Exercise and Type 2 Diabetes.

The epidemic of diabetes mellitus has already become a serious global health threat. In the past three decades, the number of people with diabetes mellitus has quadrupled globally, and diabetes mellitus is known as the ninth major cause of death in the world nowadays. The increasing prevalence of type 2 diabetes mellitus is in coincidence with the augmentation of obesity in most developed countries as well as in developing countries. A sedentary lifestyle is well-known as one of the major reasons for the rising epidemic of type 2 diabetes mellitus besides the other reasons such as adopting energy-dense diets relative to the actual need for energy and population aging. Exercise as a regular physical activity at a medium to vigorous intensity is found to be an efficient influencer that would switch back most of the known type 2 diabetes mellitus factors toward healthier positions. Exercise is proven to have clinical benefits, such as improved insulin sensitivity, reductions in glycosylated hemoglobin (A1C) and increased peak oxygen consumption (VO2peak) which are definitely preventive toward diabetes. Exercise training can favorably affect glycemic parameters, the lipid profile, blood pressure, and high-sensitivity C-reactive protein. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, and regulates body weight by reducing body fat percentage and enhancing lean mass. In this chapter, the effect of regular exercise on the prevention of diabetes and short-term glucose and energy metabolism will be discussed. In addition, the effect of exercise on most common complications of type 2 diabetes including cardiovascular diseases, dyslipidemia, nephropathy, neuropathy, and retinopathy will be reviewed.

Effects of Exercise on the Immune Function, Quality of Life, and Mental Health in HIV/AIDS Individuals.

Physical exercise is a common type of planned physical activity in order to enhance or maintain a person's physical fitness. Physical exercise may act as an effective strategy to take control of certain conditions associated with HIV-1 infection. HIV infection and its related treatments not only affect the immune system but also cause several musculoskeletal disorders including pre-sarcopenia or sarcopenia, myalgia, and low bone mineral density. Moderate- to high-intensity aerobic exercise, progressive resistance exercise, or a combination of both is considered as a complementary part of medical care and treatment of HIV-infected individuals. In the present chapter, the results of recent investigations regarding the effects of physical activity on muscle strength and function, mental health, and immune system of HIV infected individuals will be discussed.

The effects of aerobic, resistance, and combined exercises on the plasma irisin levels, HOMA-IR, and lipid profiles in women with metabolic syndrome: A randomized controlled trial.

BACKGROUND/OBJECTIVE: Irisin is suggested to be an exercise beneficial effects mediator. This study aimed to examine the effects of the aerobic exercise (AE), resistance exercise (RE), and combined exercise (CE) on the plasma levels of irisin and some metabolic and anthropometric indices. METHODS: Sixty overweight women with metabolic syndrome were assigned equally into four groups: AE, RE, CE, and control. The study variables were measured before and 24 h after the intervention period. RESULTS: None of the study groups showed statistically significant changes in the serum irisin. However, muscle mass significantly increased in the RE and CE groups. Also, a significant decrease was observed in the body fat percentage in all groups. In addition, compared with the control group, the homeostatic model assessment of insulin resistance in the AE (p = 0.021), RE (p = 0.039), and in the CE (p = 0.003) groups reduced significantly. According to the analysis of indices' changes, serum irisin was significantly correlated with the body fat percentage (r = 0.532) and HOMA-IR (r = 0.424). CONCLUSIONS: The systematic exercise program for 8-weeks did not change circulating irisin and no statistically significant difference was observed between the exercise methods. Also, serum irisin seemed to be associated with the glycemic status, body fat and weight independent of exercise activity. RCT REGISTRATION CODE: IRCT20180806040721N2. REGISTRY NAME: Iranian Registry of Clinical Trials.

Greater adherence to the dietary approaches to stop hypertension (DASH) dietary pattern is associated with lower blood pressure in healthy Iranian primary school children.

