مجله دیابت و متابولیسم ایران
سال بیست و سوم شماره 6 (پیاپی 115، بهمن و اسفند 1402)

Considering the increasing and alarming trend of overweight and obesity as well as its related complications, in this study, a comprehensive clinical guide for the medical care of patients with obesity was written based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, and it has been adjusted as much as possible based on the conditions in Iran.

A complete search was performed in the available databases without any restrictions with a specific strategy. Using the opinions of experts in this field, the best clinical guidelines were selected and obesity clinical guidelines were written for Iranian adults. Recommendations were given based on a detailed review of available clinical evidence and considering objective factors.

A total of 1788 references were used and in response to 9 clinical questions, 123 recommendations, including 160 special statements, were provided to determine a comprehensive medical care program for obesity. In this article, we discuss the prevention, screening, diagnosis, benefits and goals of obesity treatment. Questions 6 to 9 regarding obesity treatment steps and its individualization will be published in the next part of the article.

The detailed evidence-based questions and recommendations outlined in this study identify clinical considerations that facilitate decision-making in obese patients from screening and diagnosis to goals of treatment.

Adiponectin is one of the most well-known adipokines with anti-inflammatory effects that plays an important role in regulating the whole-body metabolism. The aim of this study was to investigate the effect of high-intensity interval training (HIIT) versus moderate intensity continuous training (MICT) on the circulating levels of adiponectin in individuals with and without metabolic disorders.

A systematic search was conducted in the databases of PubMed, Web of Science, Academic Jihad Center and Magiran using the keywords "HIIT" and "adiponectin" to identify Persian and English languages published articles until October 2022. Effect size (SMD) and 95% confidence interval were calculated using CMA2 software. I2 test for calculation of the heterogeneity and visual interpretation of funnel plot test and Egger test for assessment of the publication bias were used.

Data analysis of 28 interventions (24 studies) showed that HIIT resulted in a significant increase in adiponectin [0.40 CI: 0.12 to 0.68), P=0.004]. Also, the data analysis of eight interventions showed that HIIT led to a non-significant increase in adiponectin compared to the MICT [0.41 CI: -0.04 to 0.86), P=0.07].

The findings of the present study showed that HIIT is a suitable and efficient training method to increase adiponectin, especially in people with metabolic disorders.

Considering the importance of exercise in the prevention and treatment of diseases related to obesity the objective of this experimental study was to determine the effect of six weeks of intensive interval training on PEPCK expression in liver tissue, glucose and insulin and insulin resistance in obese rats with type 2 diabetes and compared with non-diabetic obese group.

28 male Wistar rats aged 10 weeks (220 ± 20 g) were obesed by six weeks of high-fat diet (HFD). Then type 2 diabetes was induced in 14 rats by intraperitoneal injection of STZ (30 mg/kg). Finally, the studied rats were divided into 4 groups (n= 7): 1) control obese, 2) interval obese, 3) control obese diabetic, 4) interval obese diabetic. Interval groups participated in an interval exercise program of five sessions per week for six weeks consists of 10 repetitions of a 40-second run on the treadmill with 2-minute rest (active rest) between repetitions. Finally, 48 hours after the last session, the fasting levels of glucose, insulin, PEPCK expression in liver tissue were measured and compared by two-way ANOVA.

Compared with control groups, interval training in diabetic and obese rats resulted in significant decrease of fasting glucose (P= 0.001). Interval training also led to an increase in serum insulin compared to the diabetic control group (P= 0.006) and a decrease in PEPCK expression compared to the diabetic control group (P= 0.005).

Improved glucose response to interval training in type 2 diabetic rats may be rooted in increase insulin with decrease in hepatic PEPCK expression. Measurement of activity or expression of other liver enzymes is suggested for general conclusion.

The health and proper functioning of the endoplasmic reticulum in the liver can lead to an increase in the quality of the metabolism of liver cells. Exercise can lead to liver health by regulating liver enzymes and factors related to apoptosis pathway. Therefore, the aim of the current research is to compare the performance of the endoplasmic reticulum chaperone protein of the liver of healthy model rats with the intervention of different training sessions and starvation.

