Restricted accessReview articleFirst published online 2022-1
Effects of Lifestyle Intervention on Inflammatory Markers and Waist Circumference in Overweight/Obese Adults With Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Physical inactivity and an imbalanced diet could lead to some cardio metabolic risk factors.
Objective:
The objective of this meta-analysis was to investigate the effects of lifestyle modification on inflammatory indicators and waist circumference (WC) in overweight/obese subjects with metabolic syndrome (MS)
Data sources:
A systematic search was conducted in PubMed, CINAHL, MEDLINE, Cochrane, Google Scholar, and Web of Science.
Study selection:
The selection criteria were randomized controlled trials (RCTs) investigating the effects of lifestyle interventions on inflammation and WC from inception to 20 December 2020. The weighted mean difference (WMD) and 95% confidence interval (CI) between interventions were computed using a random or fixed-effects model.
Results:
Six RCTs (including 1246 MS patients who had, on average, overweight/obesity) met all inclusion criteria. Interventions lasted 6 to 12 months (2–5 sessions per week). Lifestyle intervention significantly reduced C-reactive protein (WMD: −0.52 mg/ml, 95% CI: −0.72, −0.33), IL-6 (WMD: −0.50 pg/ml, 95% CI: −0.56, −0.45), and increased adiponectin (WMD: 0.81 µg/ml, 95% CI, 0.64, 0.98). Moreover, lifestyle modification significantly decreased WC (WMD: −3.12 cm, 95% CI, −4.61, −1.62).
Conclusion:
Our findings provide evidence that lifestyle alterations, including physical activity and diet, can lead to significant improvement in abdominal obesity, measured by WC and some inflammation markers among overweight/obese individuals with MS. Further high-quality research is needed to clarify the mechanisms underlying the effect of such interventions on this population’s inflammatory markers.
AlbertiK. G. M.ZimmetP.ShawJ. (2005). The metabolic syndrome—a new worldwide definition. The Lancet, 366(9491), 1059–1062.
2.
Alizaei YousefabadiH.NiyaziA.AlaeeS.FathiM.Mohammad RahimiGh. R. (2021). Anti-inflammatory effects of exercise on metabolic syndrome patients: A systematic review and meta-analysis. Biological Research for Nursing, 23(2), 280–292.
3.
AronsonD.BarthaP.ZinderO.KernerA.MarkiewiczW.AvizoharO.BrookG.LevyY. (2004). Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome. International Journal of Obesity, 28(5), 674–679.
4.
AsbaghiO.FouladvandF.Ashtary-LarkyD.BagheriR.ChoghakhoriR.WongA.BakerJ. S.AbbasnezhadA. (2020). Effects of green tea supplementation on serum concentrations of adiponectin in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Archives of Physiology and Biochemistry, 1–8.
5.
American Diabetes Association. (2005). Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance. Diabetes, 54(5), 1566–1572.
6.
Attarzadeh HosseiniS. R.Mohammad RahimiGh. R.GhaemiJ. (2017). Compare waist circumference, waist-to-hip ratio and waist-to-stature ratio in predicting overweight/obese male students. Razi Journal of Medical Sciences, 24(161), 67–76.
7.
BeaversK. M.AmbrosiusW. T.NicklasB. J.RejeskiW. J. (2013). Independent and combined effects of physical activity and weight loss on inflammatory biomarkers in overweight and obese older adults. Journal of the American Geriatrics Society, 61(7), 1089–1094.
8.
BeaversK. M.NicklasB. J. (2011). Effects of lifestyle interventions on inflammatory markers in the metabolic syndrome. Frontiers in Bioscience (Scholar edition), 3, 168.
9.
BergA. H.SchererP. E. (2005). Adipose tissue, inflammation, and cardiovascular disease. Circulation Research, 96(9), 939–949.
10.
BlüherM. (2013). Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Practice & Research Clinical Endocrinology & Metabolism, 27(2), 163–177.
11.
BoS.CicconeG.BaldiC.BeniniL.DusioF.ForastiereG.LuciaC.NutiC.DurazzoM.CassaderM. (2007). Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. Journal of General Internal Medicine, 22(12), 1695–1703.
12.
BoS.CicconeG.BaldiI.GambinoR.MandrileC.DurazzoM.GentileL.CassaderM.Cavallo-PerinP.PaganoG. (2009). Plasma visfatin concentrations after a lifestyle intervention were directly associated with inflammatory markers. Nutrition, Metabolism and Cardiovascular Diseases, 19(6), 423–430.