PURPOSE: The dietary determinants of children blood pressure (BP) are poorly understood. We examined the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and BP in healthy Iranian primary school children. METHODS: This cross-sectional study was conducted among a representative sample (n = 407) of healthy Shirazi students aged 6-12 years. Subjects' systolic and diastolic BP were measured by a validated oscillometric BP monitor. Usual dietary intakes over the past 12 months were assessed using a valid and reproducible 168-item semi-quantitative food frequency questionnaire via face-to-face interviews. A DASH score was calculated for each subject based on his/her energy-adjusted intakes of 8 major dietary components emphasized or minimized in the DASH dietary pattern. The higher the DASH score of a subject, the more his/her adherence to the DASH dietary pattern. RESULTS: After controlling for several potential confounders in the analysis of covariance models, multivariable-adjusted means of systolic and mean BP of subjects in the highest tertile of DASH score were significantly lower than those in the lowest tertile (for systolic BP: mean difference -6.2 mmHg, P = 0.010; and for mean BP: mean difference -5.4 mmHg, P = 0.013). Furthermore, a similar but statistically insignificant difference was found in terms of multivariable-adjusted means of diastolic BP (mean difference -3.9 mmHg, P = 0.146). CONCLUSIONS: The findings suggest that greater adherence to the DASH dietary pattern is associated with lower BP in healthy Iranian primary school children. However, future prospective studies of adequate methodological quality are warranted to confirm these findings.

Toxic effects of subacute inhalation exposure to trichloroethylene on serum lipid profile, glucose and biochemical parameters in Sprague-Dawley rats.

The current study evaluated the inhalation toxicity of trichloroethylene (TCE) at 0, 10, 100, 250 and 400 ppm in Sprague-Dawley rats for 10 day period, because the subacute inhalation toxicity of TCE on serum lipid profile, glucose and some biochemical parameters has not been previously reported. TCE vapors were generated using the dynamic generation system based on evaporation method in the exposure chamber. On the basis of the results, mean serum low-density lipoprotein (LDL) and albumin (ALB) decreased significantly in all the groups exposed to TCE compared with the control group (p < .005), but there was a significant increase for parameters: fasting blood glucose (FBG) and alkaline phosphatase (ALP) (p < .005). Rats exposed to 400 ppm TCE showed a significant decrease in serum cholesterol (CHOL) and protein (Pr) compared with the control group (p < .005). A negative relationship was found between triglycerides (TG), very low density lipoprotein (VLDL), CHOL, LDL, Pr, ALB and urea levels and the subacute exposure to concentrations of TCE (R2 = -0.26, p < .05), but there was a direct correlation for parameters FBG, ALP and alanine aminotransferase (ALT) (R2 = 0.42, p < .05). In conclusion, studies with Sprague-Dawley rats demonstrated that subacute inhalation exposure to TCE (≥ 100 PPM) is associated with biochemical and lipotoxicity in the form of decreased serum ALB and LDL and raised ALP and glucose levels. The present study also provides additional evidence relating to decreased serum CHOL and Pr after subacute inhalation exposure to 400 ppm TCE.

A Western dietary pattern is associated with higher blood pressure in Iranian adolescents.

PURPOSE: The dietary determinants of adolescent blood pressure (BP) are not well understood. We determined the association between major dietary patterns and BP in a sample of Iranian adolescents. METHODS: This cross-sectional study was conducted among a representative sample (n = 557) of Shirazi adolescents aged 12-19 years. Participants' systolic and diastolic BP was measured using a validated oscillometric BP monitor. Usual dietary intakes during the past 12 months were assessed using a valid and reproducible 168-item semiquantitative food frequency questionnaire through face-to-face interviews. Principal component factor analysis was used to identify major dietary patterns based on a set of 25 predefined food groups. RESULTS: Overall, three major dietary patterns were identified, among which only the Western pattern (abundant in soft drinks, sweets and desserts, salt, mayonnaise, tea and coffee, salty snacks, high-fat dairy products, French fries, and red or processed meats) had a significant association with BP. After adjusting for potential confounders in the analysis of covariance models, multivariable adjusted means of the systolic and mean BP of subjects in the highest tertile of the Western pattern score were significantly higher than those in the lowest tertile (for systolic BP: mean difference 6.9 mmHg, P = 0.001; and for mean BP: mean difference 4.2 mmHg, P = 0.003). A similar but statistically insignificant difference was observed in terms of diastolic BP. CONCLUSIONS: The findings suggest that a Western dietary pattern is associated with higher BP in Iranian adolescents. However, additional large-scale prospective studies with adequate methodological quality are required to confirm these findings.

