Title

The effects of diet and/or exercise on the abdominal fat distribution, chronic low-grade inflammation, and metabolic status of postmenopausal women with type 2 diabetes

Date of Award

2003

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Science Teaching

Advisor(s)

Jill A. Kanaley

Keywords

Exercise, Abdominal fat, Inflammation, Postmenopausal, Women, Diabetes

Subject Categories

Communication | Dietetics and Clinical Nutrition | Health Communication | Medicine and Health Sciences | Social and Behavioral Sciences

Abstract

Abdominal obesity, abnormal secretion of adipocytokines and chronic-low grade inflammation are proposed to contribute to the development of type 2 diabetes. How diet and exercise specifically affect these disorders is not clear. This study investigated the effects of diet and exercise on the abdominal obesity, adipocytokine and inflammatory protein levels of postmenopausal women with type 2 diabetes. A secondary purpose was to identify the level of "diabetes scientific literacy" of this population, and the adequacy of their diabetes education. Following 14 weeks of diet (D) and diet + exercise (D + E) intervention, significant reductions were observed in total abdominal fat and subcutaneous fat (SAT) from pre to post (total abdominal fat: D = -7%, D + E = -11%; SAT: D = -8%, D + -E = -10%), and decreases in fasting blood glucose (D: -14%, D + E: -26%) and total cholesterol levels (D: -5%, D + E: -9%). The addition of exercise (EX) to diet resulted in greater reductions (13%) in visceral adiposity (VAT) suggesting that exercise is essential in the weight loss treatment. Reductions in total abdominal fat and SAT contributed to 57% and 9.7%, respectively, of the variability in fasting glucose changes, while the reductions in VAT contributed to 15.9% of the changes in fasting insulin. Further, we demonstrated for the first time clinically relevant reductions in two inflammatory markers, interleukin 6 (IL-6) (D: -12%; D + E: -27%) and C-reactive protein (CRP) (D: -13%; D + E: -18%) with the D and D + E intervention. Plasma leptin levels were significantly reduced (D: 20% D + E: -40.5%) and adiponectin levels were slightly elevated (D: +17%; D + E: +31%), while EX had no effect on their concentration. These changes were partly explained by changes in abdominal adiposity, and were related to insulin sensitivity improvements. Lastly, women were found to have adequate understanding of the type 2 diabetes physiology, but to have difficulty understanding the scientific terminology of the disease. Further, the diabetes education that the women received from the diabetes practitioners was rated as inadequate. In conclusion, the combination of diet and exercise appears to be the most beneficial treatment for improvements in abdominal adiposity, inflammatory and adipose-derived cytokines, and metabolic status of postmenopausal women with type 2 diabetes.

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