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Otten, J., Andersson, J., Ståhl, J., Stomby, A., Saleh, A., Waling, M., . . . Olsson, T. (2019). Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 8(2), Article ID e010634.
Öppna denna publikation i ny flik eller fönster >>Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus
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2019 (Engelska)Ingår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, nr 2, artikel-id e010634Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12-week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function.

Methods and Results: Twenty-two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard-care exercise recommendations ( PD ) or to a Paleolithic diet plus supervised exercise training 3 hours per week ( PD - EX ). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD - EX group showed significant decreases in myocardial triglycerides levels (-45%, P=0.038) and left ventricle mass to end-diastolic volume ratio (-13%, P=0.008) while the left ventricle end-diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group.

Conclusions: Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus.

Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01513798.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2019
Nyckelord
cardiovascular magnetic resonance imaging, diet, exercise, myocardial metabolism, type 2 diabetes mellitus
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:umu:diva-157046 (URN)10.1161/JAHA.118.010634 (DOI)000460105800010 ()30652528 (PubMedID)
Tillgänglig från: 2019-03-07 Skapad: 2019-03-07 Senast uppdaterad: 2019-03-27Bibliografiskt granskad
Otten, J., Stomby, A., Waling, M., Isaksson, A., Söderström, I., Ryberg, M., . . . Olsson, T. (2018). 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. Diabetologia, 61(7), 1548-1559
Öppna denna publikation i ny flik eller fönster >>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
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2018 (Engelska)Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, nr 7, s. 1548-1559Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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-H-2(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 Umca University Hospital, Umca, 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.

Ort, förlag, år, upplaga, sidor
Springer, 2018
Nyckelord
Exercise, Hyperinsulinaemic-euglycaemic clamp, Insulin sensitivity, Intramyocellular fat, Liver fat, Nutrition, Obesity, Paleolithic diet, Proton magnetic resonance spectroscopy, Weight loss
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:umu:diva-150764 (URN)10.1007/s00125-018-4618-y (DOI)000434250500007 ()29696296 (PubMedID)
Tillgänglig från: 2018-08-27 Skapad: 2018-08-27 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
Goedecke, J. H., Mendham, A. E., Clamp, L., Nankam, P. A. N., Fortuin-de Smidt, M. C., Phiri, L., . . . Olsson, T. (2018). An Exercise Intervention to Unravel the Mechanisms Underlying Insulin Resistance in a Cohort of Black South African Women: Protocol for a Randomized Controlled Trial and Baseline Characteristics of Participants. JMIR Research Protocols, 7(4), Article ID e75.
Öppna denna publikation i ny flik eller fönster >>An Exercise Intervention to Unravel the Mechanisms Underlying Insulin Resistance in a Cohort of Black South African Women: Protocol for a Randomized Controlled Trial and Baseline Characteristics of Participants
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2018 (Engelska)Ingår i: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 7, nr 4, artikel-id e75Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The pathogenesis of type 2 diabetes (T2D) in black African women is complex and differs from that in their white counterparts. However, earlier studies have been cross-sectional and provide little insight into the causal pathways. Exercise training is consistently used as a model to examine the mechanisms underlying insulin resistance and risk for T2D.

Objective: The objective of the study was to examine the mechanisms underlying the changes in insulin sensitivity and secretion in response to a 12-week exercise intervention in obese black South African (SA) women.

Methods: A total of 45 obese (body mass index, BMI: 30-40 kg/m2) black SA women were randomized into a control (n=22) or experimental (exercise; n=23) group. The exercise group completed 12 weeks of supervised combined aerobic and resistance training (40-60 min, 4 days/week), while the control group maintained their typical physical activity patterns, and both groups were requested not to change their dietary patterns. Before and following the 12-week intervention period, insulin sensitivity and secretion (frequently sampled intravenous glucose tolerance test) and its primary and secondary determinants were measured. Dietary intake, sleep quality and quantity, physical activity, and sedentary behaviors were measured every 4 weeks.

Results: The final sample included 20 exercise and 15 control participants. Baseline sociodemographics, cardiorespiratory fitness, anthropometry, cardiometabolic risk factors, physical activity, and diet did not differ between the groups (P>.05).

Conclusions: The study describes a research protocol for an exercise intervention to understand the mechanisms underlying insulin sensitivity and secretion in obese black SA women and aims to identify causal pathways underlying the high prevalence of insulin resistance and risk for T2D in black SA women, targeting specific areas for therapeutic intervention.