Adherence to a western dietary pattern and risk of invasive ductal and lobular breast carcinomas: a case-control study.

Little is known about the role of diet in the risk of invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast, the most common histological subtypes of breast cancer (BC). This is because, the majority of studies on the association of diet and the risk of BC are focused on single food items, and studies considering the overall diet in terms of dietary patterns are limited. Also, the potential heterogeneity in the impact of Western diet (WD) on histological subtypes of BC is not established. This, the age-frequency-matched case-control study included 1009 incident BC cases and 1009 healthy controls. The required data was obtained from the patients' medical files and interviews using a previously validated researcher-designed questionnaire for collecting data on socio-economic and anthropometric statuses and a valid food frequency questionnaire (FFQ) to measure the participants' dietary intake. We used multinomial logistic regression, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A positive and significant association was observed between higher adherence to a WD and risk of IDC (OR comparing highest with the lowest tertile: 2.45, 95% CI 1.88, 3.17; p-trend < 0.001), whereas no significant association was observed between adherence to the WD and the risk of ILC (OR comparing highest with the lowest tertile: 1.63, 95% CI 0.63, 3.25) (p for heterogeneity = 0.03). The results of an analysis stratified by menopausal status suggested a similar pattern. We provided evidence that adherence to a WD raises the risk of IDC, but not ILC, suggesting different etiological mechanisms for IDC and ILC.

The effects of high fructose fruits and honey on the serum level of metabolic factors and nonalcoholic fatty liver disease.

INTRODUCTION: The effect of the natural sources of fructose such as high fructose fruits and honey on the risk of fatty liver is still challenging. This study aimed to compare the effect of fructose, high fructose fruits, and honey on the metabolic factors and non-alcoholic fatty liver disease (NAFLD). METHODS: Forty-four rats were divided into four groups including normal diet group, high fructose group (HF), high fructose fruits group (HFF), and honey group (HO). After 120 days of intervention, the levels of insulin resistance, hepatic enzyme, and lipid profile were measured. Also, the expression levels of the acetyl-coA carboxylase (ACC), sterol regulatory element-binding protein 1c (SREBP-1c), Interleukin 6 (IL-6), and transforming growth factor-beta (TGF-ß) genes were assessed. In addition, a histopathologic assessment was performed on liver tissues. RESULTS: Insulin resistance (IR) increased significantly in the HF, HFF, and HO groups (All P < 0.05). The levels of liver enzymes was significantly increased only in the group receiving the HF regimen (P < 0.01). A significant decrease in total cholesterol and HDL-C (high density lipoprotein cholesterol) levels was found in HO group compared to the control group (P < 0.05). The expression levels of ACC and SREBP-1c genes in HF, HFF, and HO groups were significantly higher than the control group (All P < 0.05). The HF group had a greater increase in the level of gene expression of IL-6 and TGF-ß (All P < 0.05). Histopathological assessment did not find any changes in fatty liver formation and inflammatory damage. CONCLUSION: Consumption of fructose-rich honey and fruits improved the status of inflammatory markers and liver enzymes compared with the industrial fructose-rich products.

