Top

Published in:

01-03-2009 | Article

Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study

Authors: C. Herder, M. Peltonen, W. Koenig, K. Sütfels, J. Lindström, S. Martin, P. Ilanne-Parikka, J. G. Eriksson, S. Aunola, S. Keinänen-Kiukaanniemi, T. T. Valle, M. Uusitupa, H. Kolb, J. Tuomilehto, for the Finnish Diabetes Prevention Study Group

Published in: Diabetologia | Issue 3/2009

Abstract

Aims/hypothesis

Subclinical inflammation confers an increased risk of type 2 diabetes, cardiovascular disease, neurodegenerative disorders and other age-related chronic diseases. Physical activity and diet can attenuate systemic immune activation, but it is not known which individual components of a comprehensive lifestyle intervention are most effective in targeting subclinical inflammation.

Methods

We used data from the baseline examination and the 1 year follow-up of a subsample of 406 of 522 participants of the Finnish Diabetes Prevention Study (DPS) to estimate the effect of individual components of lifestyle intervention on C-reactive protein (CRP) and IL-6 levels, which represent the best characterised proinflammatory risk factors for type 2 diabetes. Changes in metabolic markers, dietary patterns and exercise were analysed to determine which were most strongly associated with the anti-inflammatory effect of lifestyle changes.

Results

Lifestyle intervention reduced circulating levels of CRP (p < 0.001) and IL-6 (p = 0.060). Increases in fibre intake and moderate to vigorous leisure time physical activity (LTPA), but not total LTPA, predicted decreases in CRP and/or IL-6 and remained associated even after adjustment for baseline BMI or changes in BMI during the first year of the study. Changes in carbohydrate or fat intake were either weakly or not linked to reductions in CRP and IL-6.

Conclusions/interpretation

The present study assessed the individual effects of dietary and physical activity measures on low-grade inflammation in individuals at high cardiometabolic risk. Our results underline the importance of moderate to vigorous LTPA and a diet rich in natural fibre, and this should be emphasised in lifestyle recommendations.

Trial registration: ClinicalTrials.gov NCT00518167

Funding: The study was funded by the European Foundation for the Study of Diabetes, the German Federal Ministry of Health, the Ministry of Innovation, Science, Research and Technology of the State of North Rhine-Westphalia, the German Diabetes Foundation (Deutsche Diabetes-Stiftung), the Department of Internal Medicine II—Cardiology at the University of Ulm, the Academy of Finland, the Juho Vainio Foundation, the Finnish Ministry of Education, the Novo Nordisk Foundation, the Yrjö Jahnsson Foundation, the Finnish Diabetes Research Foundation and EVO funds from Tampere and Kuopio University Hospital.

Available only for authorised users

American Diabetes Association (2008) Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31:S61–S78CrossRef

Kempf K, Rathmann W, Herder C (2008) Impaired glucose regulation and type 2 diabetes in children and adolescents. Diabetes Metab Res Rev 24:427–437PubMedCrossRef

Pan XR, Li GW, Hu YH et al (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20:537–544PubMedCrossRef

Tuomilehto J, Lindström J, Eriksson JG et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350PubMedCrossRef

Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403PubMedCrossRef

Ramachandran A, Snehalatha C, Mary S et al (2006) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49:289–297PubMedCrossRef

Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention. Follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679PubMedCrossRef

Schmidt MI, Duncan BB, Sharrett AR et al (1999) Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet 353:1649–1652PubMedCrossRef

Barzilay JI, Abraham L, Heckbert SR et al (2001) The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Study. Diabetes 50:2384–2389PubMedCrossRef

10.

Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM (2001) C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 286:327–334PubMedCrossRef

11.

Meigs JB, Hu FB, Rifai N, Manson JE (2004) Biomarkers of endothelial dysfunction and risk of type 2 diabetes mellitus. JAMA 291:1978–1986PubMedCrossRef

12.

