Advertisement

International Journal of Biometeorology

, Volume 59, Issue 7, pp 783–789 | Cite as

Clinical and biochemical effects of a 3-week program of diet combined with spa therapy in obese and diabetic patients: a pilot open study

  • Antonella FioravantiEmail author
  • Przemysław Adamczyk
  • Nicola Antonio Pascarelli
  • Chiara Giannitti
  • Renato Urso
  • Michał Tołodziecki
  • Irena Ponikowska
Original Paper

Abstract

Obesity is a major risk factor for arterial hypertension, coronary artery disease, dyslipidemias, and type 2 diabetes. Spa therapy has long been used for treating obesity and its comorbidities. Enlargement of adipose tissue has been linked to a dysregulation of adipokine secretion and adipose tissue inflammation. Adipokines are currently investigated as potential drug targets in these conditions. Our primary aim was to assess the clinical efficacy of a 3-week program of diet combined with spa therapy in obese patients with and without type 2 diabetes. The secondary aim was to examine whether this combined program influences the response of serum levels of leptin, adiponectin, visfatin, and high-sensitivity C-reactive protein. Fifty obese males were enrolled and 21 of these featured a type 2 diabetes. During the 3-week period of the study, the patients were on a 1,000-kcal diet and were involved in mineral bath and total body’s mud-pack applications (15 procedures). Patients were assessed at baseline and at the end of the therapy for clinical and biochemical parameters (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glycemia, and adipokines). We showed that a 3-week program of spa therapy in obese patients induced significant decrease of body weight, body mass index, triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, glycemia, and serum levels of leptin and high-sensitivity C-reactive protein. So, a cycle of mud-bath therapy associated with a controlled diet may be a promising treatment for obesity and type 2 diabetes decreasing body weight and many risk factors for atherosclerosis and metabolic syndrome.

