ReviewObesity, risk of diabetes and role of physical activity, exercise training and cardiorespiratory fitness
Section snippets
Obesity and adipose tissue remodeling
Obesity is a multifactorial chronic disease, in which environmental and genetic factors, as well as abnormalities of energy metabolism regulation, which may be caused by the use of medications that induce weight gain as a side effect, contribute to weight gain. Monogenic forms of obesity, mainly resulting from dysregulation of energy homeostasis, also exist.12 Although environmental factors (i.e., unhealthy diet, physical inactivity and SB) are considered the major causes for obesity, the fact
Mechanisms leading obesity to T2DM: contributions of insulin resistance and chronic low-grade systemic inflammation
With respect to the risk of metabolic diseases, obesity remains perhaps the strongest modifiable risk factor for the development of insulin resistance, ultimately resulting in T2DM.33 Hyperplasia and hypertrophy of the adipocytes can, in fact, occur in different locations within the body, including insulin-dependent tissues, like skeletal muscle, liver, and the adipose tissue itself.34 In addition to accumulation of excess fat within the adipose tissue, skeletal muscle and liver, ectopic fat
PA and ET to improve body weight and CRF to prevent T2DM
As discussed at length elsewhere, intentional weight loss induced by caloric restriction, but also pharmacologic and surgical interventions, in the setting of a comprehensive lifestyle modification program, remains the cornerstone therapy to improve insulin sensitivity and in some circumstances to prevent the incidence of T2DM in individuals with obesity and prediabetes.64 The amount of weight loss required to result in clinically significant improvements can vary, but even small improvements
PA and ET to increase CRF in T2DM
In addition to the strong association between improved CRF and reduced risk for T2DM, the role of CRF has been also investigated in those with established disease. In a recent analysis of 150 patients with T2DM, CRF (i.e., peak VO2) was found to be markedly reduced, even after adjustments for fat-free mass,8 which has been proposed to be a better assessment of CRF,82 particularly in individuals with overweight and obesity, in which the use of CRF adjusted by total body weight may result in an
Conclusions
Chronic positive caloric balance from unhealthy dietary habits, reduced PA and increased SB result in increased adiposity, eventually leading to adipose tissue remodeling and obesity. This excess adiposity, in turn, markedly increases the risk for cardiometabolic disease, particularly T2DM. Importantly, in patients with obesity, T2DM can be prevented by implementing lifestyle behavior modifications, including improvements in diet, increased PA, ET and perhaps SB, ultimately leading to improved
Funding support
Salvatore Carbone is supported by a Career Development Award 19CDA34660318 from the American Heart Association.
Declaration of competing interest
None.
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