Thorand B, Kolb H, Baumert J et al (2005) Elevated levels of interleukin-18 predict the development of type 2 diabetes: results from the MONICA/KORA Augsburg Study, 1984–2002. Diabetes 54:2932–2938PubMedCrossRef

13.

Herder C, Baumert J, Thorand B et al (2006) Chemokines as risk factors for type 2 diabetes: results from the MONICA/KORA Augsburg Study, 1984–2002. Diabetologia 49:921–929PubMedCrossRef

14.

Herder C, Klopp N, Baumert J et al (2008) Effect of macrophage migration inhibitory factor (MIF) gene variants and MIF serum concentrations on the risk of type 2 diabetes: results from the MONICA/KORA Augsburg Case–Cohort Study, 1984–2002. Diabetologia 51:276–284PubMedCrossRef

15.

Herder C, Peltonen M, Koenig W et al (2006) Systemic immune mediators and lifestyle changes in the prevention of type 2 diabetes: results from the Finnish Diabetes Prevention Study. Diabetes 55:2340–2346PubMedCrossRef

16.

Diabetes Prevention Program Research Group (2005) Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance. Diabetes 54:1566–1572CrossRef

17.

Selvin E, Paynter NP, Erlinger TP (2007) The effect of weight loss on C-reactive protein. Arch Intern Med 167:31–39PubMedCrossRef

18.

Fung TT, McCullough ML, Newby PK et al (2005) Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 82:163–173PubMed

19.

Schulze MB, Hoffmann K, Manson JE et al (2005) Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr 82:675–684PubMed

20.

Kolb H, Mandrup-Poulsen T (2005) An immune origin of type 2 diabetes. Diabetologia 48:1038–1050PubMedCrossRef

21.

Van Gaal LF, Mertens IL, De Block CE (2006) Mechanisms linking obesity with cardiovascular disease. Nature 444:875–880PubMedCrossRef

22.

Krabbe KS, Pedersen M, Bruunsgaard H (2004) Inflammatory mediators in the elderly. Exp Gerontol 39:687–699PubMedCrossRef

23.

Licastro F, Candore G, Lio D et al (2005) Innate immunity and inflammation in ageing: a key for understanding age-related diseases. Immun Ageing 2:8PubMedCrossRef

24.

Ferrucci L, Harris TB, Guralnik JM et al (1999) Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc 47:639–646PubMed

25.

Eriksson J, Lindström J, Valle T et al (1999) Prevention of type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland: study design and 1-year interim report on the feasibility of the lifestyle intervention programme. Diabetologia 42:793–801PubMedCrossRef

26.

Uusitupa M, Louheranta A, Lindström J et al (2000) The Finnish Diabetes Prevention Study. Br J Nutr 83(Suppl 1):S137–S142PubMed

27.

Lindström J, Eriksson JG, Valle TT et al (2003) Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: results from a randomized clinical trial. J Am Soc Nephrol 14:S108–S113PubMedCrossRef

28.

Laaksonen DE, Lindström J, Lakka TA et al (2005) Physical activity in the prevention of type 2 diabetes. The Finnish Diabetes Prevention Study. Diabetes 54:158–165PubMedCrossRef

29.

Lakka TA, Venäläinen JM, Rauramaa R, Salonen R, Tuomilehto J, Salonen JT (1994) Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. N Engl J Med 330:1549–1554PubMedCrossRef

30.

Lindström J, Louheranta A, Mannelin M et al (2003) The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 26:3230–3236PubMedCrossRef

31.

Ovaskainen ML, Valsta L, Lauronen J (1996) The compilation of food analysis values as a database for dietary studies: the Finnish experience. Food Chemistry 57:133–136CrossRef

32.

Nicklas BJ, You T, Pahor M (2005) Behavioural treatments for chronic systematic inflammation: effects of dietary weight loss and exercise training. CMAJ 172:1199–1209PubMed

33.

Fogarty AW, Glancy C, Jones S, Lewis SA, McKeever TM, Britton JR (2008) A prospective study of weight change and systematic inflammation over 9 y. Am J Clin Nutr 87:30–35PubMed

34.

