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A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial

Aims/hypothesis The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods Thirty... Full description

Journal Title: Diabetologia 2018-04-26, Vol.61 (7), p.1548-1559
Main Author: Otten, Julia
Other Authors: Stomby, Andreas , Waling, Maria , Isaksson, Andreas , Söderström, Ingegerd , Ryberg, Mats , Svensson, Michael , Hauksson, Jón , Olsson, Tommy
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
ID: ISSN: 0012-186X
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title: A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial
format: Article
creator:
  • Otten, Julia
  • Stomby, Andreas
  • Waling, Maria
  • Isaksson, Andreas
  • Söderström, Ingegerd
  • Ryberg, Mats
  • Svensson, Michael
  • Hauksson, Jón
  • Olsson, Tommy
subjects:
  • Adipose tissue
  • Adipose Tissue - metabolism
  • Adipose Tissue - physiopathology
  • Adiposity
  • Adult
  • Aged
  • Analysis
  • Article
  • Blood Glucose - metabolism
  • Body fat
  • Body weight
  • Body weight loss
  • Clinical Medicine
  • Clinical trials
  • Combined Modality Therapy
  • Diabetes
  • Diabetes mellitus
  • Diabetes mellitus (non-insulin dependent)
  • Diabetes Mellitus, Type 2 - blood
  • Diabetes Mellitus, Type 2 - diagnosis
  • Diabetes Mellitus, Type 2 - diet therapy
  • Diabetes Mellitus, Type 2 - physiopathology
  • Diabetes therapy
  • Diet
  • Diet, Paleolithic
  • Endocrinology
  • Endocrinology and Diabetes
  • Endokrinologi och diabetes
  • euglycaemic clamp
  • Evidence-based medicine
  • Exercise
  • Exercise Therapy
  • Female
  • Fitness training programs
  • Human Physiology
  • Humans
  • Hyperinsulinaemic
  • Hyperinsulinaemic-euglycaemic clamp
  • Insulin
  • Insulin Resistance
  • Insulin sensitivity
  • Internal Medicine
  • Intramyocellular fat
  • Klinisk medicin
  • Liver
  • Liver - metabolism
  • Liver - physiopathology
  • Liver fat
  • Magnetic resonance spectroscopy
  • Male
  • Medical and Health Sciences
  • Medicin och hälsovetenskap
  • Medicine
  • Medicine & Public Health
  • Metabolic Diseases
  • Middle Aged
  • Muscle, Skeletal - metabolism
  • Muscle, Skeletal - physiopathology
  • Muscles
  • Nuclear magnetic resonance spectroscopy
  • Nutrition
  • Obesity
  • Obesity - blood
  • Obesity - diagnosis
  • Obesity - diet therapy
  • Obesity - physiopathology
  • Paleolithic
  • Paleolithic diet
  • Proton magnetic resonance spectroscopy
  • Single-Blind Method
  • Skeletal muscle
  • Soleus muscle
  • Spectrum analysis
  • Sweden
  • Time Factors
  • Treatment Outcome
  • Type 2 diabetes
  • Weight Loss
ispartof: Diabetologia, 2018-04-26, Vol.61 (7), p.1548-1559
description: Aims/hypothesis The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods Thirty-two individuals with type 2 diabetes with BMI 25–40 kg/m 2 and 30–70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic–euglycaemic clamp technique combined with [6,6- 2 H 2 ]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umeå University Hospital, Umeå, Sweden. Results Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous ( p  
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
  • 1432-0428
url: Link


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titleA heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial
creatorOtten, Julia ; Stomby, Andreas ; Waling, Maria ; Isaksson, Andreas ; Söderström, Ingegerd ; Ryberg, Mats ; Svensson, Michael ; Hauksson, Jón ; Olsson, Tommy
creatorcontribOtten, Julia ; Stomby, Andreas ; Waling, Maria ; Isaksson, Andreas ; Söderström, Ingegerd ; Ryberg, Mats ; Svensson, Michael ; Hauksson, Jón ; Olsson, Tommy
descriptionAims/hypothesis The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods Thirty-two individuals with type 2 diabetes with BMI 25–40 kg/m 2 and 30–70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic–euglycaemic clamp technique combined with [6,6- 2 H 2 ]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umeå University Hospital, Umeå, Sweden. Results Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous ( p  < 0.05 for the difference between groups). IMCL content of the soleus muscle decreased by 40% in the PD group and by 22% in the PD-EX group ( p  < 0.05 for the difference between groups). Both groups improved their peripheral and adipose tissue insulin sensitivity, but not their hepatic insulin sensitivity. Plasma fetuin-A decreased by 11% in the PD group ( p <  0.05) and remained unchanged in the PD-EX group. Liver fat changes during the intervention were correlated with changes in fetuin-A ( r S  = 0.63, p <  0.01). Participants did not report any important adverse events caused by the intervention. Conclusions/interpretation A Paleolithic diet reduced liver fat and IMCL content, while there was a tissue-specific heterogeneous response to added exercise training. Trial registration ClinicalTrials.gov NCT01513798 Funding Swedish Diabetes Research Foundation, County Council of Västerbotten, Swedish Heart and Lung Foundation, King Gustav V and Queen Victoria’s Foundation