The effect of genistein on insulin resistance, inflammatory factors, lipid profile, and histopathologic indices in rats with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, irregular menstruation, ovulatory dysfunction, and insulin resistance. Recent studies have reported the possible role of phytoestrogens in PCOS. This animal study aimed to evaluate the effects of genistein on insulin resistance, inflammatory factors, lipid profile, and histopathologic indices on PCOS. METHODS: PCOS was induced by 1 mg/kg of letrozole in adult Sprague-Dawley rats. The rats then received normal saline (PCOS group), 150 mg/kg of metformin, or 20 mg/kg of genistein dissolved in 1% methylcellulose solution for 42 days. Body weight, the glycemic and lipid profile, and inflammatory, antioxidative, and histopathological parameters were assessed at the end of the intervention. RESULTS: Treatment with genistein significantly alleviated the increased level of fasting blood insulin (p=0.16) and the homeostatic model assessment of insulin resistance (p=0.012). In addition, the genistein group had significantly lower levels of serum malondialdehyde (p=0.039) and tumor necrosis factor-alpha (p=0.003), and higher superoxide dismutase enzyme activity (p<0.001). Furthermore, the histopathological analysis indicated that genistein administration led to an increase in luteinization and the development of fewer cysts (p<0.05). CONCLUSION: Biochemical and histopathological analyses indicated that genistein administration to rats with PCOS induced significant remission in oxidative, inflammatory, and glycemic and histopathologic parameters.

Dietary Patterns and Risk of Invasive Ductal and Lobular Breast Carcinomas: A Systematic Review and Meta-analysis.

The histopathologic subtypes of breast cancer, including invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC), differ in terms of risk factors, progression, and response to treatment. The PubMed/Medline, Web of Science, and Scopus databases were searched up to February 2020 for published studies on the association between dietary patterns (Western diet [WD] or Mediterranean diet [WD]) and the risk of IDC/ILC of breast. Multivariable adjusted relative risk (RR) and 95% confidence intervals (CIs) comparing the highest and lowest categories of WD and MD patterns were combined by using the random-effects meta-analyses. After searching the databases, 10 eligible studies on the association of diet and IDC (7 articles) and ILC (3 articles) were included in the analysis. A statistically significant adverse association was observed between MD and IDC in case-control studies (RR = 0.47; 95% CI, 0.39-0.55; I2 = 85.1%; P < .001). However, the association was nonsignificant in cohort studies (RR = 0.98; 95% CI, 0.92-1.05; I2 = 88.8%; P = .003). The pooled analysis also suggested a significant and direct association between the WD and the risk of IDC (RR = 1.36; 95% CI, 1.18-1.53; I2 = 63.7%; P = .017). The risk of ILC for the highest compared to the lowest category of MD was highly protective (RR = 0.76; 95% CI, 0.64-0.87; I2 = 89.2%; P < .001), and a marginally significant association was found between the WD and risk of ILC (RR = 1.45; 95% CI, 1.04-1.86), with no heterogeneity (I2 = 0; P = .52). This meta-analysis provides supporting evidence for the association between MD decreased risk of IDC and ILC of the breast and the association between WD and increased risk of IDC and ILC. Further investigations are needed to better understand the reasons behind the etiologic mechanisms of how dietary patterns affect patients differently by common breast cancer subtypes, including IDC and ILC.

Protection by pure and genistein fortified extra virgin olive oil, canola oil, and rice bran oil against acetic acid-induced ulcerative colitis in rats.

