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      In middle-aged and old obese patients, training intervention reduces leptin level: A meta-analysis

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          Abstract

          Background

          Leptin is one of the major adipokines in obesity that indicates the severity of fat accumulation. It is also an important etiological factor of consequent cardiometabolic and autoimmune disorders. Aging has been demonstrated to aggravate obesity and to induce leptin resistance and hyperleptinemia. Hyperleptinemia, on the other hand, may promote the development of age-related abnormalities. While major weight loss has been demonstrated to ameliorate hyperleptinemia, obese people show a poor tendency to achieve lasting success in this field. The question arises whether training intervention per se is able to reduce the level of this adipokine.

          Objectives

          We aimed to review the literature on the effects of training intervention on peripheral leptin level in obesity during aging, in order to evaluate the independent efficacy of this method. In the studies that were included in our analysis, changes of adiponectin levels (when present) were also evaluated.

          Data sources

          3481 records were identified through searching of PubMed, Embase and Cochrane Library Database. Altogether 19 articles were suitable for analyses.

          Study eligibility criteria

          Empirical research papers were eligible provided that they reported data of middle-aged or older (above 45 years of age) overweight or obese (body mass index above 25) individuals and included physical training intervention or at least fitness status of groups together with corresponding blood leptin values.

          Statistical methods

          We used random effect models in each of the meta-analyses calculating with the DerSimonian and Laird weighting methods. I-squared indicator and Q test were performed to assess heterogeneity. To assess publication bias Egger’s test was applied. In case of significant publication bias, the Duval and Tweedie's trim and fill algorithm was used.

          Results

          Training intervention leads to a decrease in leptin level of middle-aged or older, overweight or obese male and female groups, even without major weight loss, indicated by unchanged serum adiponectin levels. Resistance training appears to be more efficient in reducing blood leptin level than aerobic training alone.

          Conclusions

          Physical training, especially resistance training successfully reduces hyperleptinemia even without diet or major weight loss.

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          Most cited references54

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          Plasma concentrations of a novel, adipose-specific protein, adiponectin, in type 2 diabetic patients.

          Adiponectin is a novel, adipose-specific protein abundantly present in the circulation, and it has antiatherogenic properties. We analyzed the plasma adiponectin concentrations in age- and body mass index (BMI)-matched nondiabetic and type 2 diabetic subjects with and without coronary artery disease (CAD). Plasma levels of adiponectin in the diabetic subjects without CAD were lower than those in nondiabetic subjects (6.6+/-0.4 versus 7.9+/-0.5 microg/mL in men, 7.6+/-0.7 versus 11.7+/-1.0 microg/mL in women; P<0.001). The plasma adiponectin concentrations of diabetic patients with CAD were lower than those of diabetic patients without CAD (4.0+/-0.4 versus 6.6+/-0.4 microg/mL, P<0.001 in men; 6.3+/-0.8 versus 7.6+/-0. 7 microg/mL in women). In contrast, plasma levels of leptin did not differ between diabetic patients with and without CAD. The presence of microangiopathy did not affect the plasma adiponectin levels in diabetic patients. Significant, univariate, inverse correlations were observed between adiponectin levels and fasting plasma insulin (r=-0.18, P<0.01) and glucose (r=-0.26, P<0.001) levels. In multivariate analysis, plasma insulin did not independently affect the plasma adiponectin levels. BMI, serum triglyceride concentration, and the presence of diabetes or CAD remained significantly related to plasma adiponectin concentrations. Weight reduction significantly elevated plasma adiponectin levels in the diabetic subjects as well as the nondiabetic subjects. These results suggest that the decreased plasma adiponectin concentrations in diabetes may be an indicator of macroangiopathy.
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            Beneficial health effects of modest weight loss.

            The medical effects of modest weight reduction (approximately 10% or less) in patients with obesity-associated medical complications were reviewed. The National Library of Medicine MEDLINE database and the Derwent RINGDOC database were searched to identify English language studies that examined the effects of weight loss in obese patients with serious medical complications commonly associated with obesity (non-insulin dependent diabetes mellitus (NIDDM or type II), hypertension, hyperlipidemia, hypercholesterolemia, and cardiovascular disease). Studies in which patients experienced approximately 10% or less weight reduction were selected for review. Studies indicated that, for obese patients with NIDDM, hypertension or hyperlipidemia, modest weight reduction appeared to improve glycemic control, reduce blood pressure, and reduce cholesterol levels, respectively. Modest weight reduction also appeared to increase longevity in obese individuals. In conclusion, a large proportion of obese individuals with NIDDM, hypertension, and hyperlipidemia experienced positive health benefits with modest weight loss. For patients who are unable to attain and maintain substantial weight reduction, modest weight loss should be recommended; even a small amount of weight loss appears to benefit a substantial subset of obese patients.
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              Obesity, body size, and risk of postmenopausal breast cancer: the Women's Health Initiative (United States).

