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临床试验/NCT07251504
NCT07251504已完成不适用

Mitochondrial Metabolism and Oxidative Stress in Function of the Type of Physical Exercise and Nutritional Counseling in Type 2 Diabetes Mellitus

University of Cadiz2 个研究点 分布在 1 个国家目标入组 146 人开始时间: 2022年3月10日最近更新:
适应症
干预措施

试验速览

阶段
不适用
状态
已完成
入组人数
146
试验地点
2
主要终点
Assessed changes in haemoglobin saturation delta

研究概览

简要总结

The goal of this ancillary study is to learn about the effects of different aerobic modalities (moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT)) and diet on mitochondrial properties and oxidative stress in patients with prediabetes or type 2 diabetes (T2D), and overweight or obesity. It will also learn about the different effects of these interventions in men and women. The main questions it aims to answer are:

  • What is the isolated and combined effect of these exercise modalities and diet? Is there a superior approach for mitochondrial metabolism and oxidative stress in patients with T2D?
  • Is there a sex-specific best combination choice for these different interventions?
  • Is there any relation between exercise and diet-induced changes in mitochondrial properties and oxidative stress and other health-related outcomes such as body composition or insulin sensitivity?

To answer these questions, researchers designed a two-factor study. One factor was exercise, which had three levels (MICT, HIIT, and the inactive (INACT) condition). The second factor was diet, with two levels (Diet (D) and no diet (ND)). Hence, participants were randomly allocated into 6 groups: INACT-ND, INACT-D, MICT-ND, MICT-D, HIIT-ND, and HIIT-D.

Participants did:

  • Underwent a 12-week intervention within the condition of his/her group
  • Visit the research group facilities three times per week if in an exercise group or once every two weeks if in a diet group.

详细描述

This is an ancillary study of a randomized controlled trial (The APETEX study [NCT05259449]) conducted in the Province of Cádiz (Spain). The sample size for this ancillary study was determined by the calculation performed for the parent trial.

A total of 146 participants were enrolled and underwent baseline assessment of the study outcomes. Just after the baseline determination, participants were randomly allocated to one of the aforementioned study groups. The randomization process was stratified by sex, which means that approximately 50% of participants in each group were women. All participants received detailed written and verbal information about the study objectives, procedures, benefits, and potential risks before providing written informed consent. This study adhered to the principles of the Declaration of Helsinki and was approved by the Provincial Research Ethics Committee of Cádiz and the Coordinating Committee of Biomedical Research Ethics of Andalucía (registration number 92.21; PEIBA number 1026-N-21; internal codes SICEIA-2025-001870 and SICEIA-2025-000778).

At both baseline and post-intervention, participants were scheduled in the morning following an overnight fast of 8-10 hours. They were instructed to maintain their usual lifestyle, abstain from alcohol and caffeine for 24 hours, and avoid strenuous physical activity for at least 48 hours prior to testing. Procedures included body composition assessment through electrical bioimpedance, a vastus lateralis muscle biopsy, fasting blood collection, and an oral glucose tolerance test (OGTT) by ingesting 75 grams of glucose and blood draws at 30, 60, 90, 120, 150, and 180 minutes post-ingestion. The same protocol was repeated after the 12-week intervention, with exercise groups completing their final training session at least 48 hours before the post-intervention assessments (range: 48 - 72 hours).

研究设计

研究类型
Interventional
分配方式
Randomized
干预模型
Parallel
主要目的
Treatment
盲法
Double (Investigator, Outcomes Assessor)

盲法说明

Due to the nature of the intervention, participants and intervention providers can not be blinded. However, outcome assessors and statisticians remained blinded to group allocation. Additionally, the randomization procedure was administered by an independent researcher.

入排标准

年龄范围
30 Years 至 65 Years(Adult, Older Adult)
性别
All
接受健康志愿者

入选标准

  • Diagnosis of T2D or prediabetes (glycated hemoglobin ≥ 5.7%)
  • No history of substance abuse (tobacco, alcohol, or other drugs).
  • Body mass index ≥25 kg/m², maintaining habitual dietary patterns with stable body weight for at least 6 months
  • Stable physical activity and medication regimen for at least 6 months
  • Lack of habitual vigorous-intensity physical activity and the presence of sedentary behavior characterized by prolonged sitting time (screened using the International Physical Activity Questionnaire short form).
  • Not insulin-dependent
  • Absence of injury, disease, disability, or other known medical condition which could affect the ability to successfully participate in physical exercise tests
  • Absence of tumors and cancer disease
  • Absence of other pathologies that could affect the study outcomes.
  • Not on a medication regimen that could affect the study outcomes.
  • Being able to understand communication in Spanish or English.
  • Not pregnant

排除标准

  • Failure to attend more than 2 consecutive sessions or a total of 4 sessions of nutritional intervention.
  • Failure to attend more than 4 consecutive or a total of 6 sessions of physical training.
  • Serious injury
  • Voluntary withdrawal
  • Increased dose of diabetes medication

研究组 & 干预措施

Moderate-intensity continuous training (ND-MICT)

Active Comparator

Participants who did not receive nutritional intervention but were enrolled in a moderate-intensity continuous training exercise program.