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publisherBerlin/Heidelberg: Springer Berlin Heidelberg
subjectAdipose tissue ; Adipose Tissue - metabolism ; Adipose Tissue - physiopathology ; Adiposity ; Adult ; Aged ; Analysis ; Article ; Blood Glucose - metabolism ; Body fat ; Body weight ; Body weight loss ; Clinical Medicine ; Clinical trials ; Combined Modality Therapy ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - diet therapy ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes therapy ; Diet ; Diet, Paleolithic ; Endocrinology ; Endocrinology and Diabetes ; Endokrinologi och diabetes ; euglycaemic clamp ; Evidence-based medicine ; Exercise ; Exercise Therapy ; Female ; Fitness training programs ; Human Physiology ; Humans ; Hyperinsulinaemic ; Hyperinsulinaemic-euglycaemic clamp ; Insulin ; Insulin Resistance ; Insulin sensitivity ; Internal Medicine ; Intramyocellular fat ; Klinisk medicin ; Liver ; Liver - metabolism ; Liver - physiopathology ; Liver fat ; Magnetic resonance spectroscopy ; Male ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Middle Aged ; Muscle, Skeletal - metabolism ; Muscle, Skeletal - physiopathology ; Muscles ; Nuclear magnetic resonance spectroscopy ; Nutrition ; Obesity ; Obesity - blood ; Obesity - diagnosis ; Obesity - diet therapy ; Obesity - physiopathology ; Paleolithic ; Paleolithic diet ; Proton magnetic resonance spectroscopy ; Single-Blind Method ; Skeletal muscle ; Soleus muscle ; Spectrum analysis ; Sweden ; Time Factors ; Treatment Outcome ; Type 2 diabetes ; Weight Loss
ispartofDiabetologia, 2018-04-26, Vol.61 (7), p.1548-1559
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0Otten, Julia
1Stomby, Andreas
2Waling, Maria
3Isaksson, Andreas
4Söderström, Ingegerd
5Ryberg, Mats
6Svensson, Michael
7Hauksson, Jón
8Olsson, Tommy
title
0A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial
1Diabetologia
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0Diabetologia
1Diabetologia
descriptionAims/hypothesis The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods Thirty-two individuals with type 2 diabetes with BMI 25–40 kg/m 2 and 30–70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic–euglycaemic clamp technique combined with [6,6- 2 H 2 ]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umeå University Hospital, Umeå, Sweden. Results Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous ( p  < 0.05 for the difference between groups). IMCL content of the soleus muscle decreased by 40% in the PD group and by 22% in the PD-EX group ( p  < 0.05 for the difference between groups). Both groups improved their peripheral and adipose tissue insulin sensitivity, but not their hepatic insulin sensitivity. Plasma fetuin-A decreased by 11% in the PD group ( p <  0.05) and remained unchanged in the PD-EX group. Liver fat changes during the intervention were correlated with changes in fetuin-A ( r S  = 0.63, p <  0.01). Participants did not report any important adverse events caused by the intervention. Conclusions/interpretation A Paleolithic diet reduced liver fat and IMCL content, while there was a tissue-specific heterogeneous response to added exercise training. Trial registration ClinicalTrials.gov NCT01513798 Funding Swedish Diabetes Research Foundation, County Council of Västerbotten, Swedish Heart and Lung Foundation, King Gustav V and Queen Victoria’s Foundation
subject
0Adipose tissue
1Adipose Tissue - metabolism
2Adipose Tissue - physiopathology
3Adiposity
4Adult
5Aged
6Analysis
7Article
8Blood Glucose - metabolism
9Body fat
10Body weight
11Body weight loss
12Clinical Medicine
13Clinical trials
14Combined Modality Therapy
15Diabetes
16Diabetes mellitus
17Diabetes mellitus (non-insulin dependent)
18Diabetes Mellitus, Type 2 - blood
19Diabetes Mellitus, Type 2 - diagnosis
20Diabetes Mellitus, Type 2 - diet therapy
21Diabetes Mellitus, Type 2 - physiopathology
22Diabetes therapy
23Diet
24Diet, Paleolithic
25Endocrinology
26Endocrinology and Diabetes
27Endokrinologi och diabetes
28euglycaemic clamp
29Evidence-based medicine
30Exercise
31Exercise Therapy
32Female
33Fitness training programs
34Human Physiology
35Humans
36Hyperinsulinaemic
37Hyperinsulinaemic-euglycaemic clamp
38Insulin
39Insulin Resistance
40Insulin sensitivity
41Internal Medicine
42Intramyocellular fat
43Klinisk medicin
44Liver
45Liver - metabolism
46Liver - physiopathology
47Liver fat
