS) estimated from an OGTT, into MHO (IS in the upper quartile, n = 26) and OIR (IS in the lower three quartiles, n = 77). Total body and visceral fat were measured by magnetic resonance (MR) tomography and liver fat by (1)H-MR spectroscopy. RESULTS: During the intervention, visceral fat decreased significantly in both groups (both p ≤ 0.009), whereas total body and liver fat decreased only in the OIR group (p < 0.0001; MHO p = 0.12 for total body fat and p = 0.47 for liver fat). IS improved in the OIR group (p < 0.0001), but remained essentially unchanged in the MHO group (p = 0.30). However, despite the significant increase in the OIR group, IS at follow-up barely exceeded 50% of the IS of the MHO group (OIR 9.30 ± 0.53 arbitrary units [AU]; MHO 16.41 ± 1.05 AU; p < 0.0001). CONCLUSIONS/ INTERPRETATION: IS improves during the lifestyle intervention in OIR individuals. However, it does not reach a level where adequate protection from type 2 diabetes and cardiovascular disease is expected. Thus, stratification of obese individuals based on their metabolic phenotype is important to identify those who are likely to need early pharmacological treatment in addition to the lifestyle intervention.
Authors: Nora Klöting; Mathias Fasshauer; Arne Dietrich; Peter Kovacs; Michael R Schön; Matthias Kern; Michael Stumvoll; Matthias Blüher Journal: Am J Physiol Endocrinol Metab Date: 2010-06-22 Impact factor: 4.310
Authors: Rachel P Wildman; Paul Muntner; Kristi Reynolds; Aileen P McGinn; Swapnil Rajpathak; Judith Wylie-Rosett; MaryFran R Sowers Journal: Arch Intern Med Date: 2008-08-11
Authors: Benoit J Arsenault; Mélanie Côté; Amélie Cartier; Isabelle Lemieux; Jean-Pierre Després; Robert Ross; Conrad P Earnest; Steven N Blair; Timothy S Church Journal: Atherosclerosis Date: 2009-05-21 Impact factor: 5.162
Authors: Yong-Moon Mark Park; Moon Kyung Choi; Seong-Su Lee; Nitin Shivappa; Kyungdo Han; Susan E Steck; James R Hébert; Anwar T Merchant; Dale P Sandler Journal: Clin Nutr Date: 2018-04-16 Impact factor: 7.324
Authors: Shelby Sullivan; Erik P Kirk; Bettina Mittendorfer; Bruce W Patterson; Samuel Klein Journal: Hepatology Date: 2012-04-25 Impact factor: 17.425
Authors: Vera Schmid; Robert Wagner; Corinna Sailer; Louise Fritsche; Konstantinos Kantartzis; Andreas Peter; Martin Heni; Hans-Ulrich Häring; Norbert Stefan; Andreas Fritsche Journal: Diabetologia Date: 2017-08-24 Impact factor: 10.122
Authors: Harish Dharuri; Peter A C 't Hoen; Jan B van Klinken; Peter Henneman; Jeroen F J Laros; Mirjam A Lips; Fatiha El Bouazzaoui; Gert-Jan B van Ommen; Ignace Janssen; Bert van Ramshorst; Bert A van Wagensveld; Hanno Pijl; Ko Willems van Dijk; Vanessa van Harmelen Journal: Diabetologia Date: 2014-08-07 Impact factor: 10.122
Authors: D Samocha-Bonet; V D Dixit; C R Kahn; R L Leibel; X Lin; M Nieuwdorp; K H Pietiläinen; R Rabasa-Lhoret; M Roden; P E Scherer; S Klein; E Ravussin Journal: Obes Rev Date: 2014-07-25 Impact factor: 9.213