Weinstein AR, Sesso HD, Lee IM et al (2004) Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA 292:1188–1194PubMedCrossRef

35.

Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE (2004) Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 351:2694–2703PubMedCrossRef

36.

Petersen AMW, Pedersen BK (2005) The anti-inflammatory effect of exercise. J Appl Physiol 98:1154–1162PubMedCrossRef

37.

Kristiansen OP, Mandrup-Poulsen T (2005) Interleukin-6 and diabetes: the good, the bad, or the indifferent. Diabetes 54(Suppl 2):S114–S124PubMedCrossRef

38.

Kempf K, Rose B, Herder C et al (2007) The metabolic syndrome sensitizes leukocytes for glucose-induced immune gene expression. J Mol Med 85:389–396PubMedCrossRef

39.

Koenig K, Khuseyinova N, Baumert J et al (2006) Increased concentrations of C-reactive protein and IL-6 but not IL-18 are independently associated with incident coronary events in middle-aged men and women. Results from the MONICA/KORA Augsburg Case–Cohort Study, 1984–2002. Arterioscler Thromb Vasc Biol 26:2745–2751PubMedCrossRef

40.

Thorand B, Baumert J, Koenig W et al (2007) Sex differences in the prediction of type 2 diabetes by inflammatory markers: results from the MONICA/KORA Augsburg case–cohort study, 1984–2002. Diabetes Care 30:854–860PubMedCrossRef

41.

Ajani UA, Ford ES, Mokdad AH (2004) Dietary fiber and C-reactive protein: findings from the National Health and Nutrition Examination Survey data. J Nutr 134:1181–1185PubMed

42.

Qi L, Van Dam RB, Liu S, Franz M, Mantzoros C, Hu FB (2006) Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care 29:207–211PubMedCrossRef

43.

Ma Y, Griffith JA, Chasan-Taber L et al (2006) Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr 83:760–766PubMed

44.

King DE, Egan BM, Woolson RF, Mainous AG 3rd, Al-Solaiman Y, Jesri A (2007) Effect of high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. Arch Intern Med 167:502–506PubMedCrossRef

45.

Nilsson AC, Östmann EM, Holst JJ, Björck IME (2008) Including indigestible carbohydrates in the evening meal of healthy subjects improves glucose tolerance, lowers inflammatory markers, and increases satiety after a subsequent standardized breakfast. J Nutr 138:732–739PubMedCrossRef

46.

Lindström J, Peltonen M, Eriksson JG et al (2006) High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia 49:912–920PubMedCrossRef

47.

King DE (2005) Dietary fiber, inflammation, and cardiovascular disease. Mol Nutr Food Res 49:594–600PubMedCrossRef

48.

Heinrich PC, Castell JV, Andus T (1990) Interleukin-6 and the acute phase response. Biochem J 265:621–636PubMed

Title: Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study
Authors: C. Herder
M. Peltonen
W. Koenig
K. Sütfels
J. Lindström
S. Martin
P. Ilanne-Parikka
J. G. Eriksson
S. Aunola
S. Keinänen-Kiukaanniemi
T. T. Valle
M. Uusitupa
H. Kolb
J. Tuomilehto
for the Finnish Diabetes Prevention Study Group
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Diabetologia / Issue 3/2009
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-008-1243-1

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 3/2009

The risk allele load accelerates the age-dependent decline in beta cell function

Paired box 6 (PAX6) regulates glucose metabolism via proinsulin processing mediated by prohormone convertase 1/3 (PC1/3)

Childhood BMI trajectories and the risk of developing young adult-onset diabetes

Impaired glucagon-like peptide-1-induced insulin secretion in carriers of transcription factor 7-like 2 (TCF7L2) gene polymorphisms

Sustained insulin secretory response in human islets co-cultured with pancreatic duct-derived epithelial cells within a rotational cell culture system

Guidelines for medical management of hyperglycaemia in type 2 diabetes and duality of interest

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page