Acta Diabetologica

, Volume 51, Issue 3, pp 369–375

Relationships between cardiorespiratory fitness, metabolic control, and fat distribution in type 2 diabetes subjects

  • Elisabetta Bacchi
  • Carlo Negri
  • Cantor Tarperi
  • Anna Baraldo
  • Niccolò Faccioli
  • Chiara Milanese
  • Maria Elisabetta Zanolin
  • Massimo Lanza
  • Antonio Cevese
  • Enzo Bonora
  • Federico Schena
  • Paolo Moghetti
Original Article

Abstract

Factors contributing to the reduced cardiorespiratory fitness typical of sedentary subjects with type 2 diabetes are still largely unknown. In this study, we assessed the relationships between cardiorespiratory fitness and abdominal and skeletal muscle fat content in 39 untrained type 2 diabetes subjects, 27 males and 12 females (mean ± SD age 56.5 ± 7.3 year, BMI 29.4 ± 4.7 kg/m2). Peak oxygen uptake (VO2peak) and ventilatory threshold (VO2VT) were assessed by maximal cycle ergometer exercise test, insulin sensitivity by euglycemic–hyperinsulinemic clamp, and body composition by dual-energy X-ray absorptiometry. Magnetic resonance imaging was used to evaluate visceral, total subcutaneous (SAT), superficial (SSAT) and deep sub-depots of subcutaneous abdominal adipose tissue, and sagittal abdominal diameter (SAD), as well as femoral quadriceps skeletal muscle fat content. In univariate analysis, both VO2peak and VO2VT were inversely associated with BMI, total fat mass, SAT, SSAT, and sagittal abdominal diameter. VO2peak was also inversely associated with skeletal muscle fat content. A significant direct association was observed between VO2VT and insulin sensitivity. No associations between cardiorespiratory fitness parameters and metabolic profile data were found. In multivariable regression analysis, after adjusting for age and gender, VO2peak was independently predicted by higher HDL cholesterol, and lower SAD and skeletal muscle fat content (R2 = 0.64, p < 0.001), whereas VO2VT was predicted only by sagittal abdominal diameter (R2 = 0.48, p = 0.025). In conclusion, in untrained type 2 diabetes subjects, peak oxygen uptake is associated with sagittal abdominal diameter, skeletal muscle fat content, and HDL cholesterol levels. Future research should target these features in prospective intervention studies.

Keywords

Type 2 diabetes Peak oxygen uptake Insulin resistance Sagittal abdominal diameter Skeletal muscle fat content 

