Twenty year fitness trends in young adults and incidence of prediabetes and diabetes: the CARDIA study

The prospective association between cardiorespiratory fitness (CRF) measured in young adulthood and middle age on development of prediabetes, defined as impaired fasting glucose and/or impaired glucose tolerance, or diabetes by middle age remains unknown. We hypothesised that higher fitness levels would be associated with reduced risk for developing incident prediabetes/diabetes by middle age

Association of Mediterranean diet and cardiorespiratory fitness with the development of pre-diabetes and diabetes: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Objective To better understand the association between a modified Mediterranean diet pattern in young adulthood, cardiorespiratory fitness in young adulthood, and the odds of developing pre-diabetes or diabetes by middle age. Research design and methods Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study who did not have pre-diabetes or diabetes at baseline (year 0 (Y0), ages 18–30) and who had data available at the Y0 and year 25 (Y25) visits were included in this analysis (n=3358). Polytomous logistic regression models were used to assess the association between baseline dietary intake and fitness data and odds of pre-diabetes or diabetes by middle age (Y25, ages 43–55). Results At the Y25 visit, 1319 participants (39%) had pre-diabetes and 393 (12%) had diabetes. Higher baseline fitness was associated with lower odds of pre-diabetes and of diabetes at Y25. After adjustment for covariates, each SD increment in treadmill duration (181 s) was associated with lower odds for pre-diabetes (OR 0.85, 95% CI 0.75 to 0.95, p=0.005) and for diabetes (OR 0.71, 95% CI 0.60 to 0.85, p=0.0002) when compared to normal glycemia. A modified Mediterranean diet pattern was not associated with either pre-diabetes or diabetes. No interaction between cardiorespiratory fitness and dietary intake was observed, but baseline fitness remained independently associated with incident pre-diabetes and diabetes following adjustment for diet. Conclusions Higher cardiorespiratory fitness in young adulthood, but not a modified Mediterranean diet pattern, is associated with lower odds of pre-diabetes and of diabetes in middle age. Trial registration number NCT00005130

VE/VCO2 slope in lean and overweight women and its relationship to lean leg mass

Ventilation/carbon dioxide production (VE/VCO2slope) is used clinically to determine cardiorespiratory fitness and morbidity in heart failure (HF). Previously, we demonstrated that lower lean leg mass is associated with high VE/VCO2slope during exercise in HF. In healthy individuals, we evaluated 1) whether VE/VCO2slope differed between lean and overweight women and 2) the relationship between lean leg mass and VE/VCO2slope in overweight sedentary (OWS), overweight trained (OWTR) and lean, trained (LTR) women. Methods: Gas exchange and ventilation were collected during a treadmill peak oxygen uptake test (VO2peak) in 40 women [26 OWS (29 ± 7 yrs., mean ± SD), 7 OWTR (33 ± 5 yrs) and 7 LTR (26 ± 6 yrs)]. Body composition was measured by dual X-ray absorptiometry. Results: VO2peak was highest in LTR (46.6 ± 8 ml/kg/min) compared with OWTR (38.1 ± 4.9 ml/kg/min) and OWS women (25.3 ± 4.8 ml/kg/min, p  0.05). Higher lean leg mass was associated with lower VE/VCO2slope in overweight women (OWS + OWTR: r = −0.55, p < 0.001), contrasting with higher VE/VCO2slope in LTR women (r = 0.86, p < 0.001). Conclusions: These findings suggest VE/VCO2slope may not differentiate between low and high cardiorespiratory fitness in healthy individuals and muscle mass may play a role in determining the VE/VCO2slope, independent of disease. Keywords: Ventilatory efficiency, Body composition, Peak VO2, VE/VCO2slope, Obesit

The impact of high BMI on acute changes in body composition following 90 min of running

Objectives: Although physical activity ameliorates the metabolic impact of high body mass index (BMI), runners with BMI ≥25 kg/m2 are relatively understudied. This study had two goals: (1) to identify differences in body composition, as measured by dual X-ray absorptiometry (DXA), between overweight (BMI ≥ 25 kg/m2) runners (OWR) and normal weight (BMI < 25 kg/m2) runners (NWR) and (2) to examine whether a 90-min run alters total or regional fat mass, as measured by DXA, in OWR and NWR. We hypothesized that OWR would have higher total body fat than NWR and OWR with greater changes in visceral fat after a prolonged run. Design: Body composition analysis before and after a supervised run. Methods: We recruited NWR (n = 16, F: n = 7, 28.1 ± 1.4 years, BMI 22.0 ± 0.4 kg/m2, results as mean ± SE) and OWR (n = 11, F: n = 7, 32.0 ± 1.6 years, BMI 30.5 ± 1.4 kg/m2) participants. DXA-based body composition was measured before and after a supervised, 90-min run at 60% heart rate reserve. Results: OWR had higher body fat than NWR in all measured regions. Both groups did not significantly reduce fat mass at any measured fat depots after the running exposure. Conclusions: OWR had higher body fat in all measured regions than NWR. DXA could not demonstrate any acute fat mass changes after a prolonged run

