The online version of this article (doi:10.1186/1758-5996-6-127) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
JADRN and JF contributed to conception, design, analysis and interpretation of data and drafted the manuscript. EK and MS contributed to design, analysis and interpretation of data and drafted the manuscript. RY and LPM contributed to conception and drafted the manuscript. All authors read and approved the final manuscript.
Fasting insulin (FI), fasting glucose (FG), systolic blood pressure (SBP), high density lipoproteins (HDL), triacylglycerides (TAG), and body mass index (BMI) are well-known risk factors for type 2 diabetes. Reliable estimates of lifestyle intervention effects on these factors allow diabetes risk to be predicted accurately. The present meta-analyses were conducted to quantitatively summarize effects of diet and exercise intervention programs on FI, FG, SBP, HDL, TAG and BMI in adults without diabetes.
MEDLINE and EMBASE were searched to find studies involving diet plus exercise interventions. Studies were required to use adults not diagnosed with type 2 diabetes, involve both dietary and exercise counseling, and include changes in diabetes risk factors as outcome measures. Data from 18, 24, 23, 30, 29 and 29 studies were used for the analyses of FI, FG, SBP, HDL, TAG and BMI, respectively. About 60% of the studies included exclusively overweight or obese adults. Mean age and BMI of participants at baseline were 48 years and 30.1 kg/m2. Heterogeneity of intervention effects was first estimated using random-effect models and explained further with mixed-effects models.
Adults receiving diet and exercise education for approximately one year experienced significant (P <0.001) reductions in FI (-2.56 ± 0.58 mU/L), FG (-0.18 ± 0.04 mmol/L), SBP (-2.77 ± 0.56 mm Hg), TAG (-0.258 ± 0.037 mmol/L) and BMI (-1.61 ± 0.13 kg/m2). These risk factor changes were related to a mean calorie intake reduction of 273 kcal/d, a mean total fat intake reduction of 6.3%, and 40 minutes of moderate intensity aerobic exercise four times a week. Lifestyle intervention did not have an impact on HDL. More than 99% of total variability in the intervention effects was due to heterogeneity. Variability in calorie and fat intake restrictions, exercise type and duration, length of the intervention period, and the presence or absence of glucose, insulin, or lipid abnormalities explained 23-63% of the heterogeneity.
Calorie and total fat intake restrictions coupled with moderate intensity aerobic exercises significantly improved diabetes risk factors in healthy normoglycemic adults although normoglycemic adults with glucose, insulin, and lipid abnormalities appear to benefit more.
Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, Khunti K: Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007, 334: 299-10.1136/bmj.39063.689375.55. PubMedCentralCrossRefPubMed
Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J: Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database Syst Rev. 2005, CD005270-
Valdes S, Botas P, Delgado E, Alvarez F, Cadorniga FD: Does the new American Diabetes Association definition for impaired fasting glucose improve its ability to predict type 2 diabetes mellitus in Spanish persons? The Asturias Study. Metabolism. 2008, 57: 399-403. 10.1016/j.metabol.2007.10.017. CrossRefPubMed
Wilkins T, Gillies RA, Davies K: EMBASE versus MEDLINE for family medicine searches: can MEDLINE searches find the forest or a tree?. Can Fam Physician. 2005, 51: 848-849. PubMed
Higgins JPT, Altman DG: Chapter 8: assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions. Edited by: Higgins JPT, Green S. 2008, Chichester: John Wiley & Sons Ltd, 187-241. CrossRef
Merrill AL, Watt BK: Energy value of foods: basis and derivation. Agriculture Handbook. 1973, Washington, DC: US Department of Agriculture, Agricultural Research Service, 74
Straznicky NE, Lambert EA, Grima MT, Eikelis N, Nestel PJ, Dawood T, Schlaich MP, Masuo K, Chopra R, Chopora R, Sari CI, Dixon JB, Tilbrook AJ, Lambert GW: The effects of dietary weight loss with or without exercise training on liver enzymes in obese metabolic syndrome subjects. Diabetes Obes Metab. 2012, 14: 139-148. 10.1111/j.1463-1326.2011.01497.x. CrossRefPubMed
Blumenthal JA, Babyak MA, Sherwood A, Craighead L, Lin PH, Johnson J, Watkins LL, Wang JT, Kuhn C, Feinglos M, Hinderliter A: Effects of the dietary approaches to stop hypertension diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids. Hypertension. 2010, 55: 1199-1205. 10.1161/HYPERTENSIONAHA.109.149153. PubMedCentralCrossRefPubMed
Ibanez J, Izquierdo M, Martinez-Labari C, Ortega F, Grijalba A, Forga L, Idoate F, Garcia-Unciti M, Fernandez-Real JM, Gorostiaga EM: Resistance training improves cardiovascular risk factors in obese women despite a significative decrease in serum adiponectin levels. Obesity (Silver Spring). 2010, 18: 535-541. 10.1038/oby.2009.277. CrossRef