干预措施: The Moderate-Intensity Continuous Training (MICT) (Other)

High-intensity interval training (ND-HIIT)

Active Comparator

Participants who did not receive nutritional intervention but were enrolled in a high-intensity interval training exercise program.

干预措施: The High-Intensity Interval Training (HIIT) (Other)

Nutritional intervention (D-INACT)

Active Comparator

Participants who received nutritional intervention but not an exercise program.

干预措施: Nutritional intervention (Behavioral)

Nutritional Intervention Moderate-Intensity continuous training (D-MICT)

Experimental

Participants who received nutritional intervention and were enrolled in a moderate-intensity continuous training exercise program.

干预措施: Nutritional intervention (Behavioral)

Nutritional Intervention Moderate-Intensity continuous training (D-MICT)

Experimental

Participants who received nutritional intervention and were enrolled in a moderate-intensity continuous training exercise program.

干预措施: The Moderate-Intensity Continuous Training (MICT) (Other)

Nutritional Intervention High-intensity interval training (D-HIIT)

Experimental

Participants who received nutritional intervention and were enrolled in a high-intensity interval training exercise program.

干预措施: Nutritional intervention (Behavioral)

ND-INACT

No Intervention

Participants who did not receive either nutritional intervention or exercise program. They were instructed to maintain their normal life habits regarding physical activity and diet.

Nutritional Intervention High-intensity interval training (D-HIIT)

Experimental

Participants who received nutritional intervention and were enrolled in a high-intensity interval training exercise program.

干预措施: The High-Intensity Interval Training (HIIT) (Other)

结局指标

主要结局

Assessed changes in haemoglobin saturation delta

时间窗: Pre and post the 12-week intervention

A NIRO-200NX device was used to measure skeletal muscle changes on oxygenated, desoxygenated, and total haemoglobin (μmol/L) through near-infrared spectroscopy (NIRS) and the modified Beer-Lambert law. The NIRS sensor (emitter-sensor distance of 3cm) was placed at 2/3 of the distance between the major trochanter and the lateral epicondyle of the dominant leg. For parameters determined by MBLL, the reference point was set after five minutes of resting in a supine position. The NIRS data were continuously acquired throughout a resting energy expenditure test for 30 minutes, a maximal fat oxidation (MFO) test on a cycloergometer, and a maximal oxygen consumption (VO2max) test on a cycloergometer. Briefly, the MFO test consisted of an incremental task with 3-minute phases starting from 15W and increasing by 15W each phase until a respiratory exchange ratio of 1. After a 5-minute rest, the VO2max test was initiated at last MFO load with 15W increases each minute until VO2max determination.

Assessed changes in Tissue Oxygenation Index

时间窗: Pre and post the 12-week intervention

A NIRO-200NX device was used to measure skeletal muscle tissue oxygenation index (%)through near-infrared spectroscopy (NIRS), the modified Beer-Lambert law (MBLL), and spatially resolved spectroscopy. The NIRS sensor (emitter-sensor distance of 3cm) was placed at 2/3 of the distance between the major trochanter and the lateral epicondyle of the dominant leg. For parameters determined by MBLL, the reference point was set after five minutes of resting in a supine position. The NIRS data were continuously acquired throughout a resting energy expenditure test for 30 minutes, a maximal fat oxidation (MFO) test on a cycloergometer, and a maximal oxygen consumption (VO2max) test on a cycloergometer. Briefly, the MFO test consisted of an incremental task with 3-minute phases starting from 15W and increasing by 15W each phase until a respiratory exchange ratio of 1. After a 5-minute rest, the VO2max test was initiated at last MFO load with 15W increases each minute until VO2max determination.

Muscle biopsy samples: mitochondrial respiratory capacity

时间窗: Pre and post the 12-week intervention

Skin was locally anesthetized, followed by an incision of approximately 6-7mm on the dermal surface. Using sterilized Bergstrom needles, approximately 3-6 mg of skeletal muscle from the lateral vastus were extracted and placed in a BIOPS buffer for immediate analysis of mitochondrial respiration (MR) through high-resolution respirometry. Before, the fibers were mechanically separated in BIOPS buffer using sterilized needles and chemically permeabilized with a 50 μg/ml saponin solution. MR was measured in a specific buffer (Mir05) in duplicate in hyperoxygenated chambers (250-450 nmol/mL of oxygen) in an Oxygraph-2k at 37ºC (Oroboros, Innsbruck, Austria). A substrate-uncoupler titration protocol was employed by adding (final concentration): malate (2mM), pyruvate (5mM), glutamate (2mM), MgCl2 (3mM), and ADP (5mM), cytochrome C (10μM), succinate (10mM), and p-trifluoromethoxyphenylhydrazone. Oxygen flux was presented as mass-specific (pmol·s/mg wet weight) and normalized to CS activity.