48Magnetic resonance spectroscopy
49Male
50Medical and Health Sciences
51Medicin och hälsovetenskap
52Medicine
53Medicine & Public Health
54Metabolic Diseases
55Middle Aged
56Muscle, Skeletal - metabolism
57Muscle, Skeletal - physiopathology
58Muscles
59Nuclear magnetic resonance spectroscopy
60Nutrition
61Obesity
62Obesity - blood
63Obesity - diagnosis
64Obesity - diet therapy
65Obesity - physiopathology
66Paleolithic
67Paleolithic diet
68Proton magnetic resonance spectroscopy
69Single-Blind Method
70Skeletal muscle
71Soleus muscle
72Spectrum analysis
73Sweden
74Time Factors
75Treatment Outcome
76Type 2 diabetes
77Weight Loss
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1Stomby, Andreas
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4Söderström, Ingegerd
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titleA heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial
authorOtten, Julia ; Stomby, Andreas ; Waling, Maria ; Isaksson, Andreas ; Söderström, Ingegerd ; Ryberg, Mats ; Svensson, Michael ; Hauksson, Jón ; Olsson, Tommy
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0Adipose tissue
1Adipose Tissue - metabolism
2Adipose Tissue - physiopathology
3Adiposity
4Adult
5Aged
6Analysis
7Article
8Blood Glucose - metabolism
9Body fat
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12Clinical Medicine
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15Diabetes
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18Diabetes Mellitus, Type 2 - blood
19Diabetes Mellitus, Type 2 - diagnosis
20Diabetes Mellitus, Type 2 - diet therapy
21Diabetes Mellitus, Type 2 - physiopathology
22Diabetes therapy
23Diet
24Diet, Paleolithic
25Endocrinology
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30Exercise
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32Female
33Fitness training programs
34Human Physiology
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38Insulin
39Insulin Resistance
40Insulin sensitivity
41Internal Medicine
42Intramyocellular fat
43Klinisk medicin
44Liver
45Liver - metabolism
46Liver - physiopathology
47Liver fat
48Magnetic resonance spectroscopy
49Male
50Medical and Health Sciences
51Medicin och hälsovetenskap
52Medicine
53Medicine & Public Health
54Metabolic Diseases
55Middle Aged
56Muscle, Skeletal - metabolism
57Muscle, Skeletal - physiopathology
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59Nuclear magnetic resonance spectroscopy
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61Obesity
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63Obesity - diagnosis
64Obesity - diet therapy
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66Paleolithic
67Paleolithic diet
68Proton magnetic resonance spectroscopy
69Single-Blind Method
70Skeletal muscle
71Soleus muscle
72Spectrum analysis
73Sweden
74Time Factors
75Treatment Outcome
76Type 2 diabetes
77Weight Loss
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atitleA heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial
jtitleDiabetologia
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addtitleDiabetologia
date2018-04-26
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issue7
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abstractAims/hypothesis The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods Thirty-two individuals with type 2 diabetes with BMI 25–40 kg/m 2 and 30–70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic–euglycaemic clamp technique combined with [6,6- 2 H 2 ]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umeå University Hospital, Umeå, Sweden. Results Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous ( p  < 0.05 for the difference between groups). IMCL content of the soleus muscle decreased by 40% in the PD group and by 22% in the PD-EX group ( p  < 0.05 for the difference between groups). Both groups improved their peripheral and adipose tissue insulin sensitivity, but not their hepatic insulin sensitivity. Plasma fetuin-A decreased by 11% in the PD group ( p <  0.05) and remained unchanged in the PD-EX group. Liver fat changes during the intervention were correlated with changes in fetuin-A ( r S  = 0.63, p <  0.01). Participants did not report any important adverse events caused by the intervention. Conclusions/interpretation A Paleolithic diet reduced liver fat and IMCL content, while there was a tissue-specific heterogeneous response to added exercise training. Trial registration ClinicalTrials.gov NCT01513798 Funding Swedish Diabetes Research Foundation, County Council of Västerbotten, Swedish Heart and Lung Foundation, King Gustav V and Queen Victoria’s Foundation
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pmid29696296
doi10.1007/s00125-018-4618-y
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