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Middle-aged overweight South Asian men exhibit a different metabolic adaptation to short-term energy restriction compared with Europeans

Abstract

Aims/hypothesis

South Asians have a higher risk of developing type 2 diabetes than Europeans. The underlying cause of this excess risk is still poorly understood but might be related to differences in the regulation of energy/nutrient-sensing pathways in metabolic tissues and subsequent changes in whole-body substrate metabolism. In this study, we investigated the whole-body and skeletal muscle metabolic adaptations to short-term energy restriction in South Asian and European volunteers.

Methods

Twenty-four middle-aged overweight South Asian and European men underwent a two-step hyperinsulinaemic–euglycaemic clamp, with skeletal muscle biopsies and indirect calorimetry before and after an 8 day diet very low in energy (very low calorie diet [VLCD]). Abdominal fat distribution and hepatic triacylglycerol content were assessed using MRI and MR spectroscopy.

Results

South Asian men had higher hepatic triacylglycerol content than European men, and exhibited elevated clamp insulin levels that probably reflect a lower insulin clearance rate. Despite higher insulin levels, endogenous glucose production rate was similar and glucose disposal rate (Rd) and nonoxidative glucose disposal rate (NOGD) were significantly lower in South Asian than European men, indicating impaired whole-body insulin sensitivity. Energy restriction decreased abdominal fat mass and hepatic triacylglycerol content in both groups. However, the shift induced by energy restriction from glucose towards lipid oxidation observed in European men was impaired in South Asian men, indicating whole-body metabolic inflexibility. Remarkably, although energy restriction improved hepatic insulin sensitivity in both groups, Rd improved only in South Asian men owing to higher NOGD. At the molecular level, an increase in insulin-induced activation of the skeletal muscle mTOR pathway was found in South Asian men, showing that skeletal muscle energy/nutrient-sensing pathways were differentially affected by energy restriction.

Conclusions/interpretation

We conclude that South Asian men exhibit a different metabolic adaptation to short-term energy restriction than European men.

Trial registration: Dutch trial registry (www.trialregister.nl), trial number NTR 2473.

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Abbreviations

4EBP1:

Eukaryotic translation initiation factor 4E-binding protein 1

ACC:

Acetyl-CoA carboxylase

AMPK:

AMP-activated protein kinase

AS160:

Akt substrate of 160 kDa

EGP:

Endogenous glucose production

ERK:

Extracellular signal-regulated kinase

GS:

Glycogen synthase

GSK3:

Glycogen synthase kinase-3

HIR:

Hepatic insulin resistance

IQR:

Interquartile range

IRβ:

Insulin receptor β

IRS1:

Insulin receptor substrate 1

LBM:

Lean body mass

MCRi :

Metabolic clearance rate of insulin

mtDNA:

Mitochondrial DNA

mTOR:

Mammalian target of rapamycin

mTORC1:

Mammalian target of rapamycin complex 1

nDNA:

Nuclear DNA

NEFA:

Nonesterified fatty acid

NOGD:

Nonoxidative glucose disposal

PKB:

Protein kinase B

PPARα:

Peroxisome proliferator-activated receptor α

PRAS40:

Proline-rich Akt substrate of 40 kDa

Rd :

Rate of glucose disposal

REE:

Resting energy expenditure

RQ:

Respiratory quotient

S6K1:

Ribosomal protein S6 kinase β1

TSC2:

Tuberous sclerosis complex 2

VLCD:

Very low calorie diet

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Acknowledgements

We are greatly indebted to E. J. M. Ladan-Eygenraam (Leiden University Medical Centre, Leiden, the Netherlands) for her technical assistance during the study.

Funding

We thank Roba Metals B. V. IJsselstein (Utrecht, the Netherlands) for financial support. Funding by the Netherlands Heart Foundation (Project UL 2009-4548) is gratefully acknowledged (The Hague, the Netherlands). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

All authors have read and approved the final version of the manuscript, and meet all three conditions as stated by the International Committee of Medical Journal Editors uniform requirements for manuscripts submitted to medical journals. LEHB contributed to the acquisition, analysis and interpretation of all data and drafted the manuscript. BG contributed to the acquisition, analysis and interpretation of skeletal muscle data and reviewed the manuscript. LDS contributed to the acquisition, analysis and interpretation of MR data and reviewed the manuscript. GCMZ contributed to the acquisition of skeletal muscle data and reviewed the manuscript. TCMS contributed to the acquisition of clamp data and reviewed the manuscript. JBK provided the statistical model, contributed to the analysis of data and reviewed the manuscript. JTJ contributed to the design of the MR protocol, contributed to the acquisition and interpretation of MR data and reviewed the manuscript. HJL contributed to the analysis and interpretation of MR data and reviewed the manuscript. JWAS contributed to the conception and design of the MR protocol, contributed to the analysis and interpretation of data and reviewed the manuscript. HP contributed to the analysis and interpretation of data and reviewed the manuscript. AEM contributed to the conception and design of the study protocol, contributed to the analysis and interpretation of all data and reviewed the manuscript. IMJ contributed to the conception and design of the protocol, contributed to the acquisition, analysis and interpretation of all data and reviewed the manuscript.

LEHB and IMJ are the guarantors of this work and, as such, have full access to all the data generated in the framework of the study and take responsibility for their integrity and the accuracy of their analysis.

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Correspondence to Leontine E. H. Bakker.

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Bakker, L.E.H., Guigas, B., van Schinkel, L.D. et al. Middle-aged overweight South Asian men exhibit a different metabolic adaptation to short-term energy restriction compared with Europeans. Diabetologia 58, 165–177 (2015). https://doi.org/10.1007/s00125-014-3408-4

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  • DOI: https://doi.org/10.1007/s00125-014-3408-4

Keywords

  • Caloric restriction
  • Energy restriction
  • European
  • Hyperinsulinaemic–euglycaemic clamp
  • Mammalian target of rapamycin
  • Metabolic flexibility
  • mTOR
  • Skeletal muscle
  • South Asian
  • Very low calorie diet