Ort, förlag, år, upplaga, sidor
JMIR PUBLICATIONS, INC, 2018
Nyckelord
diabetes mellitus type 2, insulin resistance, body fat distribution, adipose tissue, skeletal muscle, gastrointestinal microbiome, exercise, fatty liver, inflammation, energy metabolism, cardiorespiratory fitness, lipids, metabolomics, fatty acids, diet records, mitochondria, ectopic fat
Nationell ämneskategori
Näringslära
Identifikatorer
urn:nbn:se:umu:diva-151181 (URN)10.2196/resprot.9098 (DOI)000433882700008 ()29669711 (PubMedID)
Tillgänglig från: 2018-09-04 Skapad: 2018-09-04 Senast uppdaterad: 2018-09-04Bibliografiskt granskad
Otten, J., Stomby, A., Waling, M., Isaksson, A., Söderström, I., Ryberg, M., . . . Olsson, T. (2017). Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes. In: : . Paper presented at Cell Symposia Exercise Metabolism, 21-23 May, 2017, Gothenburg, Sweden.
Öppna denna publikation i ny flik eller fönster >>Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes
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2017 (Engelska)Konferensbidrag, Poster (med eller utan abstract) (Refereegranskat)
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:umu:diva-135408 (URN)
Konferens
Cell Symposia Exercise Metabolism, 21-23 May, 2017, Gothenburg, Sweden
Tillgänglig från: 2017-05-26 Skapad: 2017-05-26 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
Otten, J., Stomby, A., Waling, M., Isaksson, A., Söderström, I., Ryberg, M., . . . Olsson, T. (2017). Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes. In: : . Paper presented at Endokrindagarna, 1-3 februari 2017, Uppsala, Sweden.
Öppna denna publikation i ny flik eller fönster >>Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes
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2017 (Engelska)Konferensbidrag, Poster (med eller utan abstract) (Refereegranskat)
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:umu:diva-135409 (URN)
Konferens
Endokrindagarna, 1-3 februari 2017, Uppsala, Sweden
Tillgänglig från: 2017-05-26 Skapad: 2017-05-26 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
Otten, J., Stomby, A., Ryberg, M., Svensson, M., Hauksson, J. & Olsson, T. (2016). Effects of a paleolithic diet with and without supervised exercise on liver fat and insulin sensitivity: a randomised controlled trial in individuals with type 2 diabetes. Paper presented at 52nd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 12-16, 2016, Munich, GERMANY. Diabetologia, 59, S10-S10
Öppna denna publikation i ny flik eller fönster >>Effects of a paleolithic diet with and without supervised exercise on liver fat and insulin sensitivity: a randomised controlled trial in individuals with type 2 diabetes
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2016 (Engelska)Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 59, s. S10-S10Artikel i tidskrift, Meeting abstract (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
SPRINGER, 2016
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:umu:diva-134845 (URN)000398373700018 ()
Konferens
52nd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 12-16, 2016, Munich, GERMANY
Anmärkning

Supplement: 1, Meeting Abstract: 17

Tillgänglig från: 2017-05-19 Skapad: 2017-05-19 Senast uppdaterad: 2018-11-22Bibliografiskt granskad
Andersson, J., Mellberg, C., Otten, J., Ryberg, M., Rinnström, D., Larsson, C., . . . Olsson, T. (2016). Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention. International Journal of Cardiology, 216, 92-96
Öppna denna publikation i ny flik eller fönster >>Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention
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2016 (Engelska)Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 216, s. 92-96Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Accumulation of myocardial triglycerides (MTG) is associated with impaired left ventricular (LV) remodelling and function in obese and diabetic subjects. The role of MTG accumulation in development of heart failure in this group of patients is unknown. Short-term studies suggest that diets that lead to weight loss could mobilize MTG, with a favourable effect on cardiac remodelling. In a 24-month, randomized, investigator-blinded study, we assessed the effect of two different diets and subsequent weight loss on cardiac function and MTG in postmenopausal women. Methods: Sixty-eight healthy postmenopausal women with body mass index [BMI] >= 27 kg/m(2) were randomized to an ad libitum Palaeolithic diet (PD) or a Nordic Nutrition Recommendation (NNR) diet for 24 months. Morphology, cardiac function, and MTG levels were measured using magnetic resonance (MR) scanning, including proton spectroscopy at baseline and 6 and 24 months. Results: Despite mean weight losses of 4.9 (1.0) kg (NNR) and 7.8 (1.1) kg (PD), the MTG content did not change over time (p = 0.98 in the NNR and p = 0.11 in the PD group at 24 months). Reduced left ventricular mass was observed in both diet groups over 24 months. Blood pressure was reduced at 6 months, but returned to baseline levels at 24 months. End diastolic volume, stroke volume, and cardiac output decreased over time. No differences between diet groups were observed. Conclusions: Diet intervention and moderate weight loss over 24 months improved LV remodelling but did not alter MTG levels in overweight/obese postmenopausal women.