In this experimental research, 30 Wistar male rats with a weight range of 330 ± 25 grams were selected and divided into six groups: 1) control, 2) starvation, 3) 3 days of training per week, 4) 5 days of training per week, 5) starvation + 3 training days per week, 6) starvation + 5 training days per week. Training consisted of one hour of continuous running on a treadmill for 4 weeks, and starvation was performed for 14 hours when the rats were awake. Data analysis was performed using one-way analysis of variance and post hoc LSD statistical tests in SPSS version 23 software. A significance level of P≤ 0.05 was considered.

Data analysis showed a significant change in the levels of liver enzymes alanine aminotransferase (ALT) and aspartate transaminase (AST) (P≤ 0.05). This change in CHOP gene expression was also significant (P≤ 0.05).

Aerobic training for 3 and 5 days with starvation can lead to liver health by reducing liver enzymes (AST and ALT) and cell death-related factor (CHOP) through the apoptosis pathway.

BDNF decrease, and HbA1c and Asprosin increase in diabetic people and exercise can reverse these effects, but the effect of vigorous exercise on Asprosin and BDNF in elderly diabetic people have not been investigated. Therefore, the aim of the present study was to investigate the effect of high-intensity functional exercise on Asprosin and BDNF and their relationship with glucose and HbA1c in elderly diabetic men and women.

In this semi-experimental study, 24 elderly diabetic men and women (age: 67.25 ± 5.84, BM: 70.29 ± 13.01, height: 160.92 ± 10.29) participated. The initial blood sample was taken while fasting. After 90 minutes, the subjects performed the exercise for 50 minutes. The second blood sample was taken 10 minutes after the high-intensity functional exercise. BDNF, Asprosin, HbA1c, and glucose levels were measured by ELISA method. To analyze the data, T-tests, covariance and Pearson's correlation coefficient were used.

Asprosin and BDNF decreased (P< 0.0005) and increased (P< 0.0005), respectively in both groups. There was no significant difference between Asprosin and BDNF in elderly diabetic men and women in pre-test and post-test (P> 0.05). There was a significant negative correlation between BDNF with Asprosin, HbA1c and glucose and a significant positive correlation between Asprosin with HbA1c and glucose (P< 0.05).

Vigorous exercise decrease and increase Asprosin and BDNF in elderly diabetic men and women, respectively. Also, considering the significant negative relationship between BDNF with glucose and HbA1c and the significant positive relationship between Asprosin with glucose and HbA1c, it seems that vigorous exercise by reversing the changes of asprosin and BDNF causes possible improvement in levels of glucose and HbA1c.

Fetoin-A and -B are hepatokines that are related to type 2 diabetes. The aim of the present study was to investigate the effect of a period of resistance and endurance training with Ursolic acid consumption on the levels of Fetoin-A and -B in the liver tissue of elderly diabetics.

Fifty six 21-month-old male diabetic rats were randomly divided into seven equal groups of control (C), Ursolic acid supplement (UA), supplement+resistance exercise (UA+R), supplement+endurance exercise (UA+E), Resistance training (R), endurance training (E) and sham group (D). Resistance training protocol with intensity of 60% MVCC, 14-20 times of ladder climbing with one minute rest between each effort and endurance training including running on Treadmill at high intensity 60-75% and low intensity 30-40% of maximum speed for five days per week for eight weeks. Supplemented groups received 500 mg/kg UA in combination with a high-fat meal.

Fetoin-A level was significantly decreased in UA, E, UA+E groups (p≤0.05) and only in R and UA+R groups, there was no significant decrease. Also, The amount of Fetoin-B in diabetic rats in the UA, E, R, UA+E groups decreased significantly (p≤0.05) and only in the UA+R training group there were no significant changes. The amount of Fetoin-A and Fetoin-B was significantly different between E and R and UA+R and UA+E groups (p≤0.05), which the largest decrease was in the UA+E group.

Considering the beneficial effects of exercise training as well as UA supplementation on hepatokines, it seems that the simultaneous application of two interventions of exercise training and UA supplementation has a more therapeutic effect on the hepatic hepatokines of diabetics.