References

  1. 1.
    Regensteiner JG, Bauer TA, Reusch JE et al (1998) Abnormal oxygen uptake kinetic responses in women with type II diabetes mellitus. J Appl Physiol 85:310–317PubMedGoogle Scholar
  2. 2.
    Garber CE, Blissmer B, Deschenes MR et al (2011) American college of sports medicine. American college of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359PubMedCrossRefGoogle Scholar
  3. 3.
    Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN (2000) Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 132:605–611PubMedCrossRefGoogle Scholar
  4. 4.
    Bacchi E, Negri C, Zanolin ME et al (2012) Metabolic effects of aerobic training and resistance training in type 2 diabetes subjects: randomized controlled trial (the READ2 study). Diabetes Care 35:676–682PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502PubMedGoogle Scholar
  6. 6.
    Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60:2020–2027PubMedGoogle Scholar
  7. 7.
    DeFronzo RA, Tobin JD, Andres R (1979) Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237:E214–E223PubMedGoogle Scholar
  8. 8.
    Wokke BH, Bos C, Reijnierse M et al (2013) Comparison of dixon and T1-weighted MR methods to assess the degree of fat infiltration in duchenne muscular dystrophy patients. Magn Reson Imaging [Epub ahead of print]Google Scholar
  9. 9.
    Shen W, Wang ZM, Punyanita M et al (2003) Adipose tissue quantification by imaging methods: a proposed classification. Obes Res 11:5–16PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Johnson D, Dixon AK, Abrahams PH (1996) The abdominal subcutaneous tissue: computed tomographic, magnetic resonance, and anatomical observations. Clin Anat 9:19–24PubMedCrossRefGoogle Scholar
  11. 11.
    Guzzaloni G, Minocci A, Marzullo P, Liuzzi A (2009) Sagittal abdominal diameter is more predictive of cardiovascular risk than abdominal fat compartments in severe obesity. Int J Obes 33:233–238CrossRefGoogle Scholar
  12. 12.
    Risérus U, Arnlöv J, Brismar K, Zethelius B, Berglund L, Vessby B (2004) Sagittal abdominal diameter is a strong anthropometric marker of insulin resistance and hyperproinsulinemia in obese men. Diabetes Care 27:2041–2046PubMedCrossRefGoogle Scholar
  13. 13.
    Schoen RE, Thaete FL, Sankey SS, Weissfeld JL, Kuller LH (1998) Sagittal diameter in comparison with single slice CT as a predictor of total visceral adipose tissue volume. Int J Obes Relat Metab Disord 22:338–342PubMedCrossRefGoogle Scholar
  14. 14.
    Kelley DE, He J, Menshikova EV, Ritov VB (2002) Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes. Diabetes 51:2944–2950PubMedCrossRefGoogle Scholar
  15. 15.
    Højlund K, Mogensen M, Sahlin K, Beck-Nielsen H (2008) Mitochondrial dysfunction in type 2 diabetes and obesity. Endocrinol Metab Clin North Am 37:713–731PubMedCrossRefGoogle Scholar
  16. 16.
    Havel RJ, Carlson LA, Ekelund LG, Holmgren A (1964) Turnover rate and oxidation of different free fatty acids in man during exercise. J Appl Physiol 19:613–618PubMedGoogle Scholar
  17. 17.
    Van Pelt RE, Davy KP, Stevenson ET et al (1998) Smaller differences in total and regional adiposity with age in women who regularly perform endurance exercise. Am J Physiol 275:E626–E634PubMedGoogle Scholar
  18. 18.
    Horber FF, Kohler SA, Lippuner K, Jaeger P (1996) Effect of regular physical training on age-associated alteration of body composition in men. Eur J Clin Invest 26:279–285PubMedCrossRefGoogle Scholar
  19. 19.
    Hunter GR, Kekes-Szabo T, Treuth MS, Williams MJ, Goran M, Pichon C (1996) Intra-abdominal adipose tissue, physical activity and cardiovascular risk in pre- and post-menopausal women. Int J Obes 20:860–865Google Scholar
  20. 20.
    Regensteiner JG, Sippel J, McFarling ET, Wolfel EE, Hiatt WR (1995) Effects of non–insulin dependent diabetes on oxygen consumption during treadmill exercise. Med Sci Sports Exerc 27:875–881PubMedCrossRefGoogle Scholar
  21. 21.
    Dwyer GB, Wallace JP, Whaley MH (1994) Influence of metabolic control on the ventilatory threshold in adults with non insulin-dependent diabetes mellitus. Diabetes Res 25:39–46PubMedGoogle Scholar
  22. 22.
    Modan M, Meytes D, Rozeman P et al (1988) Significance of high HbA1 levels in normal glucose tolerance. Diabetes Care 11:422–428PubMedCrossRefGoogle Scholar
  23. 23.
    Brassard P, Ferland A, Bogaty P, Desmeules M, Jobin J, Poirier P (2006) Influence of glycemic control on pulmonary function and heart rate in response to exercise in subjects with type 2 diabetes mellitus. Metabolism 55:1532–1537PubMedCrossRefGoogle Scholar
  24. 24.
    Demir I, Ermiş C, Altunbaş H, Balci MK (2001) Serum HbA1c levels and exercise capacity in diabetic patients. Jpn Heart J 42:607–616PubMedCrossRefGoogle Scholar
  25. 25.
    Vanninen E, Uusitupa M, Remes J et al (1992) Relationship between hyperglycaemia and aerobic power in men with newly diagnosed type 2 (non insulin-dependent) diabetes. Clin Physiol 12:667–677PubMedCrossRefGoogle Scholar
  26. 26.
    Kraus WE, Houmard JA, Duscha BD et al (2002) Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 347:1483–1492PubMedCrossRefGoogle Scholar
  27. 27.
    Mauer K, Exaire JE, Stoner JA, Guthery LD, Montgomery PS, Gardner AW (2010) Reduced high-density lipoprotein level is linked to worse ankle brachial index and peak oxygen uptake in postmenopausal women with peripheral arterial disease. Angiology 61:698–704PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Haufe S, Engeli S, Budziarek P et al (2010) Cardiorespiratory fitness and insulin sensitivity in overweight or obese subjects may be linked through intrahepatic lipid content. Diabetes 59:1640–1647PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Seibaek M, Vestergaard H, Burchardt H et al (2003) Insulin resistance and maximal oxygen uptake. Clin Cardiol 26:515–520PubMedCrossRefGoogle Scholar
  30. 30.
    Fischer MA, Nanz D, Shimakawa A et al (2013) Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology 266:555–563PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Elisabetta Bacchi
    • 2
  • Carlo Negri
    • 1
  • Cantor Tarperi
    • 3
  • Anna Baraldo
    • 3
  • Niccolò Faccioli
    • 4
  • Chiara Milanese
    • 3
  • Maria Elisabetta Zanolin
    • 5
  • Massimo Lanza
    • 3
  • Antonio Cevese
    • 3
  • Enzo Bonora
    • 1
    • 2
  • Federico Schena
    • 3
  • Paolo Moghetti
    • 1
    • 2
  1. 1.Unit of Endocrinology and MetabolismAzienda Ospedaliera Universitaria IntegrataVeronaItaly
  2. 2.Unit of Endocrinology and Metabolism, Department of MedicineUniversity of VeronaVeronaItaly
  3. 3.Department of Neurological, Neuropsychological, Morphological and Movement SciencesUniversity of VeronaVeronaItaly
  4. 4.Unit of RadiologyAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
  5. 5.Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly

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