Nyckelord
Cardiac Magnetic Resonance (CMR) imaging, Diet, Metabolic heart disease, Obesity, Weight reduction
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:umu:diva-123040 (URN)10.1016/j.ijcard.2016.04.050 (DOI)000376820700015 ()27149238 (PubMedID)
Tillgänglig från: 2016-08-26 Skapad: 2016-06-27 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
Brynolfsson, P., Nilsson, D., Henriksson, R., Hauksson, J., Karlsson, M., Garpebring, A., . . . Asklund, T. (2014). ADC texture-An imaging biomarker for high-grade glioma?. Medical physics (Lancaster), 41(10), 101903
Öppna denna publikation i ny flik eller fönster >>ADC texture-An imaging biomarker for high-grade glioma?
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2014 (Engelska)Ingår i: Medical physics (Lancaster), ISSN 0094-2405, Vol. 41, nr 10, s. 101903-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose:

Survival for high-grade gliomas is poor, at least partly explained by intratumoral heterogeneity contributing to treatment resistance. Radiological evaluation of treatment response is in most cases limited to assessment of tumor size months after the initiation of therapy. Diffusion-weighted magnetic resonance imaging (MRI) and its estimate of the apparent diffusion coefficient (ADC) has been widely investigated, as it reflects tumor cellularity and proliferation. The aim of this study was to investigate texture analysis of ADC images in conjunction with multivariate image analysis as a means for identification of pretreatment imaging biomarkers.

Methods:

Twenty-three consecutive high-grade glioma patients were treated with radiotherapy (2 Gy/60 Gy) with concomitant and adjuvant temozolomide. ADC maps and T1-weighted anatomical images with and without contrast enhancement were collected prior to treatment, and (residual) tumor contrast enhancement was delineated. A gray-level co-occurrence matrix analysis was performed on the ADC maps in a cuboid encapsulating the tumor in coronal, sagittal, and transversal planes, giving a total of 60 textural descriptors for each tumor. In addition, similar examinations and analyses were performed at day 1, week 2, and week 6 into treatment. Principal component analysis (PCA) was applied to reduce dimensionality of the data, and the five largest components (scores) were used in subsequent analyses. MRI assessment three months after completion of radiochemotherapy was used for classifying tumor progression or regression.

Results:

The score scatter plots revealed that the first, third, and fifth components of the pretreatment examinations exhibited a pattern that strongly correlated to survival. Two groups could be identified: one with a median survival after diagnosis of 1099 days and one with 345 days, p = 0.0001.

Conclusions:

By combining PCA and texture analysis, ADC texture characteristics were identified, which seems to hold pretreatment prognostic information, independent of known prognostic factors such as age, stage, and surgical procedure. These findings encourage further studies with a larger patient cohort. (C) 2014 Author(s).

Nyckelord
texture analysis, glioma, multivariate image analysis, ADC
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:umu:diva-96625 (URN)10.1118/1.4894812 (DOI)000343032400019 ()
Tillgänglig från: 2014-11-27 Skapad: 2014-11-24 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
Ryberg, M., Sandberg, S., Mellberg, C., Stegle, O., Lindahl, B., Larsson, C., . . . Olsson, T. (2013). A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. Journal of Internal Medicine, 274(1), 67-76
Öppna denna publikation i ny flik eller fönster >>A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women
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2013 (Engelska)Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 274, nr 1, s. 67-76Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: Ectopic fat accumulation in liver and skeletal muscle may be an essential link between abdominal obesity, insulin resistance and increased risk of cardiovascular disease after menopause. We hypothesized that a diet containing a relatively high content of protein and unsaturated fat [mainly monounsaturated fatty acids (MUFAs)] but limited carbohydrates and saturated fat would reduce lipid content in liver and muscle and increase insulin sensitivity in postmenopausal women.

SUBJECTS: Ten healthy, nonsmoking postmenopausal women with a body mass index (BMI) >27 (28-35) kg m-2 were included in the study.