Genistein is a major isoflavone with antioxidant and anti-inflammatory activities and hydrophobic features. To increase its bioavailability, researchers supplemented genistein with dietary oils. The present study aims to compare the effectiveness of genistein supplementation with water solution or oils and find the best possible dietary oil for fortification. A total of 135 male Sprague-Dawley rats were randomly assigned to nine groups, including one control group and eight acetic acid-induced colitis groups. The rats in the intervention groups were treated with 5 ml per kg body weight of oral pure and genistein fortified forms of extra virgin olive oil (EVOO), canola oil (CaO), and rice bran oil (RBO); the Genistein group (G) received 100 mg per kg body weight of genistein in aqueous solution orally. The colitis and control groups did not receive any treatment. The levels of colonic MDA (malondialdehyde), MPO (myeloperoxidase) activity, and IL-1ß (interleukin-1ß) were evaluated and a stereological analysis of colonic tissues was performed. All of the dietary oils (EVOO, CaO, and RBO) were effective at ameliorating the rats' oxidative and inflammatory status (p < 0.05); however, EVOO (with or without genistein) prescription resulted in slightly better results, especially with regard to the inflammatory profile. Additionally, delivering genistein via an oil vehicle was more efficient at reducing MDA formation, MPO activity, and IL-1ß concentration than genistein in aqueous solution. The quantitative analysis of colonic tissue was consistent with the biochemical analysis. Our findings suggest that the oral administration of EVOO, canola oil, and rice bran oil can attenuate the elevated IL-1ß levels and oxidative damage in induced colitis. Moreover, genistein fortified oils, especially EVOO, showed more beneficial effects in decreasing these markers in comparison with the pure oils or genistein (aqueous solution).

A Randomized Controlled Trial on the Effects of 12 Weeks of Aerobic, Resistance, and Combined Exercises Training on the Serum Levels of Nesfatin-1, Irisin-1 and HOMA-IR.

Background/objective: This study aimed to investigate the impacts of a 12-week training of the aerobic exercise (AE), resistance exercise (RE), and combined exercise (CE) on the serum levels of nesfatin-1, irisin-1 and some other metabolic and anthropometric indices in overweight women with metabolic syndrome. Methods: Sixty overweight women with metabolic syndrome were assigned equally into four groups: aerobic exercise (AE, n = 15), resistance exercise (RE, n = 15), combined exercise (CE, n = 15), and control (n = 15). All groups underwent 12 weeks of intervention. The study variables were measured before and 24 h after the intervention period. Results: Twelve weeks of training resulted in an increase of irisin-1 in the AE and CE groups and nesfatin-1 in all the intervention groups. As expected, all the trained groups exhibited a positive alteration in anthropometric indices and lipid profile in comparison with the control group. Besides, compared with the control group, insulin resistance (based on the homeostatic model assessment) in AE (p = 0.022), RE (p = 0.032), and CE (p < 0.001) groups were reduced significantly. According to the observed changes in the measured indices, serum irisin-1 was significantly correlated with body weight, BMI, body fat percentage, fasting insulin, and HOMA-IR. However, with regard to nesfatin-1, only a negative correlation was observed with body fat percentage and LDL-cholesterol. Conclusions: The 12-week systematic training program changed circulating irisin-1 and nesfatin-1. Also, change in the serum irisin-1 and nesfatin-1 were correlated with the change in glycemic and anthropometric indices in addition to LDL-cholesterol. Also, exercise training significantly reduced fasting insulin and HOMA-IR in all the intervention groups. RCT Registration Code: IRCT20180806040721N2.

A comparison of the effects of Stevia extract and metformin on metabolic syndrome indices in rats fed with a high-fat, high-sucrose diet.

The beneficial effects of Stevia on metabolic indices have been studied in recent years. However, controversial results emphasize the need for further investigation. We aimed to examine and compare the effects of Stevia's hydroalcoholic extract with two dosages (200, 400 mg/kg) with those of metformin (100 mg/kg) on metabolic syndrome (MetS) indices of rats fed with a high-fat, high-sucrose diet (HFHS). It was found that both Stevia extract and metformin could prevent the adverse effects of a HFHS on lipid profile, liver enzymes, total antioxidant capacity (TAC), and histopathologic factors. Except for the finding that metformin showed a greater potential to alleviate insulin resistance than did Stevia extract, no significant difference was observed between the rats receiving metformin or Stevia extract. In addition, using a high treatment dosage of Stevia extract did not lead to better results than a low dosage. Collectively, the efficacy of Stevia extracts to modify metabolic, oxidative, and histopathological indices in a MetS model was comparable to that of the metformin. PRACTICAL APPLICATIONS: This study was aimed to compare the efficiency of Stevia hydroalcoholic extract with metformin in attenuating MetS abnormalities of rats induced by a high-fat, high-sucrose diet. The results showed the beneficial changes caused due to the administration of Stevia extract on lipid profile, antioxidant capacity, liver enzyme, and liver histopathological indices. The changes were comparable with the results of metformin group. Despite some promising results, further investigation is suggested to evaluate the effectiveness of Stevia extract on human subjects.

