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See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/236958014

Diet and Diet Combined with Chronic AerobicExercise Decreases Body Fat Mass and Alters

Plasma and Adipose Tissue Inflammatory

Markers in Obese Women

ARTICLE in INFLAMMATION MAY 2013

Impact Factor: 2.21 DOI: 10.1007/s10753-013-9661-8 Source: PubMed

CITATIONS

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READS

82

6 AUTHORS, INCLUDING:

Nadia Lakhdar

Facult de Mdecine Ibn El Jazzar de Sousse

4PUBLICATIONS 9CITATIONS

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Myriam Denguezli

University of Sousse


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Zouhair Tabka

Facult de Mdecine Ibn El Jazzar de Sousse

318PUBLICATIONS 2,103CITATIONS

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Anissa Bouassida

Institut Suprieur du Sport et de lEducatio


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Available from: Nadia Lakhdar
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Inflammation

ISSN 0360-3997

Inflammation

DOI 10.1007/s10753-013-9661-8

Diet and Diet Combined with Chronicerobic Exercise Decreases Body Fat Mass

and Alters Plasma and Adipose TissueInflammatory Markers in Obese Women

Nadia Lakhdar, Myriam Denguezli,

Monia Zaouali, Abdelkrim Zbidi,

Zouhair Tabka & Anissa Bouassida


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accepted manuscript version for posting on

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given to the original source of publication

and a link is inserted to the published article

on Springer's website. The link must be

accompanied by the following text: "The final

publication is available at link.springer.com.


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Diet and Diet Combined with Chronic Aerobic ExerciseDecreases Body Fat Mass and Alters Plasma and AdiposeTissue Inammatory Markers in Obese Women

Nadia Lakhdar,1,3 Myriam Denguezli,1 Monia Zaouali,1 Abdelkrim Zbidi,1 Zouhair Tabka,1

and Anissa Bouassida1,2

AbstractThe purpose of this study was to investigate the effect of 6 months aerobic exercise and

diet alone or in combination on markers of inammation (MOI) in circulation and in adipose

abdominal tissue (AT) in obese women. Thirty obese subjects were randomized into a 24-week

intervention: (1) exercise (EX), (2) diet (DI), and (3) exercise and diet (EXD). Blood samples were

collected at baseline, after 12 and 24 weeks. AT biopsies were obtained only at baseline and after

24 weeks. In the EXD and DI groups, the fat loss was after 12 weeks was 13.74 and 7.8 %(P


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studies have shown that exercise training induces

improvements in inammation independent of body

mass index (BMI) [8, 9] and others that suggest weight

loss-associated reductions in inammation are indepen-

dent of exercise [10, 11]. The lack of a control group

(diet or exercise only) in the majority of these studies

has been a major limitation when trying to identify the

independent effects of exercise or diet on inammation

[4, 6]. On the other hand, few studies have measured

inammatory markers concentrations in adipose tissue

[12,13].

The aim of the present study was to investigate the

independent and the combined effects of exercise on

metabolic factors and inammation in obese subjects to

determine whether exercise training per se, independent

of diet, has anti-inammatory effects. The study was a

24-week randomized intervention with three groups of

obese women: (1) exercise alone (EX), (2) hypocaloric

diet only (DI), and (3) hypocaloric diet plus exercise(EXD). The inammatory markers were determined both

in the blood circulation and in abdominal fat.

METHODS

Subjects

Thirty obese healthy females participated in this

survey. Obesity was dened as a BMI between 30 and

4 0 k g m2. Exclusion criteria were cardiovascular

disease, type 2 diabetes, pregnancy, or orthopedic

difculties causing inability to undertake an exerciseprogram. No subjects received medication that could

affect the investigated metabolic markers. Prior to

participation, the subjects gave a written informed

consent. This study was approved by the local ethics

committee of the Faculty of Medicine, University of

Sousse, Tunisia. The women gave a written informed

consent for the experimental protocol. The 30 obese

women were randomized into the 24-week intervention

study consisting of (1) EX, (2) hypocaloric DI, or (3)

EXD.

Anthropometric MeasurementsHeight was measured with a standing stadiometer

and recorded with a precision of 0.1 cm. Waist

circumference was taken as the smallest circumference

between the lower costal margin and the pelvic brim

measured to the nearest 0.5 cm. Body mass (measured to

the nearest 0.1 kg) and percent body fat were measured

using bioelectrical impedance analysis (BEURER, Ger-

many). Participants were nude or wearing only under-

wear for measurements of body mass. BMI was

calculated using the standard formula: body mass in

kilograms divided by height in meters squared (kg m2).

Their physical characteristics are shown in Table1.

Exercise Stress Test

Participants performed an incremental exercise test

to exhaustion on a calibrated cycle ergometer (Ergoline,

Germany) to determine maximal oxygen consumption

(VO2max). The test consisted of a 5-min warm-up

followed by increments in power of 1 min at 60 rpm

until exhaustion. The loads during warm-up and in-

crements were individually adjusted by taking into

account the age, height, and body mass of each subject

[14]. The analyzer was calibrated before the rest with the

gasses of known concentration. Validation of attainmentof VO2maxsatised two of the following four criteria: (1)

an oxygen uptake plateau despite increasing exercise

intensity, (2) respiratory exchange ratio 1.10, (3)

maximal heart rate within 10 beats per minute of the

age-predicted maximal values [15], and (4) subject

exhaustion.

