Worksite Wellness Interventions on Vascular Function, Insulin Sensitivity , HDL

针对血管功能、胰岛素敏感性、HDL 的工作现场健康干预

基本信息

批准号：
8557945
负责人：
Richard Cannon
金额：
$ 79.06万
依托单位：
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/8557945
关键词：
ATP binding cassette transporter 1 Adult African Age Apolipoprotein A-I Atherosclerosis Biological Markers Blood Blood Pressure Blood Vessels Body Composition Body Weight decreased Body mass index Businesses C-reactive protein Cardiovascular system Cells Cessation of life Cholesterol Counseling Coupled Dietitian Dual-Energy X-Ray Absorptiometry Employee Energy Intake Enrollment Environment Enzyme-Linked Immunosorbent Assay Epidemic Exercise Fasting Fatty acid glycerol esters Female Food Glucose Health Health Benefit Health Care Costs Height High Density Lipoprotein Cholesterol High Density Lipoproteins Home environment Hormonal Hour Hyperinsulinism Incentives Incubated Insulin Insulin Resistance Intake Intervention LDL Cholesterol Lipoproteins Label Life Style Limb structure Lipids Lower Extremity Measurement Measures Mediating Menopause Minority Modeling National Heart, Lung, and Blood Institute Nutritional Obesity Occupations Online Systems Outcome Measure Overweight Oxygen Consumption Participant Performance Plasma Population Population Study Prevalence Productivity Protocols documentation Race Randomized Records Regression Analysis Reporting Research Personnel Resources Risk Risk Reduction Serum Skeletal Muscle Societies Structure Testing Triglycerides Tyrosine United States United States National Institutes of Health Upper Extremity Visit Weight Weight-Bearing state Wellness Program Woman Work Workplace adipokines arterial stiffness brachial artery cardiovascular disorder risk cardiovascular risk factor cohort fitness improved indexing inflammatory marker insulin sensitivity meetings mortality muscle form nitration non-diabetic nutrition programs sedentary shear stress weight loss intervention

