Obesity Clinical Trial
Official title:
Fuel Utilization, Diet Composition, and Exercise in African American Women
African American women have a high prevalence of obesity and type 2 diabetes and do not optimally burn fat and carbohydrates in response to changes in these nutrients in their diets. This research project seek to determine if high intensity interval training (HIIT) exercise training can help healthy, but inactive, premenopausal, non-diabetic women increase their bodies' use of fat and carbohydrates when provided with a high fat or low fat diets. In this study, investigators will measure the rate at which fat is burned in response to weight maintaining low-fat and high-fat diets and how exercise may affect these responses.
African Americans have the highest age-adjusted death rate for heart disease and diabetes in
the United States. Obesity, a significant risk factor for these conditions, is highly
prevalent in African Americans, particularly women, leading to increased co-morbidities.
Cardiovascular risk and incidence were reported to be higher in African American women than
in both white women and African American men. Ethnic differences in lifestyle behaviors and
economic disadvantage account for some of this disparity but genetic/molecular factors may
play a role. The study team has shown that more pre-menopausal, non-diabetic, African
American women do not increase post-absorptive lipid oxidation in response to a eucaloric
increase in dietary fat than white women counterparts. African American women were also shown
to have increased rates of low aerobic capacity (VO2peak) and insulin resistance.
A lack of increasing fuel utilization in response to an increase in fuel availability,
particularly fat, is associated with obesity and insulin resistance and is attributed to a
decrease in the oxidative capacity of the skeletal muscle. An eucaloric increase in dietary
fat leads to increased post-absorptive lipid utilization through hormonal changes that affect
the mitochondria and a decrease in this response is postulated to reflect a decrease in the
mitochondria/oxidative capacity. Lipid utilization in response to an increase in dietary fat
is enhanced by acute exercise. Aerobic training could also improve aerobic capacity and
insulin resistance and increases the oxidative capacity/mitochondrial activity in the
skeletal muscle, measured in vitro. The degree to which training affects aerobic capacity and
metabolism differs with the type, intensity and duration of training and with the population
studied. High-intensity interval training (HIIT) programs improved aerobic fitness and
insulin resistance in cardiac, sedentary and obese individuals and rapidly increased markers
of lipid oxidation and mitochondrial activity in skeletal muscle, measured in vitro. A great
appeal of HIIT is that lesser time per week spent exercising may be needed to produce these
effects. There have been a paucity of effective exercise training studies in African American
women; none have employed HIIT which appears uniquely suited given their metabolic profile
and none have examined the impact of training on the metabolic response to an increase in
dietary fat.
Therefore the Aims of this study are to determine, in overweight and obese, sedentary,
pre-menopausal, non-diabetic African American women, whether a 14-week of a HIIT exercise
program will:
I. Increase systemic post-absorptive lipid oxidation in response to a higher fat diet (50%
fat, 35% CHO, 15% protein). The study team hypothesizes that the women who successfully
complete training will have significantly higher post-absorptive lipid oxidation in response
to the higher fat diet compared to the sedentary controls on a similar diet.
II. Improve aerobic endurance capacity. The study team hypothesizes that VO2peak will be
significantly higher in the women who successfully complete training compared to the
sedentary controls.
III. Improve insulin sensitivity. The study team hypothesizes that insulin sensitivity will
be significantly higher in the women who successfully complete training compared to the
sedentary controls.
Te secondary aims are to determine whether: 1) the exercise training favorably changes muscle
adipose tissue distribution and lipid accumulation and 2) these changes correlate with an
improvement in insulin sensitivity.
To test these hypotheses The study team will conduct a clinical trial in 48 pre-menopausal,
healthy, sedentary, overweight and obese African American women. All women will be challenged
with a 10-day eucaloric higher fat diet. Then, half of the women will be randomized to
participate in a 14-week HIIT program designed to significantly increase their aerobic
endurance and half will maintain baseline physical activity. Throughout the follow period all
women will be counseled to follow the same, weight-maintaining, heart-healthy diet. After 14
weeks the higher fat dietary challenges will be repeated, at weight stability ensured with
the use of the whole-body calorimeter (metabolic chamber). Post-absorptive lipid oxidation,
insulin sensitivity and muscle-associated fat will be measured at the end of each of the
higher fat diet periods, before and after the 14 weeks of exercise raining, in the sedentary
and exercising women, 2 days after the last bout of acute exercise.
HIIT has a greater potential for translation into clinical practice as the shorter exercise
time may improve compliance which is the biggest deterrent for the success of exercise
training programs. Prevention of obesity and reversal of decreased aerobic capacity and
insulin resistance in younger individuals such as African American women of child-bearing age
(pre-menopausal) could be crucial to decrease the worrisome trends of obesity-related
illnesses in African Americans.
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