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Effects of exercise training on insulin resistance and lipid oxidation in skeletal muscle in patients undergoing bariatric surgery: a randomized trial

Grant number: 15/02835-8
Support type:Scholarships in Brazil - Doctorate
Effective date (Start): August 01, 2015
Effective date (End): June 30, 2019
Field of knowledge:Health Sciences - Physical Education
Cooperation agreement: Coordination of Improvement of Higher Education Personnel (CAPES)
Principal researcher:Bruno Gualano
Grantee:Wagner Silva Dantas
Home Institution: Escola de Educação Física e Esporte (EEFE). Universidade de São Paulo (USP). São Paulo , SP, Brazil
Associated scholarship(s):17/01427-9 - Molecular mechanisms involved in the extracellular matrix remodeling of skeletal muscle of obese patients undergoing bariatric surgery: role of insulin resistance and effects of exercise training, BE.EP.DR

Abstract

Obesity is defined by excessive accumulation of body fat usually classified by calculating the body mass index (BMI). From the 80s, obesity has become a global epidemic in different age groups of the population, with an estimate of the existence of approximately 500 million obese with a BMI e 30 kg / m2. Morbid obesity is defined as a BMI e 40 kg / m2 or greater than 35 kg / m2 associated with significant medical comorbidity. It is well established the association between obesity, sedentary lifestyle and high calorie diet, especially in saturated fatty acids and carbohydrates in the development of insulin resistance and diabetes mellitus type 2.Insulin resistance is an important clinical marker present in obesity and type 2 diabetes and is associated with impaired glucose uptake and lipid skeletal muscle metabolism. Obese patients with insulin resistance demonstrates reduction in oxidative capacity, decreased fatty acid oxidation and pronounced increase in lipid accumulation in skeletal muscle compared with eutrophic individuals, leading to worsening insulin resistance by producing metabolites derived from impair fatty acids insulin signaling in skeletal muscle. Recent studies have demonstrated that bariatric surgery provides a slight improvement in insulin sensitivity in skeletal muscle in morbidly obese non-diabetic, despite a marked reduction of body weight in these patients. Other studies have shown an incomplete lipid oxidation in skeletal muscle of obese patients undergoing bariatric surgery. So once that bariatric surgery is not efficient in promoting increased lipid oxidation in skeletal muscle and causes slight improvement in insulin sensitivity in morbidly obese patients, these factors become critical elements in the deterioration of clinical and metabolic parameters after bariatric surgery. Exercise training has shown encouraging results with respect to increased capacity complete lipid oxidation and reduction of ceramides and diacylglycerol in skeletal muscle of obese subjects compared to the weight reducing diet restriction. However, it is unclear the factual role of exercise training in improving the insulin resistance in patients undergoing bariatric surgery, as well as the relationship with the complete lipid oxidation in skeletal muscle in patients undergoing bariatric surgery. Thus, the understanding of physiological, molecular and clinical exercise training in patients undergoing bariatric surgery can be considered of vital importance for the development of therapeutic strategies dedicated to the treatment of morbid obesity. Thus, our hypothesis is that the improvement of insulin resistance by exercise training is associated with improved oxidative capacity of obese patients undergoing bariatric surgery, culminating in reducing the content of diacylglycerol and ceramides in skeletal muscle. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
DANTAS, WAGNER S.; ROSCHEL, HAMILTON; MURAI, IGOR H.; GIL, SAULO; DAVULURI, GANGARAO; AXELROD, CHRISTOPHER L.; GHOSH, SUJOY; NEWMAN, SUSAN S.; ZHANG, HUI; SHINJO, SAMUEL K.; DAS NEVES, WILLIAN; MEREGE-FILHO, CARLOS; TEODORO, WALCY R.; CAPELOZZI, VERA L.; PEREIRA, ROSA MARIA; BENATTI, FABIANA B.; DE SA-PINTO, ANA L.; DE CLEVA, ROBERTO; SANTO, MARCO A.; KIRWAN, JOHN P.; GUALANO, BRUNO. Exercise-Induced Increases in Insulin Sensitivity After Bariatric Surgery Are Mediated By Muscle Extracellular Matrix Remodeling. Diabetes, v. 69, n. 8, p. 1675-1691, AUG 2020. Web of Science Citations: 0.

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