13.
BoströmP.WuJ.JedrychowskiM. P.KordeA.YeL.LoJ. C.RasbachK. A.BoströmE. A.ChoiJ. H.LongJ. Z. (2012). A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis. Nature, 481(7382), 463–468.
14.
CamhiS. M.StefanickM. L.RidkerP. M.YoungD. R. (2010). Changes in C-reactive protein from low-fat diet and/or physical activity in men and women with and without metabolic syndrome. Metabolism, 59(1), 54–61.
15.
ChenY.ZhangZ.WangJ.SunH.ZhaoX.ChengX.ZhaoQ. (2020). Sex differences in the association of abdominal adipose tissue and anthropometric data with untreated hypertension in a Chinese population. Biology of Sex Differences, 11(1), 1–9.
16.
Examination Committee. (2005). The examination committee of the criteria for metabolic syndrome in Japan. Definition and criteria of the metabolic syndrome in Japan. Japanese Society of Internal Medicine Journal, 94, 188–201.
17.
ConsultationW. E. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England), 363(9403), 157–163.
18.
CooperJ. H.CollinsB. E.AdamsD. R.RobergsR. A.DongesC. E. (2016). Limited effects of endurance or interval training on visceral adipose tissue and systemic inflammation in sedentary middle-aged men. Journal of Obesity, 2016, 2479597.
19.
De CaterinaR.LiaoJ. K.LibbyP. (2000). Fatty acid modulation of endothelial activation. The American Journal of Clinical Nutrition, 71(1), 213S–223S.
20.
De KoningL.MerchantA. T.PogueJ.AnandS. S. (2007). Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: Meta-regression analysis of prospective studies. European Heart Journal, 28(7), 850–856.
21.
de MelloV. D.KolehmainenM.SchwabU.MagerU.LaaksonenD. E.PulkkinenL.NiskanenL.GyllingH.AtalayM.RauramaaR. (2008). Effect of weight loss on cytokine messenger RNA expression in peripheral blood mononuclear cells of obese subjects with the metabolic syndrome. Metabolism, 57(2), 192–199.
22.
DespresJ. (2006). Intra-abdominal obesity: An untreated risk factor for type 2 diabetes and cardiovascular disease. Journal of Endocrinological Investigation, 29(3), 77.
23.
DesprésJ. P. (2006). Is visceral obesity the cause of the metabolic syndrome?Annals of Medicine, 38(1), 52–63.
24.
EggerM.SmithG. D.SchneiderM.MinderC. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634.
25.
EsserN.Legrand-PoelsS.PietteJ.ScheenA. J.PaquotN. (2014). Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Research and Clinical Practice, 105(2), 141–150.
26.
FallonK.FallonS.BostonT. (2001). The acute phase response and exercise: Court and field sports. British Journal of Sports Medicine, 35(3), 170–173.
27.
FedewaM. V.HathawayE. D.Ward-RitaccoC. L. (2017). Effect of exercise training on C reactive protein: A systematic review and meta-analysis of randomised and non-randomised controlled trials. British Journal of Sports Medicine, 51(8), 670–676.
28.
FestaA.D’AgostinoR.JrHowardG.MykkanenL.TracyR. P.HaffnerS. M. (2000). Chronic subclinical inflammation as part of the insulin resistance syndrome: The Insulin Resistance Atherosclerosis Study (IRAS). Circulation, 102(1), 42–47.
29.
FordE. S.MokdadA. H.GilesW. H. (2003). Trends in waist circumference among US adults. Obesity Research, 11(10), 1223–1231.
30.
FriedS. K.BunkinD. A.GreenbergA. S. (1998). Omental and subcutaneous adipose tissues of obese subjects release interleukin-6: Depot difference and regulation by glucocorticoid. The Journal of Clinical Endocrinology & Metabolism, 83(3), 847–850.
31.
GhadgeA. A.KhaireA. A.KuvalekarA. A. (2018). Adiponectin: A potential therapeutic target for metabolic syndrome. Cytokine & Growth Factor Reviews, 39, 151–158.
32.
GrundyS. M.CleemanJ. I.DanielsS. R.DonatoK. A.EckelR. H.FranklinB. A.GordonD. J.KraussR. M.SavageP. J.SmithS. C.Jr (2005). Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation, 112(17), 2735–2752.
33.