              Body size is an important modifiable risk factor for breast cancer. Although obesity has generally been found to be associated with increased risk for postmenopausal breast cancer, there remain questions concerning the role of body fat distribution, lifetime weight history, and effects within specific subgroups of women. We assessed the relationship of several anthropometric measures and risk of postmenopausal breast cancer in 85,917 women aged 50-79 at entry in the Women's Health Initiative Observational Study. Women were enrolled during 1993-1998 at 40 clinics in the US and 1030 developed invasive breast cancer by April 2000. Upon entry, trained clinical center staff measured each woman's height, weight, and waist and hip circumference. Anthropometric factors were not associated with breast cancer among women who had ever used hormone replacement therapy (HRT). Among HRT non-users, heavier women (baseline body mass index (BMI) >31.1) had an elevated risk of postmenopausal breast cancer (relative risk (RR) = 2.52; 95% confidence interval (CI) = 1.62-3.93), compared to slimmer women (baseline BMI < 22.6). The elevation in risk associated with increasing BMI appeared to be most pronounced among younger postmenopausal women. Change in BMI since age 18, maximum BMI, and weight were also associated with breast cancer in HRT non-users. While both waist and hip circumference were associated with breast cancer risk, their ratio, a measure of fat distribution, was not (RR = 1.33; 95% CI = 0.88-2.01). Our study confirms previously reported findings that generalized obesity is an important risk factor for postmenopausal breast cancer, but only among women who have never taken HRT. Lifetime weight gain is also a strong predictor of breast cancer. Waist to hip ratio, a measure of weight distribution, does not appear to be related to postmenopausal breast cancer risk.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Writing – original draft
                Role: Formal analysisRole: MethodologyRole: Visualization
                Role: Formal analysisRole: VisualizationRole: Writing – original draft
                Role: ResourcesRole: Supervision
                Role: Data curationRole: Investigation
                Role: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: Funding acquisitionRole: ValidationRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: MethodologyRole: Validation
                Role: Data curationRole: Validation
                Role: Data curationRole: Validation
                Role: Data curationRole: Validation
                Role: Data curationRole: Validation
                Role: Data curationRole: Validation
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 August 2017
                2017
                : 12
                : 8
                : e0182801
                Affiliations
                [1 ] Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
                [2 ] Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
                [3 ] Hungarian Academy of Sciences - University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
                [4 ] Division of Gastroenterology, First Department of Internal Medicine, University of Pécs, Pécs, Hungary
                [5 ] First Department of Surgery, Semmelweis University, Budapest, Hungary
                [6 ] Heim Pál Children’s Hospital, Budapest, Hungary
                Vanderbilt University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-16-42664
                10.1371/journal.pone.0182801
                5557366
                28809927
                f3d42bfa-b67c-4489-8eac-8855b4971f70
                © 2017 Rostás et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 November 2016
                : 25 July 2017
                Page count
                Figures: 6, Tables: 2, Pages: 23
                Funding
                Funded by: Medical School, University of Pécs
                Award ID: PTE ÁOK-KA No: 2017/13
                Award Recipient :
                Funded by: Medical School, University of Pécs, Hungary
                Award ID: PTE-AOK-KA-2015-14
                Award Recipient :
                Funded by: Medical School University of Pécs
                Award ID: PTE ÁOK-KA No: 2017/12
                Award Recipient :
                This work was supported by grants from the Medical School, University of Pécs, Hungary (PTE ÁOK-KA No: 2017/12 to Erika Pétervári, PTE ÁOK-KA No: 2017/13 to Márta Balaskó, and PTE-AOK-KA-2015-14 to Margit Solymár). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Biochemistry
                Hormones
                Peptide Hormones
                Leptin
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
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                Physiology
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                Research and Analysis Methods
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