Straznicky NE, Lambert EA, Nestel PJ, McGrane MT, Dawood T, Schlaich MP, Masuo K, Eikelis N, De Courten B, Mariani JA, Esler MD, Socratous F, Chopra R, Sari CI, Paul E, Lambert GW: Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes. 2010, 59: 71-79. 10.2337/db09-0934. PubMedCentralCrossRefPubMed
Herder C, Peltonen M, Koenig W, Sutfels K, Lindstrom J, Martin S, Ilanne-Parikka P, Eriksson JG, Aunola S, Keinanen-Kiukaanniemi S, Valle TT, Uusitupa M, Kolb H, Tuomilehto J: Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study. Diabetologia. 2009, 52: 433-442. 10.1007/s00125-008-1243-1. CrossRefPubMed
Morgan LM, Griffin BA, Millward DJ, DeLooy A, Fox KR, Baic S, Bonham MP, Wallace JM, MacDonald I, Taylor MA, Truby H: Comparison of the effects of four commercially available weight-loss programmes on lipid-based cardiovascular risk factors. Public Health Nutr. 2009, 12: 799-807. 10.1017/S1368980008003236. CrossRefPubMed
Dale KS, Mann JI, McAuley KA, Williams SM, Farmer VL: Sustainability of lifestyle changes following an intensive lifestyle intervention in insulin resistant adults: follow-up at 2-years. Asia Pac J Clin Nutr. 2009, 18: 114-120. PubMed
Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, Lucia C, Nuti C, Durazzo M, Cassader M, Gentile L, Pagano G: Effectiveness of a lifestyle intervention on metabolic syndrome. a randomized controlled trial. J Gen Intern Med. 2007, 22: 1695-1703. 10.1007/s11606-007-0399-6. PubMedCentralCrossRefPubMed
Arciero PJ, Gentile CL, Martin-Pressman R, Ormsbee MJ, Everett M, Zwicky L, Steele CA: Increased dietary protein and combined high intensity aerobic and resistance exercise improves body fat distribution and cardiovascular risk factors. Int J Sport Nutr Exerc Metab. 2006, 16: 373-392. PubMed
Reseland JE, Anderssen SA, Solvoll K, Hjermann I, Urdal P, Holme I, Drevon CA: Effect of long-term changes in diet and exercise on plasma leptin concentrations. Am J Clin Nutr. 2001, 73: 240-245. PubMed
Oldroyd JC, Unwin NC, White M, Imrie K, Mathers JC, Alberti KG: Randomised controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months. Diabetes Res Clin Pract. 2001, 52: 29-43. 10.1016/S0168-8227(00)00244-8. CrossRefPubMed
Hellenius ML, de Faire U, Berglund B, Hamsten A, Krakau I: Diet and exercise are equally effective in reducing risk for cardiovascular disease. results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis. 1993, 103: 81-91. 10.1016/0021-9150(93)90042-S. CrossRefPubMed
Page RC, Harnden KE, Walravens NK, Onslow C, Sutton P, Levy JC, Hockaday DT, Turner RC: ‘Healthy living’ and sulphonylurea therapy have different effects on glucose tolerance and risk factors for vascular disease in subjects with impaired glucose tolerance. Q J Med. 1993, 86: 145-154. PubMed
Viechtbauer W: Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010, 36: 1-48. CrossRef
Viechtbauer W, Cheung MWL: Outlier and influence diagnostics for meta-analysis. Res Synthesis Methods. 2010, 1: 112-125. 10.1002/jrsm.11. CrossRef
Lillioja S, Mott DM, Spraul M, Ferraro R, Foley JE, Ravussin E, Knowler WC, Bennett PH, Bogardus C: Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. prospective studies of Pima Indians. N Engl J Med. 1993, 329: 1988-1992. 10.1056/NEJM199312303292703. CrossRefPubMed
Wang JJ, Yuan SY, Zhu LX, Fu HJ, Li HB, Hu G, Tuomilehto J: Effects of impaired fasting glucose and impaired glucose tolerance on predicting incident type 2 diabetes in a Chinese population with high post-prandial glucose. Diabetes Res Clin Pract. 2004, 66: 183-191. 10.1016/j.diabres.2004.03.002. CrossRefPubMed
Rathmann W, Strassburger K, Heier M, Holle R, Thorand B, Giani G, Meisinger C: Incidence of type 2 diabetes in the elderly German population and the effect of clinical and lifestyle risk factors: KORA S4/F4 cohort study. Diabet Med. 2009, 26: 1212-1219. 10.1111/j.1464-5491.2009.02863.x. CrossRefPubMed
Janghorbani M, Amini M: Comparison of systolic and diastolic blood pressure with pulse pressure and mean arterial pressure for prediction of type 2 diabetes: the Isfahan Diabetes Prevention Study. Endokrynol Pol. 2011, 62: 324-330. PubMed
Dotevall A, Johansson S, Wilhelmsen L, Rosengren A: Increased levels of triglycerides, BMI and blood pressure and low physical activity increase the risk of diabetes in Swedish women. a prospective 18-year follow-up of the BEDA study. Diabet Med. 2004, 21: 615-622. 10.1111/j.1464-5491.2004.01189.x. CrossRefPubMed
Curioni CC, Lourenco PM: Long-term weight loss after diet and exercise: a systematic review. Int J Obes (Lond). 2005, 29: 1168-1174. 10.1038/sj.ijo.0803015. CrossRef
Schaar B, Moose-Thiele C, Platen P: Effects of exercise, diet, and a combination of exercise and diet in overweight and obese adults – a meta-analysis of the data. Open Sport Med J. 2010, 4: 17-28. 10.2174/1874387001004010017. CrossRef
- Effects of diet and exercise interventions on diabetes risk factors in adults without diabetes: meta-analyses of controlled trials
J A D Ranga Niroshan Appuhamy
Larry P Milligan
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II