GrundyS. M.HansenB.SmithS. C.JrCleemanJ. I.KahnR. A.ParticipantsC. (2004). Clinical management of metabolic syndrome: Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation, 109(4), 551–556.
34.
HamerM. (2007). The relative influences of fitness and fatness on inflammatory factors. Preventive Medicine, 44(1), 3–11.
35.
HamerM.SabiaS.BattyG. D.ShipleyM. J.TabákA. G.Singh-ManouxA.KivimakiM. (2012). Physical activity and inflammatory markers over 10 years: Follow-up in men and women from the Whitehall II cohort study. Circulation, 126(8), 928–933.
36.
HandschinC.SpiegelmanB. M. (2008). The role of exercise and PGC1α in inflammation and chronic disease. Nature, 454(7203), 463–469.
37.
HerderC.PeltonenM.KoenigW.SütfelsK.LindströmJ.MartinS.Ilanne-ParikkaP.ErikssonJ. G.AunolaS.Keinänen-KiukaanniemiS. (2009). Anti-inflammatory effect of lifestyle changes in the finnish diabetes prevention study. Diabetologia, 52(3), 433–442.
38.
HigginsJ. P. T.GreenS. (2011). Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. The Cochrane Collaboration, 2011.
39.
HigginsJ. P. TThompsonS. G.DeeksJ. J.AltmanD. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557–560.
40.
HuaC.LiaoY.LinS.TsaiT.HuangC.ChouP. (2011). Does supplementation with green tea extract improve insulin resistance in obese type 2 diabetics? A randomized, double-blind, and placebocontrolled clinical trial. Alternative Medicine Review, 16(2), 157–163.
41.
IbrahimM. S.PangD.RandhawaG.PappasY. (2019). Risk models and scores for metabolic syndrome: Systematic review protocol. BMJ Open, 9(9), e027326.
42.
IsomaaB.AlmgrenP.TuomiT.ForsénB.LahtiK.NissenM.TaskinenM.-R.GroopL. (2001). Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care, 24(4), 683–689.
43.
JenkinsD.KendallC.MarchieA.FaulknerD.JosseA.WongJ.De SouzaR.EmamA.ParkerT.LiT. (2005). Direct comparison of dietary portfolio vs statin on C-reactive protein. European Journal of Clinical Nutrition, 59(7), 851–860.
44.
JorisP. J.PlatJ.KustersY. H.HoubenA. J.StehouwerC. D.SchalkwijkC. G.MensinkR. P. (2017). Diet-induced weight loss improves not only cardiometabolic risk markers but also markers of vascular function: A randomized controlled trial in abdominally obese men. The American Journal of Clinical Nutrition, 105(1), 23–31.
45.
KadowakiT.YamauchiT. (2005). Adiponectin and adiponectin receptors. EndocrineR, 26(3), 439–451.
46.
KatzmarzykP. T.HuG.CefaluW. T.MireE.BouchardC. (2013). The importance of waist circumference and BMI for mortality risk in diabetic adults. Diabetes Care, 36(10), 3128–3130.
47.
KumadaM.KiharaS.SumitsujiS.KawamotoT.MatsumotoS.OuchiN.AritaY.OkamotoY.ShimomuraI.HiraokaH. (2003). Association of hypoadiponectinemia with coronary artery disease in men. Arteriosclerosis, Thrombosis, and Vascular Biology, 23(1), 85–89.
48.
MeccaM. S.MoretoF.BuriniF. H.DalanesiR. C.McLellanK. C.BuriniR. C. (2012). Ten-week lifestyle changing program reduces several indicators for metabolic syndrome in overweight adults. Diabetology & Metabolic Syndrome, 4(1), 1–7.
49.
MiddletonE. (1998). Effect of plant flavonoids on immune and inflammatory cell function. Flavonoids in the Living System, 175–182.
50.
MillerE. G.SethiP.NowsonC. A.DunstanD. W.DalyR. M. (2017). Effects of progressive resistance training and weight loss versus weight loss alone on inflammatory and endothelial biomarkers in older adults with type 2 diabetes. European Journal of Applied Physiology, 117(8), 1669–1678.
51.
Mohamed-AliV.GoodrickS.RaweshA.KatzD.MilesJ.YudkinJ.KleinS.CoppackS. (1997). Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-α, in vivo. The Journal of Clinical Endocrinology & Metabolism, 82(12), 4196–4200.
52.