INTERVENTIONS: Participants were instructed to consume an ad libitum Palaeolithic-type diet intended to provide approximately 30 energy percentage (E%) protein, 40 E% fat (mainly MUFAs) and 30 E% carbohydrate. Intramyocellular lipid (IMCL) levels in calf muscles and liver triglyceride levels were quantified using proton magnetic resonance spectroscopy (1 H-MRS) before and 5 weeks after dietary intervention. Insulin sensitivity was estimated by homoeostasis model assessment (HOMA) indices and the euglycaemic hyperinsulinaemic clamp technique.

RESULTS: Mean energy intake decreased by 25% with a weight loss of 4.5 kg. BMI, waist and hip circumference, waist/hip ratio and abdominal sagittal diameter also decreased significantly, as did diastolic blood pressure (mean -7 mmHg), levels of fasting serum glucose, cholesterol, triglycerides, LDL/HDL cholesterol, apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1), urinary C-peptide and HOMA indices. Whole-body insulin sensitivity did not change. Liver triglyceride levels decreased by 49%, whereas IMCL levels in skeletal muscle were not significantly altered.

CONCLUSIONS: A modified Palaeolithic-type diet has strong and tissue-specific effects on ectopic lipid deposition in postmenopausal women.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2013
Nyckelord
adipose tissue, diet, fatty liver, insulin resistance, postmenopausal, weight
Nationell ämneskategori
Arbetsmedicin och miljömedicin Näringslära
Forskningsämne
Kostvetenskap
Identifikatorer
urn:nbn:se:umu:diva-67135 (URN)10.1111/joim.12048 (DOI)000320279000005 ()23414424 (PubMedID)
Tillgänglig från: 2013-03-14 Skapad: 2013-03-14 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ryberg, M., Sandberg, S., Mellberg, C., Stegle, O., Lindahl, B., Larsson, C., . . . Olsson, T. (2013). Tissue-specific effects on ectopic lipid deposition by a Palaeolithic-type diet in obese postmenopausal women. Journal of Internal Medicine, 274(1), 67-76
Öppna denna publikation i ny flik eller fönster >>Tissue-specific effects on ectopic lipid deposition by a Palaeolithic-type diet in obese postmenopausal women
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2013 (Engelska)Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 274, nr 1, s. 67-76Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives Ectopic fat accumulation in liver and skeletal muscle may be an essential link between abdominal obesity, insulin resistance and increased risk of cardiovascular disease after menopause. We hypothesized that a diet containing a relatively high content of protein and unsaturated fat [mainly monounsaturated fatty acids (MUFAs)] but limited carbohydrates and saturated fat would reduce lipid content in liver and muscle and increase insulin sensitivity in postmenopausal women.

Subjects Ten healthy, nonsmoking postmenopausal women with a body mass index (BMI) >27 (28–35) kg m−2 were included in the study.

Interventions Participants were instructed to consume an ad libitum Palaeolithic-type diet intended to provide approximately 30 energy percentage (E%) protein, 40 E% fat (mainly MUFAs) and 30 E% carbohydrate. Intramyocellular lipid (IMCL) levels in calf muscles and liver triglyceride levels were quantified using proton magnetic resonance spectroscopy (1H-MRS) before and 5 weeks after dietary intervention. Insulin sensitivity was estimated by homoeostasis model assessment (HOMA) indices and the euglycaemic hyperinsulinaemic clamp technique.

Results Mean energy intake decreased by 25% with a weight loss of 4.5 kg. BMI, waist and hip circumference, waist/hip ratio and abdominal sagittal diameter also decreased significantly, as did diastolic blood pressure (mean −7 mmHg), levels of fasting serum glucose, cholesterol, triglycerides, LDL/HDL cholesterol, apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1), urinary C-peptide and HOMA indices. Whole-body insulin sensitivity did not change. Liver triglyceride levels decreased by 49%, whereas IMCL levels in skeletal muscle were not significantly altered.

Conclusions A modified Palaeolithic-type diet has strong and tissue-specific effects on ectopic lipid deposition in postmenopausal women.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2013
Nyckelord
adipose tissue, diet, fatty liver, insulin resistance, postmenopausal, weight
Nationell ämneskategori
Arbetsmedicin och miljömedicin Allmänmedicin
Identifikatorer
urn:nbn:se:umu:diva-62255 (URN)10.1111/joim.12048 (DOI)000320279000005 ()
Tillgänglig från: 2012-12-13 Skapad: 2012-12-13 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
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