项目摘要

The prevalence of obesity among adults in the United States is high, approaching 60% for black women, with likely contribution of sedentary occupations. We proposed that regular nutritional counseling at the work place would facilitate weight loss in overweight and obese female employees with a large minority representation. One hundred, ninety-nine non-diabetic women were randomized to regular meetings and weigh-ins with a dietitian (intervention) or control; all were provided Web-based nutritional and lifestyle information, advised to reduce daily energy intake by 500 kcal, instructed to increase daily pedometer counts by 5000 over baseline and given access to fitness rooms at the work place. Three-day food records, body composition (DXA), lipids, glucose, insulin, and exercise performance were measured at baseline and 6 month visits. At 6 months, 139 subjects (55% of African descent) who completed the program reported decreased daily total energy and fat intake (p< 0.001), with significant reduction in weight (-35%) and fat mass (-59%); improved insulin sensitivity (+697%); reduced total cholesterol (-512%) and triglyceride (-628%) levels; and improved exercise performance (7.314.1%) (all p< 0.001). There were no significant differences between intervention and control subjects in these outcome measures. Intervention subjects in the highest tertile of attendance (≥ 80% of sessions) lost significantly more weight (-4.23.8 vs. -0.92.8 kg, p=0.001) and fat mass (-3.33.5 vs. -0.82.1 kg, p= 0.007) than women in the lowest tertile (<65%) of attendance. We conclude that overweight and obese female employees provided with Web-based information and worksite exercise resources significantly improve health measures. Consistent attendance at nutrition counseling and weigh-in sessions may facilitate greater weight and fat loss. Obesity is associated with increases in both fat and lean masses. Increased lower extremity muscle mass may be compensatory to fat mass load, but the relation of upper extremity lean mass to obesity is unclear. We propose that elevated insulin levels may contribute to both lower and upper extremity lean masses in overweight or obese women. The following measurements were performed in 197 non-diabetic women (57% black, 35% white; age 4611 years meanSD, BMI range 25.0 to 57.7 kg/m2): dual-energy X-ray absorptiometry for fat and extremity lean masses; exercise performance by peak oxygen consumption (VO2 peak) during graded treadmill exercise; fasting insulin and in 183 subjects insulin sensitivity index (SI) calculated from the minimal model. SI (range 0.5 to 14.1 liter/mU-1min-1) was negatively, and fasting insulin (range 1.9 to 47.6 U/mL) positively, associated with both lower and upper extremity lean masses (all P<0.001), independent of age and height. Sixty-seven percent of women completed 6 months of participation in a weight loss and exercise program: Reduction in fasting insulin (7.96.4 to 6.76.5 U/mL, P=0.001) was associated with a decrease in both lower (P=0.025) and upper (P=0.014) extremity lean masses, independent of reduction in fat mass or improvement in VO2 peak, and without significant change in SI or interaction by race. Thus, hyperinsulinemia in overweight or obese women is associated with increased lean mass in weight-bearing as well as non-weight-bearing extremities, which is partially reversible with reduction in fasting insulin concentration, consistent with stimulatory effects of insulin on skeletal muscle. Subjects at risk for atherosclerosis may have dysfunctional high-density lipoprotein (HDL) despite normal cholesterol content in plasma. We considered whether efflux of excess cellular cholesterol to HDL from obese subjects is associated with impaired arterial endothelial function, a biomarker of cardiovascular risk. Fifty-four overweight (body mass index 25 C 29.9 kg/m2) or obese women (body mass index 30 kg/m2), age 46 11 years, were enrolled in a worksite wellness program. HDL cholesterol averaged 57 17 mg/dL and was inversely associated with BMI (r= -0.419, P= 0.002). Endothelial function was assessed by brachial artery flow-mediated dilation (FMD). Cholesterol efflux from 3H-cholesterol-labeled BHK cells transfected with the ATP-binding cassette transporter 1 (ABCA1) showed 8.2 to 22.5% cholesterol efflux over 18 hours when incubated with 1% serum and was positively correlated with FMD (P <0.05), especially in the 34 obese subjects (r= 0.482, P= 0.004). This relationship was independent of age, HDL or low-density lipoprotein cholesterol concentrations in plasma, blood pressure or insulin resistance by stepwise multiple regression analysis (= 0.31, R2= 0.21, P= 0.007). Nitration of apoA-I tyrosine residues (by sandwich ELISA) was significantly higher in obese women with the lowest cholesterol efflux than in overweight women with the highest cholesterol efflux (P= 0.01). We conclude that decreased cholesterol efflux via the ABCA1 transporter is associated with increased nitration of apoA-I in HDL and is an independent predictor of impaired endothelial function in obese women. This suggests that functional measures of HDL may be better markers for cardiovascular risk than HDL cholesterol levels in this population.

