Year of Publication

2005

Document Type

Dissertation

College

Graduate School

Department

Nutritional Sciences

First Advisor

James W. Anderson

Abstract

Obesity increases the risk for the development of cardiovascular disease, type 2 diabetes and other co-morbid conditions. Type 2 diabetes also is often associated with excessive visceral abdominal fat. Weight loss in obese individuals decreases the risk for developing the co-morbid conditions. Individuals with type 2 diabetes often have a greater difficulty in controlling these complications compared to individuals without type 2 diabetes. The purpose of this study was to evaluate adherence to a medically-supervised low-energy diet (LED) weight loss program and changes in body composition and metabolic parameters after weight loss in women with and without type 2 diabetes. Subjects consisted of Caucasian women, between the ages of 40 to 65 years, with BMIs between 30 and 45 kg/m2. There was no significant difference in BMI between the groups at study initiation (38.1 kg/m2, diabetics (DM) and 36.0 kg/m2, non-diabetics (NDM), p=0.2314). All subjects participated in the HMR Program for 16 weeks. Twenty-nine subjects completed the weight loss phase (18 diabetics, 11 non-diabetics) and were evaluated for change in weight, body composition, and blood parameters. Data were analyzed by repeated-measures ANCOVA and students t-tests using SAS version 8.02. DM and NDM lost 11.7% and 16% of body weight, respectively (p=0.6474). Results indicate DM has more total lean tissue (p=0.004), more total body fat (p=0.04), more total abdominal tissue (p=0.001), more visceral adipose tissue (p=0.001) and lost less percent body fat (p=0.04) than NDM after 16 weeks of weight loss. After weight loss there was no significant difference in leptin, ghrelin or adiponectin levels. DM had greater insulin (p=0.05), HOMA-IR (pandlt;0.0001), glucose (pandlt;0.0001), HbA1c (pandlt;0.0001), resistin (p=0.04) and PAI-1 (p=0.02). There were no differences after weight loss in lipid levels, blood pressure, diet compliance or exercise. The data show that medically-supervised LEDs are safe and effective for treating obesity in individuals with type 2 diabetes. Cardiovascular risk factors improved in both NDM and DM subjects with weight loss. The findings also suggest that insulin and metabolically dysfunctional lean tissue may play a critical role in the complex axes affecting changes in body composition and inflammation in individuals with type 2 diabetes.

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