The impact of high BMI on acute changes in body composition following 90 min of running

<p>Objectives: Although physical activity ameliorates the metabolic impact of high body mass index (BMI), runners with BMI ≥25 kg/m² are relatively understudied. This study had two goals: (1) to identify differences in body composition, as measured by dual X-ray absorptiometry (DXA), between overweight (BMI ≥ 25 kg/m²) runners (OWR) and normal weight (BMI < 25 kg/m²) runners (NWR) and (2) to examine whether a 90-min run alters total or regional fat mass, as measured by DXA, in OWR and NWR. We hypothesized that OWR would have higher total body fat than NWR and OWR with greater changes in visceral fat after a prolonged run. Design: Body composition analysis before and after a supervised run. Methods: We recruited NWR (<i>n</i> = 16, F: <i>n</i> = 7, 28.1 ± 1.4 years, BMI 22.0 ± 0.4 kg/m², results as mean ± SE) and OWR (<i>n</i> = 11, F: <i>n</i> = 7, 32.0 ± 1.6 years, BMI 30.5 ± 1.4 kg/m²) participants. DXA-based body composition was measured before and after a supervised, 90-min run at 60% heart rate reserve. Results: OWR had higher body fat than NWR in all measured regions. Both groups did not significantly reduce fat mass at any measured fat depots after the running exposure. Conclusions: OWR had higher body fat in all measured regions than NWR. DXA could not demonstrate any acute fat mass changes after a prolonged run.</p

Differential Effects of Type 2 Diabetes Treatment Regimens on Diabetes Distress and Depressive Symptoms in GRADE: A Randomized Clinical Trial

Objective: We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments. Research Design and Methods: The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study of adults with T2DM of < 10 years duration, HbA1c of 6.8-8.5%, and taking metformin monotherapy randomly assigned participants to add insulin glargine U-100, sulfonylurea glimepiride, glucagon-like peptide-1 receptor agonist liraglutide, or dipeptidyl peptidase 4 inhibitor sitagliptin. The Emotional Distress Substudy enrolled 1,739 GRADE participants (mean[SD] age, 58.0[10.2] years; 32% female; 56% non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic) and assessed diabetes distress and depressive symptoms every six months. Analyses examined differences at one year and over the 3-year follow-up. Results: Across treatments, diabetes distress (-0.24, p<0.0001) and depressive symptoms (-0.67, p<0.0001) decreased over one year. Diabetes distress was lower at one year for glargine compared to the other groups combined (-0.10, p=0.002). Diabetes distress was also lower for liraglutide compared to glimepiride or sitagliptin (-0.10, p=0.008). Over the 3-year follow-up, there were no significant group differences in total diabetes distress; interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms. Conclusions: Contrary to expectations, this randomized trial found no evidence for a deleterious effect of basal insulin on emotional distress; glargine lowered diabetes distress modestly at one year rather than increasing it. Liraglutide also reduced diabetes distress at one year. Results can inform treatment decisions for adults with early T2DM.</p

Physical Function Following a Long-Term Lifestyle Intervention Among Middle Aged and Older Adults With Type 2 Diabetes: The Look AHEAD Study

Background: Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention (ILI) on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods: Overweight and obese (body mass index ≥ 25 kg/m2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an ILI designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years postrandomization and 1.5 years after the intervention was stopped (n = 3,783). Results: Individuals randomized to ILI had lower odds of slow gait speed (\u3c0.8 m/s) compared to those randomized to DSE (adjusted OR [95% CI]: 0.84 [0.71 to 0.99]). Individuals randomized to ILI also had faster gait speed over 4- and 400-m (adjusted mean difference [95% CI]: 0.019 [0.007 to 0.031] m/s, p = .002, and 0.023 [0.012 to 0.034] m/sec, p \u3c .0001, respectively) and higher SPPBexp scores (0.037 [0.011 to 0.063], p = .005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPBexp scores among older versus younger participants (0.081 [0.038 to 0.124] vs 0.013 [-0.021 to 0.047], p = .01). Conclusions: An intensive lifestyle intervention has modest but significant long-term benefits on physical function in overweight and obese middle-aged and older adults with type 2 diabetes. ClinicalTrials.gov Identifier: NCT00017953