Mohammad RahimiG. R.BijehN.RashidlamirA. (2020). Effects of exercise training on serum preptin, undercarboxylated osteocalcin and high molecular weight adiponectin in adults with metabolic syndrome. Experimental Physiology, 105(3), 449–459.
53.
NanriA.TomitaK.MatsushitaY.IchikawaF.YamamotoM.NagafuchiY.KakumotoY.MizoueT. (2012). Effect of six months lifestyle intervention in Japanese men with metabolic syndrome: Randomized controlled trial. Journal of Occupational Health, 54(3), 215–222.
54.
OhE. G.BangS. Y.KimS. H.HyunS. S.ChuS. H.JeonJ. Y.ImJ. A.LeeJ. E.LeeM. K. (2013). Therapeutic lifestyle modification program reduces plasma levels of the chemokines CRP and MCP-1 in subjects with metabolic syndrome. Biological Research for Nursing, 15(1), 48–55.
55.
OhE. G.ChuS. H.BangS. Y.LeeM. K.KimS. H.HyunS. S.JeonJ. Y.ImJ. A.LeeJ. E. (2011). Effects of a therapeutic lifestyle modification program on inflammatory chemokines and insulin resistance in subjects with metabolic syndrome. Biological Research for Nursing, 13(2), 182–188.
56.
OkitaK.NishijimaH.MurakamiT.NagaiT.MoritaN.YonezawaK.IizukaK.KawaguchiH.KitabatakeA. (2004). Can exercise training with weight loss lower serum C-reactive protein levels?Arteriosclerosis, Thrombosis, and Vascular Biology, 24(10), 1868–1873.
57.
OuchiN.WalshK. (2007). Adiponectin as an anti-inflammatory factor. Clinica chimica acta, 380(1-2), 24–30.
58.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.ShamseerL.TetzlaffJ. M.AklE. A.BrennanS. E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.
59.
PahwaR.Adams-HuetB.JialalI. (2017). The effect of increasing body mass index on cardio-metabolic risk and biomarkers of oxidative stress and inflammation in nascent metabolic syndrome. Journal of Diabetes and its Complications, 31(5), 810–813.
60.
PeronaJ. S.Schmidt-RioValleJ.Rueda-MedinaB.Correa-RodríguezM.González-JiménezE. (2017). Waist circumference shows the highest predictive value for metabolic syndrome, and waist-to-hip ratio for its components, in Spanish adolescents. Nutrition Research, 45, 38–45.
61.
PetersenA. M. W.PedersenB. K. (2005). The anti-inflammatory effect of exercise. Journal of Applied Physiology, 98(4), 1154–1162.
62.
PlaisanceE. P.GrandjeanP. W. (2006). Physical activity and high-sensitivity C-reactive protein. Sports Medicine, 36(5), 443–458.
63.
PradhanA. D.MansonJ. E.RifaiN.BuringJ. E.RidkerP. M. (2001). C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA, 286(3), 327–334.
64.
RichardC.CoutureP.DesrochesS.LamarcheB. (2013). Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome. Obesity, 21(1), 51–57.
65.
RidkerP. M.HennekensC. H.BuringJ. E.RifaiN. (2000). C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. New England Journal of Medicine, 342(12), 836–843.
66.
RogowskiO.ShapiraI.BassatO. K.-B.ChundadzeT.FinnT.BerlinerS.SteinvilA. (2010). Waist circumference as the predominant contributor to the micro-inflammatory response in the metabolic syndrome: A cross sectional study. Journal of Inflammation, 7(1), 1–7.
67.
SaklayenM. G. (2018). The global epidemic of the metabolic syndrome. Current Hypertension Reports, 20(2), 1–8.
68.
SantosA.LopesC.GuimaraesJ.BarrosH. (2005). Central obesity as a major determinant of increased high-sensitivity C-reactive protein in metabolic syndrome. International Journal of Obesity, 29(12), 1452–1456.
69.
SattarN.GawA.ScherbakovaO.FordI.O’ReillyD. S. J.HaffnerS. M.IslesC.MacfarlaneP. W.PackardC. J.CobbeS. M. (2003). Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland coronary prevention study. Circulation, 108(4), 414–419.
70.
SchulzeM. B.RimmE. B.ShaiI.RifaiN.HuF. B. (2004). Relationship between adiponectin and glycemic control, blood lipids, and inflammatory markers in men with type 2 diabetes. Diabetes Care, 27(7), 1680–1687.
71.