Keywords

Obesity Type 2 diabetes Spa therapy Adipokines Weight Body mass index 

Abbreviations

TNF

Tumor necrosis factor

hs-CRP

High-sensitivity C-reactive protein

BMI

Body mass index

NaCl

Sodium chloride

HDL-C

High-density lipoprotein cholesterol

LDL-C

Low-density lipoprotein cholesterol

EIA

Enzyme immunoassay

ELISA

Enzyme-linked immunosorbent assay

LMW

Low molecular weight

HMW

High molecular weight

References

  1. AL-Suhaimi EA, Shehzad A (2013) Leptin, resistin and visfatin: the missing link between endocrine metabolic disorders and immunity. Eur J Med Res 13:12. doi: 10.1186/2047-783X-18-12 CrossRefGoogle Scholar
  2. American Diabetes Association (1997) Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20:1183–1197CrossRefGoogle Scholar
  3. American Medical Association (2013) Obesity as a disease policy statement. http://www.ama-assn.org/assets/meeting/2013a/a13-addendum-refcomm-d.pdf#page=19
  4. Anand SS, Yusuf S (2010) C-reactive protein is a bystander of cardiovascular disease. Eur Heart J 31:2092–2096. doi: 10.1093/eurheartj/ehq242 CrossRefGoogle Scholar
  5. Bender T, Karagülle Z, Bálint GP, Gutenbrunner C, Bálint PV, Sukenik S (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25:220–224. doi: 10.1007/s00296-004-0487-4 CrossRefGoogle Scholar
  6. Cantarini L, Brucato A, Simonini G et al (2013) Leptin, adiponectin, resistin, visfatin serum levels and idiopathic recurrent pericarditis: biomarkers of disease activity? A preliminary report. Clin Exp Rheumatol 31:207–212Google Scholar
  7. Chang YH, Chang DM, Lin KC, Shin SJ, Lee YJ (2011) Visfatin in overweight/obesity, type 2 diabetes mellitus, insulin resistance, metabolic syndrome and cardiovascular diseases: a meta-analysis and systematic review. Diabetes Metab Res Rev 27:515–527. doi: 10.1002/dmrr.1201 CrossRefGoogle Scholar
  8. Deng Y, Scherer PE (2010) Adipokines as novel biomarkers and regulators of the metabolic syndrome. Ann N Y Acad Sci 1212:E1–E19. doi: 10.1111/j.1749-6632.2010.05875.x CrossRefGoogle Scholar
  9. Development Core Team R (2006) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
  10. Fantuzzi G (2005) Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 115:911–919. doi: 10.1016/j.jaci.2005.02.023 CrossRefGoogle Scholar
  11. Festa A, D’Agostino RJ, Howard G, Mykkänen L, Tracy RP, Haffner SM (2000) Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 102:42–47. doi: 10.1161/01.CIR.102.1.42 CrossRefGoogle Scholar
  12. Fioravanti A, Cantarini L, Bacarelli MR, de Lalla A, Ceccatelli L, Blardi P (2011) Effects of spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Rheumatol Int 31:879–882. doi: 10.1007/s00296-010-1401-x CrossRefGoogle Scholar
  13. Fukuhara A, Matsuda M, Nishizawa M et al (2005) Visfatin: a protein secreted by visceral fat that mimics the effects of insulin. Science 307:426–430. doi: 10.1126/science.1097243 CrossRefGoogle Scholar
  14. Hanh T, Serog P, Fauconnier J, Batailler P, Mercier F, Roques CF, Blin P (2012) One-year effectiveness of a 3-week balneotherapy program for the treatment of overweight or obesity. Evid Based Complement Alternat Med 2012:150839. doi: 10.1155/2012/150839 CrossRefGoogle Scholar
  15. Hooper PL (1999) Hot-tub therapy for type 2 diabetes mellitus. N Engl J Med 341:924–925. doi: 10.1056/NEJM199909163411216 CrossRefGoogle Scholar
  16. Hosseinzadeh-Attar MJ, Golpaie A, Janani L, Derakhshanian H (2013) Effect of weight reduction following bariatric surgery on serum visfatin and adiponectin levels in morbidly obese subjects. Obes Facts 6:193–202. doi: 10.1159/000351162 CrossRefGoogle Scholar
  17. Kahn SE, Hull RL, Utzschneider KM (2006) Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444:840–846. doi: 10.1038/nature05482 CrossRefGoogle Scholar
  18. Kershaw EE, Flier JS (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89:2578–2556. doi: 10.1210/jc.2004-0395 Google Scholar
  19. Komura N, Kihara S, Sonoda M (2008) Clinical significance of high-molecular weight form of adiponectin in male patients with coronary artery disease. Circ J 72:23–28. doi: 10.1253/circj.72.23 CrossRefGoogle Scholar
  20. LeBlanc E, O’Connor E, Whitlock EP, Patnode C, Kapka T (2011) Screening for and management of obesity and overweight in adults. Evidence Synthesis No 89. Rockville MD, Agency for Healthcare Research and Quality, USAGoogle Scholar
  21. Lumeng CN, Saltiel AR (2011) Inflammatory links between obesity and metabolic disease. J Clin Invest 121:2111–2117. doi: 10.1172/JCI57132 CrossRefGoogle Scholar
