Effects of a Therapeutic Lifestyle Modification Program on Inflammatory Chemokines and Insulin Resistance in Subjects With Metabolic Syndrome

Abstract

Background. Although therapeutic lifestyle modification (TLM) effectively improves the values of diagnostic biomarkers of metabolic syndrome, less is known about its effects on inflammatory chemokines and insulin resistance (IR) in patients with this syndrome. Objectives. To examine the effects of a short-term TLM program on inflammatory chemokines (monocyte chemoattractant protein-1 [MCP-1], retinol binding protein-4 [RBP-4]) and IR in subjects with metabolic syndrome. Method. Twenty-nine women (aged 66.5 ± 9.5 years) with metabolic syndrome were randomly assigned to the TLM intervention group (n = 16) or control group (n = 13). The TLM intervention group was provided with 4 weeks of health screening, education, exercise, diet, and counseling. Participants in the control group were instructed to maintain their usual lifestyle behavior. Outcome variables measured included MCP-1, RBP-4, fasting glucose, fasting insulin, and homeostasis model assessment (HOMA). An intention-to-treat strategy was not followed, and the final number of subjects in the analysis was 22 (14 in the TLM group and 8 in the control group). Results. After a 4-week TLM program, MCP-1, fasting insulin, and HOMA were significantly decreased in the TLM group compared to those in the control group (all p < .05). Conclusions. We conclude that a short-term TLM program could be effective for improving inflammatory state and IR, which are significant preceding biomarkers for cardiovascular complications in subjects with metabolic syndrome.

Keywords

metabolic syndrome lifestyle modification inflammation insulin resistance

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References

Bo, S. , Ciccone, G. , Baldi, C. , Benini, L. , Dusio, F. , Forastiere, G. , ... Pagano, G. ( 2007). Effectiveness of a lifestyle intervention on metabolic syndrome: A randomized controlled trial. Journal of General Internal Medicine, 22, 1695-1703.

Christopher, M.L. , Jordan, R.M. , Sarah, E.T. , Ashley, A.W. , Abbie, E.S. , Vincent, J.D. , ... Jeffrey, R.S. ( 2008). Minimal nutrition intervention with high-protein/low-carbohydrate and low-fat, nutrient-dense food supplement improves body composition and exercise benefits in overweight adults: A randomized controlled trial. Nutrition & Metabolism, 5, 11.

Despres, J.P. , Lamarche, B. , Mauriege, P. , Cantin, B. , Dagenais, G.R. , Moorgani, S. , ... Lupien, P.J. ( 1996). Hyperinsulinemia as an independent risk factor for ischemic heart disease. New England Journal of Medicine, 334, 952-957.

Eckel, R.H. , Grundy, S.M. , & Zimmet, P.Z. ( 2005). The metabolic syndrome. Lancet, 365, 1415-1428.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. (2001). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NIH Publication no. 01-3670). Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute , National Cholesterol Education Program. Retrieved from http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf

Ferroni, P. , Basili, S. , Falco, A. , & Davi, G. ( 2004). Inflammation, insulin resistance, and obesity. Current Atherosclerosis Reports, 6, 424-431.

Ford, E.S. , Giles, W.H. , & Dietz, W.H. ( 2002). Prevalence of the metabolic syndrome among US adults: Findings from the third National Health and Nutrition Examination Survey. The Journal of the American Medical Association, 287, 356-359.

Graham, T.E. , Yang, Q. , Bluher, M. , Hammarstedt, A. , Ciaraldi, T.P. , Henry, R.R. , ... Kahn, B.B. ( 2006). Retinol-binding protein 4 and insulin resistance in lean, obese, and diabetic subjects. New England Journal of Medicine , 354, 2552-2563.

Grundy, S.M. , Cleeman, J.I. , Daniels, S.R. , Donato, K.A. , Eckel, R.H. , Franklin, B.A. , ... Costa, F. ( 2005). American Heart Association, National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement . Circulation, 112, 2735-2752.