美国成年人中肥胖症的流行率很高，黑人妇女的近60％，可能持续的职业贡献。我们建议在工作场所进行定期营养咨询，以促进超重和肥胖的女性雇员的体重减轻。一百，九十一名非糖尿病妇女被随机分配给定期会议，并通过营养师（干预）或对照来称重；所有这些都提供了基于Web的营养和生活方式信息，建议将每日能量摄入减少500 kcal，指示每日计时计的计数增加了5000，并可以在工作场所获得健身室。三天的食物记录，身体成分（DXA），脂质，葡萄糖，胰岛素和运动性能在基线和6个月访问时测量。在6个月中，完成该计划的139名受试者（占非洲血统的55％）报告说，每日总能量和脂肪摄入量减少（P <0.001），体重显着降低（-35％）和脂肪质量（-59％）；提高胰岛素敏感性（+697％）；总胆固醇（-512％）和甘油三酸酯（-628％）降低；并提高运动表现（7.314.1％）（全p <0.001）。在这些结果指标中，干预和对照对象之间没有显着差异。出勤率最高的干预受试者（≥80％的会话）的体重（-4.23.8 vs. -0.92.8 kg，p = 0.001）和脂肪质量（-3.33.5 vs. -0.82.1 kg，p = 0.007）的体重明显高于最低三分位数（-3.33.5 vs. -0.82.1 kg，p = 0.007）。我们得出的结论是，向拥有基于网络的信息和工作场所的超重和肥胖的女性员工大大改善了健康措施。持续参加营养咨询和称重会议可能有助于更大的体重和减肥。肥胖与脂肪和瘦肉的增加有关。下肢肌肉质量增加可能是脂肪质量负荷的补偿性，但是上肢瘦质量与肥胖的关系尚不清楚。我们建议升高的胰岛素水平可能有助于超重或肥胖女性的下肢和上肢瘦肉肿块。在197名非糖尿病女性（黑色57％，白色35％； 4611年的平均值，BMI范围25.0至57.7 kg/m2）中进行了以下测量：双能量X射线吸收率，用于脂肪和肢性瘦质量；在分级跑步机运动中，通过峰值消耗量（VO2峰）进行运动表现；禁食胰岛素和183名受试者胰岛素灵敏度指数（SI）是根据最小模型计算得出的。 SI（0.5至14.1升/MU-1Min-1）是负面的，禁食胰岛素（范围为1.9至47.6 U/mL）呈正相关，与下肢和上肢瘦肉质量（所有P <0.001）相关，与年龄和身高无关。 67％的女性完成了6个月参加体重减轻和运动计划的6个月：减少禁食胰岛素（7.96.4至6.76.5 u/ml，p = 0.001）均与较低（p = 0.025）的降低（p = 0.025）和较高质量的较低量（p = 0.014）相关（p = 0.014），而没有脂肪质量的较低或相互作用，而在vo2中的相互作用则无关紧要。因此，超重或肥胖女性中的高胰岛素血症与体重承重和非重重的四肢瘦质量增加有关，这与空腹胰岛素浓度的降低部分可逆，这与胰岛素对骨骼肌的刺激作用一致。尽管血浆中的胆固醇含量正常，但患有动脉粥样硬化的受试者可能患有功能失调的高密度脂蛋白（HDL）。我们考虑了肥胖受试者过多的细胞胆固醇对HDL的外排是否与动脉内皮功能受损（心血管风险的生物标志物）有关。五十四个超重（体重指数25 C 29.9 kg/m2）或肥胖女性（体重指数30 kg/m2），年龄46岁11岁，参加了工作场所健康计划。 HDL胆固醇平均为57 17 mg/dL，与BMI成反比（r = -0.419，p = 0.002）。通过臂动脉流介导的扩张（FMD）评估内皮功能。与ATP结合盒转运蛋白1（ABCA1）转染的3H-胆固醇标记的BHK细胞中的胆固醇流出在18小时内显示8.2至22.5％的胆固醇外排，当与1％血清孵育时，与1％血清孵育时，与FMD呈呈阳性相关（p <0.05）（p <0.05），尤其是34 ofs（p <0.05），尤其是0.042482（p = 0.4）。这种关系与年龄，HDL或低密度脂蛋白胆固醇浓度在血浆，血压或胰岛素抵抗中通过逐步多元回归分析（= 0.31，R2 = 0.21，p = 0.007）无关。胆固醇排出最低的肥胖女性的ApoA-I酪氨酸残基（通过三明治ELISA）的硝化量明显高于胆固醇外排的超重女性（p = 0.01）。我们得出的结论是，通过ABCA1转运蛋白减少胆固醇外排与HDL中APOA-I的硝化增加有关，并且是肥胖女性内皮功能受损的独立预测指标。这表明，与该人群中HDL胆固醇水平相比，HDL的功能测量可能是心血管风险的更好标志。