Genistein supplementation improves insulin resistance and inflammatory state in non-alcoholic fatty liver patients: A randomized, controlled trial.

BACKGROUND & AIMS: The beneficial effect of genistein has indicated on metabolic disorders and inflammatory state. The aim of this study was to investigate the effect of genistein supplementation on non-alcoholic fatty liver disease (NAFLD) as the hepatic manifest of metabolic syndrome. METHODS: In the present randomized double-blind controlled trial, patients with NAFLD were daily supplemented with either 250 mg genistein (n = 41) or placebo (n = 41) for 8-weeks. Both groups were instructed to follow an energy-balanced diet and physical activity recommendations. And their anthropometric and biochemical indices were assessed before and after the intervention. RESULTS: At the end of the study, the genistein group had lower level of serum insulin (p = 0.001) and homeostasis model assessment for insulin resistance (HOMA-IR) (p = 0.041) compare to the placebo group. In addition serum malondialdehyde (MDA) (p = 0.004), tumor necrosis factor-α (TNF-α) (p = 0.045) and interleukin (IL)-6 (p = 0.018) also were lower in the genistein group. Compare with placebo, genistein supplementation significantly reduced waist to hip ratio (p = 0.021), body fat percentage (p = 0.015) and triglyceride (p = 0.018). However, there were no significant changes in BMI, fasting blood glucose (p = 0.122), alanine aminotransferase (ALT) (p = 0.536), aspartate aminotransferase (AST) (p = 0.265) between the two groups. CONCLUSIONS: Oral supplementation with 250 mg genistein for 8-weeks can reduce insulin resistance, oxidative and inflammatory indices along with improvement in fat metabolism in patients with NAFLD. Studies with longer duration and larger samples might be needed to reveal other beneficial effects of genistein.

The Effect of 12 Weeks Aerobic, Resistance, and Combined Exercises on Omentin-1 Levels and Insulin Resistance among Type 2 Diabetic Middle-Aged Women.

BACKGROUND: Recent studies have shown that omentin-1 derived from adipokines can affect physiological regulations and some metabolic dis-eases such as type 2 diabetes mellitus (T2DM). METHODS: The purpose of this study was to examine the impact of 12 weeks of aerobic (cycle ergometer), resistance, and combined exercises on omentin-1 level, glucose and insulin resistance indices in overweight middle age women with T2DM. In this study, 60 overweight middle age diabetic women were selected using simple random sampling and they were assigned to three groups of aerobic exercise (n=12), resistant exercise (n=12) and combined exercise (n=13), and one control group (n=15). Exercises were done in a three times per week sessions for a total of 12 weeks. Blood samples were collected before each exercise session and 24 hours after of the last session. RESULTS: Present study showed that fasting blood sugar decreased significantly in all intervention groups, while homeostasis model assessment of insulin resistance (HOMA-IR) decreased only in the aerobic and combined exercises groups. Furthermore, there was a significant increase in the omentin-1 level only in the combined exercise group. CONCLUSION: Compared to aerobic and resistance exercises, 12 weeks of combined exercise was more efficient in improving HOMA-IR and increasing serum omentin-1 among women with T2DM.

Corrigendum: Author's Name and Affiliation Correction. The Effect of 12 Weeks Aerobic, Resistance, and Combined Exercises on Omentin-1 Levels and Insulin Resistance among Type 2 Diabetic Middle-Aged Women.

This corrects the article on p. 205 in vol. 41, PMID: 28537059.