Exercise Intervention

Aerobic training included three sessions per week

of walking/running on a treadmill, starting at 55 % of

maximal heart rate for 30 min for weeks 14 for 30 min.

Exercise intensity and duration were gradually increasedevery month until subjects exercised at 80 % of

maximum heart rate for 45 min at weeks 2024.

Dietary Protocol

A balanced and personalized dietary restriction

program was established by a dietician after an initial

dietary assessment in order to dene the total amount of

calories consumed per day. Subjects in the DI and EXD

groups recorded the times and amounts of food and uid

intake for a week before the beginning of the program.

The dietary program was set at500 kcal/day below the

initial dietary records. It was composed of 15 %proteins, 55 % carbohydrates, and 30 % lipids. The

women recorded, in a specically designed notebook,

the quantity of food and the time at which it was eaten

(four times a week). The foods were selected according

to the subjects dietary habits. Power Point presentations,

videos, and role play scripts were designed for trainers to

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use during the educational program. Each individuals

diet was designed using a Bilnut 4 Software package

(SCDA Nutrsoft, Cerelles, France), a computerized

database that calculates the food intake and composition

from the National Institute of Statistics of Tunis 1978.

The body mass was measured every week to assess the

immediate effect of the nutritional modications.

Diet+ Exercise Intervention

The EXD intervention combined the above in-

terventions.

Blood Sampling and Analysis

Blood samples were collected by venepuncture on

three occasions: at the beginning of the protocol control

value (CV), after 12 weeks (S1), and after 24 weeks

(S2). Blood samples were collected in the morning at 7

8 A.M. after an overnight fast. For menstrual status, all the

participants were menstruating regularly and dened as

eumenorrheic; all testing was performed during the

follicular phase of the menstrual cycle.

The plasma was separated and frozen at80 C for

later analysis. Fasting plasma glucose concentrations

were measured using an automated device (AU2700,

Olympus, France). The inter-assay coefcient of vari-

ability (CoV) was 1.7 %. Fasting plasma insulin was

assayed by an IRMA Insulin kit (Immunotech, France).

The intra-and inter-assay CoV were 3.34 and 3.7

4.8 %, respectively. Insulin resistance was assessed

using the homeostatic model assessment for insulinresistance (HOMA-R). The HOMA-R has been validat-

ed in obese women and was computed as follows:

HOMA-R [insulinemia (microunit per milliliter)glyce-

mia (millimole per liter)]/22.5 [16]. Fasting TNF-and

IL-6 were determined using an ELISA kit (Immunotech

A Beckman Coulter Company) CoV intra assay preci-

sion was ranged between 1.6 and 10 % and inter-assay

ranged between 5.4 and 12.8 % for TNF-and for IL-6

CoV intra assay precision was ranged between 1.6 and

6.8 % and inter-assay ranged between 7.9 and 14.6 %.

Adipose Tissue BiopsiesAt baseline and after 24 weeks, the abdominal

tissue (AT) biopsies were obtained from the abdominal

subcutaneous AT depot 510 cm lateral to the umbilicus.

The skin was anesthetized with lidocaine (10 mg/ml)

before a small incision was made and 200 mg of AT was

removed under sterile conditions using a liposuction

Table1.TheCha

racteristicsoftheSubjectsBeforeandAfter1

2and24Weeks

EXD(n=10)

DI(n=10)

EX(n=

10)

Before

(CV)

After12

weeks(S1)

After24

weeks(S2)

Before

(CV)

After12

weeks(S1)

After24

weeks(S2)

Before

(CV)

After1

2

weeks(S1)

After24

weeks(S2)

Age(years)

38.904.37

38.903.94

36.205.00

Height(m)

1.680.03

1.600.05

1.610.05

Waistcircumference(cm

)

995

974

935*

983

962*

932**

985

985

975c

Weight(kg)

92.465.5

85.105.26*

80.305.06*

84.606.71

79.306.18

75.006.59*

86.997.96

85.007.52

82.807.52

BMIkgm2

32.982.17

30.362.08*

28.652.07**

33.021.89

30.941.53

29.251.55

33.523.75

32.763.61b

31.923.69

Bodyfat(%)

421.49

39.761.28**

38.260.84**

41.650.97

39.520.67**

38.860.61**

41.261.22

41.241.23c

41.121.35bc

Bodyfatmass(kg)

39.263.50

33.903.08**

30.752.47**

35.283.44

31.382.90*

29.182.97**

35.964.19

35.134.05

34.134.10bc

VO2max(mlminkg1)

22.302.97

27.101.92*a

31.002.02*a

20.100.94

21.001.41

21.001.00

21.301.42*

25.101.22*

29.901.14*b

Dataarepresentedasme

ansSD

EXDexerciseanddietcombined,

DIdietonly,

EXexerciseonly,

BMI

bodymassindex,CVcontrolvalue,Ssamplin

g

*P

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