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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
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.ORCID iD: 0000-0001-9016-1139
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.ORCID iD: 0000-0002-9169-1059
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.ORCID iD: 0000-0001-9743-8567
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
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2018 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, no 7, p. 1548-1559Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 61, no 7, p. 1548-1559
Keywords [en]
Exercise, Hyperinsulinaemic-euglycaemic clamp, Insulin sensitivity, Intramyocellular fat, Liver fat, Nutrition, Obesity, Paleolithic diet, Proton magnetic resonance spectroscopy, Weight loss
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-150764DOI: 10.1007/s00125-018-4618-yISI: 000434250500007PubMedID: 29696296OAI: oai:DiVA.org:umu-150764DiVA, id: diva2:1242046
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-08-27Bibliographically approved

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Otten, JuliaStomby, AndreasWaling, MariaIsaksson, AndreasSöderström, IngegerdRyberg, MatsSvensson, MichaelHauksson, JónOlsson, Tommy

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