  22. Madsen EL, Rissanen A, Bruun JM, Skogstrand K, Tonstad S, Hougaard DM, Richelsen B (2008) Weight loss larger than 10% is needed for general improvement of levels of circulating adiponectin and markers of inflammation in obese subjects: a 3-year weight loss study. Eur J Endocrinol 158:179–187. doi: 10.1530/EJE-07-0721 CrossRefGoogle Scholar
  23. Mokdad AH, Ford ES, Bowman BA, Nelson DE, Engelgau MM, Vinicor F, Marks JS (2000) Diabetes trends in the US: 1990–1998. Diabetes Care 23:1278–1283CrossRefGoogle Scholar
  24. Montecucco F, Steffens S, Burger F, Pelli G, Monaco C, Mach F (2008) C-reactive protein (CRP) induces chemokine secretion via CD11b/ICAM-1 interaction in human adherent monocytes. J Leukoc Biol 84:1109–1119. doi: 10.1189/jlb.0208123 CrossRefGoogle Scholar
  25. Ohtsuka Y, Yabunaka N, Watanabe I, Noro H, Agishi Y (1996) Balneotherapy and platelet glutathione metabolism in type II diabetic patients. Int J Biometeorol 39:156–159CrossRefGoogle Scholar
  26. Oláh M, Koncz Á, Fehér J, Kálmánczhey J, Oláh C, Balogh S, Nagy G, Bender T (2010) The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels. Int J Biometeorol 54:249–254. doi: 10.1007/s00484-009-0276-6 CrossRefGoogle Scholar
  27. Oláh M, Koncz Á, Fehér J, Kálmánczhey J, Oláh C, Nagy G, Bender T (2011) The effect of balneotherapy on antioxidant, inflammatory, and metabolic indices in patients with cardiovascular risk factors (hypertension and obesity)—a randomised, controlled, follow-up study. Contemp Clin Trials 32:793–801. doi: 10.1016/j.cct.2011.06.003 CrossRefGoogle Scholar
  28. Petersen KF, Oral EA, Dufour S et al (2002) Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. J Clin Invest 109:1345–1350. doi: 10.1172/JCI15001 CrossRefGoogle Scholar
  29. Pinheiro J, Bates D, DebRoy S, Sarkar D, the R Development Core team (2012) Nlme: linear and nonlinear mixed effects models (R Package Version 3.1-103).Google Scholar
  30. Punzi L, Ramonda R, Deberg M, Frallonardo P, Campana C, Musacchio E, Henrotin Y (2012) Coll2-1, Coll2-1NO2 and myeloperoxidase serum levels in erosive and non-erosive osteoarthritis of the hands. Osteoarthr Cartil 20:557–561. doi: 10.1016/j.joca.2012.02.638 CrossRefGoogle Scholar
  31. Reilly JJ, Kelly J (2011) Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond) 35:891–898. doi: 10.1038/ijo.2010.222 CrossRefGoogle Scholar
  32. Revelle W (2013) psych: procedures for personality and psychological research, North Western University, Evanston, Illinois, USA. http://CRAN.R-project.org/package=psych Version = 1.3.2
  33. Rolland C, Hession M, Broom L (2011) Effect of weight loss on adipokine levels in obese patients. Diabetes Metab Syndr Obes 4:315–323. doi: 10.2147/DMSO.S22788 CrossRefGoogle Scholar
  34. Samad F, Ruf W (2013) Inflammation, obesity, and thrombosis. Blood 122:3415–3422. doi: 10.1182/blood-2013-05-427708 CrossRefGoogle Scholar
  35. Shimodozono M, Matsumoto S, Ninomiya K, Miyata R, Ogata A, Etoh S, Watanabe S, Kawahira K (2012) Acute effects of a single warm-water bath on serum adiponectin and leptin levels in healthy men: a pilot study. Int J Biometeorol 56:933–999. doi: 10.1007/s00484-011-0502-x CrossRefGoogle Scholar
  36. Swarbrick M, Stanhope K, Austrheim-Smith I, Van Loan M, Ali M, Wolfe B, Havel PJ (2008) Longitudinal changes in pancreatic and adipocyte hormones following Roux-en-Y gastric bypass surgery. Diabetologia 51:1901–1911. doi: 10.1007/s00125-008-1118-5 CrossRefGoogle Scholar
  37. WHO (2011) Obesity and overweight. http://www.who.int/ mediacentre/factsheets/fs311/en/index.html.
  38. Widjaja A, Stratton IM, Horn R, Holman RR, Turner R, Brabant G (1997) UKPDS 20: plasma leptin, obesity, and plasma insulin in type 2 diabetic subjects. J Clin Endocrinol Metab 82:654–657CrossRefGoogle Scholar
  39. Zakynthinos E, Pappa N (2009) Inflammatory biomarkers in coronary artery disease. J Cardiol 53:317–333. doi: 10.1016/j.jjcc.2008.12.007 CrossRefGoogle Scholar

Copyright information

© ISB 2014

Authors and Affiliations

  • Antonella Fioravanti
    • 1
    Email author
  • Przemysław Adamczyk
    • 2
  • Nicola Antonio Pascarelli
    • 1
  • Chiara Giannitti
    • 1
  • Renato Urso
    • 3
  • Michał Tołodziecki
    • 4
  • Irena Ponikowska
    • 4
  1. 1.Department of Medicine, Surgery and Neuroscience, Rheumatology UnitUniversity of Siena, “Le Scotte” PoliclinicoSienaItaly
  2. 2.Thermal HospitalCiechocinekPoland
  3. 3.Department of Medicine, Surgery and Neuroscience, Pharmacology Unit “Giorgio Segre”University of SienaSienaItaly
  4. 4.Department of Balneology and Physical Medicine Collegium Medicum in BydgoszczUMKBydgoszczPoland

Personalised recommendations