10.

Hulya, C. , & Rukiye, P. ( 2006). Randomized controlled trial on lifestyle modification in hypertension patients. Western Journal of Nursing Research , 28, 190-209.

11.

Ikeda, U. , Matsui, K. , Murakami, Y. , & Shimada, K. ( 2002). Monocyte chemoattractant protein-1 and coronary artery disease. Clinical Cardiology, 25, 143-147.

12.

Kahn, B.B. ( 1998). Type 2 diabetes: When insulin secretion fails to compensate for insulin resistance. Cell, 92, 593-596.

13.

King, H. , Aubert, R.E. , & Herman, W.H. ( 1998). Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care, 21, 1414-1431.

14.

Lakka, H.M. , Laaksonen, D.E. , Lakka, T.A. , Niskanen, L.K. , Kumpusalo, E. , Tuomilehto, J. , ... Salonen, J.T. ( 2002). The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. The Journal of the American Medical Association, 288, 2709-2716.

15.

Lim, S. , Choi, S.H. , Jeong, I.K. , Kim, J.H. , Moon, M.K. , Park, K.S. , ... Jang, H.C. ( 2008). Insulin-sensitizing effects of exercise on adiponectin and retinol binding protein-4 concentrations in young and middle-aged women . Journal of Clinical Endocrinology & Metabolism, 93, 2263-2268.

16.

Marius, T. , Knut, T.L. , Tor, C. , Jan, K.D. , Lars, M. , Randi, B. , ... Tom, E.M. ( 2003). Exercise reduces plasma levels of the chemokines MCP-1 and IL-8 in subjects with the metabolic syndrome. European Heart Journal, 25, 349-355.

17.

Ng, T.W.K. , Rye, K. , Watts, G.F. , Chan, D.C. , & Barrett, P.H. ( 2007). Effect of weight loss on LDL and HDL kinetics in the metabolic syndrome. Diabetes Care, 30, 2945-2950.

18.

Oh, E.G. , Hyun, S.S. , Kim, S.H. , Bang, S.Y. , Chu, S.H. , Jeon, J.Y. , ... Kang, M.S. ( 2008). A randomized controlled trial of therapeutic lifestyle modification in rural women with metabolic syndrome: A pilot study. Metabolism, 57, 255-261.

19.

Sell, H. , & Eckel, J. ( 2007). Monocyte chemotactic protein-1 and its role in insulin resistance. Current Opinion in Lipidology, 18, 258-262.

20.

Simona, B. , Giovannino, C. , Carla, B. , Lorenzo, B. , Ferruccio, D. , Giuseppe, F. , ... Giaanfranco, P. ( 2007). Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. Journal of General Internal Medicine, 22, 1695-1703.

21.

Trøseid, M. , Lappegård, K.T. , Claudi, T. , Damås, J.K. , Mørkrid, L. , Brendberg, R. , ... Mollnes, T. ( 2004). Exercise reduces plasma levels of the chemokines MCP-1 and IL-8 in subjects with the metabolic syndrome. European Heart Journal, 25, 349-355.

22.

Tschoner, A. , Sturm, W. , Engl, J. , Kaser, S. , Laimer, M. , Laimer, E. , ... Ebenbichler, C.F. (2008). Retinol binding protein 4, visceral fat, and the metabolic syndrome: Effects of weight loss. Obesity, 16, 2439-2444.

23.

WHO Expert Consultation. (2004). Appropriate body mass index for Asian population and its implications for policy and intervention strategies. Lancet, 363, 157-163.

24.

Yang, Q. , Graham, T.E. , Mody, N. , Preiner, F. , Peroni, O.D. , Zabolotny, J.M. , ... Kahn, B.B. ( 2005). Serum retinol binding protein 4 contributes to insulin resistance in obesity and type 2 diabetes. Nature, 436, 356-362.