Assessed changes in Oxidative Stress

时间窗: Pre and post the 12-week intervention

The level of oxidative stress was assessed by the concentration of 8-OHdG as a biomarker of DNA oxidation. A competitive ELISA detection method was employed in serum samples. Briefly, the standard and the sample were added to a pre-coated microplate along with the biotinylated detection antibody. After washing, HRP-Streptavidin was added. Then, the TMB substrate was added, and the reaction was terminated with an acid solution. The color production was measured spectrophotometrically at a wavelength of 450nm. The optical density values of samples were compared with those of the standard curve to determine the 8-OHdG concentration (ng/ml).

Muscle biopsy sample: Citrate Synthase activity

时间窗: Pre and post the 12-week intervention

2-5 mg of frozen muscle was homogenized in a 1:20 dilution of CelLytic™ MT Tissue Lysis (C3228, Sigma-Aldrich, Dorset, UK), with 1 % protease inhibitor cocktail (P8340, Sigma-Aldrich, Dorset, UK) at 4 °C. The lysate was centrifuged at 12,000 × g for 10 min at 4 °C to pellet debris, and the supernatant was stored at -80 °C. CS activity was quantified in duplicates using an assay kit following the manufacturer's instructions (CS0720: Sigma-Aldrich, Dorset, UK). Briefly, endogenous activity was recorded through color emission by DTNB, and total activity was calculated after the addition of oxalacetate. Protein concentration was determined in duplicates using a bicinchoninic acid assay kit (BCA1: Sigma-Aldrich, Dorset, UK), enabling normalization of CS activity values to total protein content (µmol/g/min). CS activity and protein concentration were measured in 96-well plates using a microplate reader at 412 nm and 562 nm, respectively (MQX200R2, Biotek instruments, Burlington, USA).

次要结局

  • Assessed changes in Fat-free Mass (percentage of Fat-free Mass)(Pre and Post 12-week Intervention)
  • Assessed changes in Body Weight(Pre and Post the 12-week intervention)
  • Assessed changes in Fat Mass (kilograms of Fat Mass)(Pre and Post 12-week Intervention)
  • Assessed changes in Fat Mass (percentage of Fat Mass)(Pre and Post 12-week Intervention)
  • Assessed changes in Fat-free Mass (kilograms of Fat-free Mass)(Pre and Post 12-week Intervention)
  • Assessed changes in Tissue Oxygenation Index(Pre and post the 12-week intervention)
  • Assessed changes in haemoglobin saturation delta(Pre and post the 12-week intervention)
  • Assessed changes in interleukin-6(Pre and Post the 12-week intervention)
  • Assessed changes in C-reactive protein(Pre and Post the 12-week intervention)
  • Assessed changes in alanine aminotransferase(Pre and Post the 12-week intervention)
  • Assessed changes in aspartate aminotransferase(Pre and Post the 12-week intervention)
  • Assessed changes in gamma-glutamyl transferase(Pre and Post the 12-week intervention)
  • Assessed changes in tumor necrosis factor-alpha(Pre and Post the 12-week intervention)
  • Assessed changes in triglycerides(Pre and Post the 12-week intervention)
  • Assessed changes in total cholesterol(Pre and Post the 12-week intervention)
  • Assessed changes in high-density lipoprotein(Pre and Post the 12-week intervention)
  • Assessed changes in low-density lipoprotein(Pre and Post the 12-week intervention)
  • Assessed changes in Body Mass Index(Pre and Post 12-week Intervention)
  • Assessed changes in Body composition: Fat mass and Fat-free mass.(Pre and post the 12-week intervention)
  • Assessed changes in Insulin Resistance: HOMA-IR(Pre and Post 12-week intervention)
  • Assessed changes in Glucose concentration(Pre and Post the 12-week intervention)
  • Assessed changes in Insulin concentration(Pre and Post the 12-week intervention)
  • Assessed changes in Insulin Sensitivity: Matsuda Index(Pre and Post 12-week intervention)
  • Assessed changes in Insulin Sensitivity: Quicki(Pre and Post 12-week intervention)
  • Assessed Height(Pre and Post 12-week Intervention)
  • Assessed changes in Anthropometry: Perimeters(Pre and Post 12-week Intervention)
  • Assessed changes in Anthropometry: Skinfold thickness(Pre and Post 12-week Intervention)
  • Assessed changes in Anthropometry: Waist to Hip Ratio(Pre and Post 12-week Intervention)

研究者

申办方类型
Other
责任方
Sponsor

研究点 (2)

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