SeligmanB. G.PolanczykC. A.SantosA. S.FoppaM.JungesM.BonzaniniL.NicolaidisG.CameyS.LopesA. L.SehlP. (2011). Intensive practical lifestyle intervention improves endothelial function in metabolic syndrome independent of weight loss: A randomized controlled trial. Metabolism, 60(12), 1736–1740.
72.
Serrano-FerrerJ.WaltherG.CrendalE.VinetA.DutheilF.NaughtonG.LesourdB.ChapierR.CourteixD.ObertP. (2014). Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program. Cardiovascular Diabetology, 13(1), 1–11.
73.
SmartN. A.WaldronM.IsmailH.GiallauriaF.VigoritoC.CornelissenV.DiebergG. (2015). Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. International Journal of Evidence-Based Healthcare, 13(1), 9–18.
74.
SnelM.van DiepenJ. A.StijnenT.PijlH.RomijnJ. A.MeindersA.VosholP.JazetI. M. (2011). Immediate and long-term effects of addition of exercise to a 16-week very low calorie diet on low-grade inflammation in obese, insulin-dependent type 2 diabetic patients. Food and Chemical Toxicology, 49(12), 3104–3111.
75.
StaynorJ. M.SmithM. K.DonnellyC. J.El SallamA.AcklandT. R. (2020). DXA reference values and anthropometric screening for visceral obesity in Western Australian adults. Scientific Reports, 10(1), 1–11.
76.
SteckhanN.HohmannC.-D.KesslerC.DobosG.MichalsenA.CramerH. (2016). Effects of different dietary approaches on inflammatory markers in patients with metabolic syndrome: A systematic review and meta-analysis. Nutrition, 32(3), 338–348.
77.
Van GaalL. F.MertensI. L.ChristopheE. (2006). Mechanisms linking obesity with cardiovascular disease. Nature, 444(7121), 875–880.
78.
van NamenM.PrendergastL.PeirisC. (2019). Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis. Metabolism, 101, 153988.
79.
VieiraV. J.ValentineR. J.WilundK. R.AntaoN.BaynardT.WoodsJ. A. (2009). Effects of exercise and low-fat diet on adipose tissue inflammation and metabolic complications in obese mice. American Journal of Physiology-Endocrinology and Metabolism, 296(5), E1164–E1171.
80.
VinetA.ObertP.DutheilF.DiagneL.ChapierR.LesourdB.CourteixD.WaltherG. (2015). Impact of a lifestyle program on vascular insulin resistance in metabolic syndrome subjects: The RESOLVE study. The Journal of Clinical Endocrinology and Metabolism, 100(2), 442–450.
81.
VolekJ. S.GomezA. LKraemerW. J. (2000). Fasting lipoprotein and postprandial triacylglycerol responses to a low-carbohydrate diet supplemented with n-3 fatty acids. Journal of the American College of Nutrition, 19(3), 383–391.
82.
WeyerC.FunahashiT.TanakaS.HottaK.MatsuzawaY.PratleyR. E.TataranniP. A. (2001). Hypoadiponectinemia in obesity and type 2 diabetes: Close association with insulin resistance and hyperinsulinemia. The Journal of Clinical Endocrinology and Metabolism, 86(5), 1930–1935.
83.
YadavR. K.MaganD.MehtaN.SharmaR.MahapatraS. C. (2012). Efficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: Preliminary results. The Journal Of Alternative and Complementary Medicine, 18(7), 662–667.
84.
YadavR. K.YadavR. K.KhadgawatR.PandeyR. M. (2019). Comparative efficacy of a 12 week yoga-based lifestyle intervention and dietary intervention on adipokines, inflammation, and oxidative stress in adults with metabolic syndrome: A randomized controlled trial. Translational Behavioral Medicine, 9(4), 594–604.
85.
YamaokaK.TangoT. (2012). Effects of lifestyle modification on metabolic syndrome: A systematic review and meta-analysis. BMC Medicine, 10(1), 1–10.
86.
YatagaiT.NishidaY.NagasakaS.NakamuraT.TokuyamaK.ShindoM.TanakaH.IshibashiS. (2003). Relationship between exercise training-induced increase in insulin sensitivity and adiponectinemia in healthy men. Endocrine Journal, 50(2), 233–238.
87.
YudkinJ. S.StehouwerC.EmeisJ.CoppackS. (1999). C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: A potential role for cytokines originating from adipose tissue?Arteriosclerosis, Thrombosis, and Vascular Biology, 19(4), 972–978.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
