Abstract

Objective:

The aim of our study is to evaluate the impact of a combined program take charge, including physical activity and diet on anthropometric, metabolic and hormonal parameters in a group of obese women.

Material and Methods:

Twenty adult obese women (age: 31.90 ± 10.36) were recruited at the National Institute of Nutrition. This group received a low-calorie diet by reducing 1/3 of caloric intake + running at 60 minutes / day. The duration of the combined program was 7 months. All women were followed regularly every 15 days by the nutritionist to help them overcome difficulties. Parameters measured are anthropometric, metabolic parameters and two adipokines.

Results:

A significant decrease has characterized the main anthropometric parameters (weight, waist circumference, hip circumference, body fat percentage) and metabolic parameters (total cholesterol, LDL-C, triglycerides, blood sugar). Resistin was correlated positively and significantly with leptin, body mass index, the rate of body fat before and after the treatment program combined load. Also, serum leptin and resistin were significantly reduced (-4 ng / ml, -2, 37 ng / ml respectively).

Conclusion:

The program supported exerted beneficial effects on anthropometric, metabolic and hormonal parameters in obese women. Further studies are needed to evaluate this program supported by changing several parameters: number of participants, age, sex, duration of treatment.

Keywords physical activity, diet, Obesity, resistin

Author and Article information

Author info
1. National Institute of Public Health, Tunisia
2. Faculty of Pharmacy of Monastir, National Institute of Public Health, Tunisia
3. National Institute of Nutrition, Tunisia
4. Laboratory of Biochemistry and Bio-Technology, Faculty of Sciences of Tunis, National Institute of Nutrition, Tunisia

RecievedSep 17 2013　　AcceptedOct 30 2013　　PublishedNov 6 2013

CitationFethi BS, Saber J, Fatma BH, Chiheb BRM, Ahmed A, Mohamed H, Omrane BH (2013) Effect of a low calorie diet combined at a physical activity (walking) on the rate of resistin, leptin, lipids and anthropometric parameters in a group of obese women. Science Postprint 1(1): e00004. doi:10.14340/spp.2013.11A0001

Copyright©2013 The Authors. Science Postprint published by General Healthcare Inc.. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.1 Japan (CC BY-NC-ND 2.1 JP) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

FundingFinancing of work has been done within the framework of a collaboration between:
• Department of Biochemistry and Bio- Technology, Faculty of Sciences of Tunis
• The National Institute of Public Health
• The Laboratory of Clinical Biochemistry and the Department of Metabolic Diseases of the National Institute of Nutrition

Competing interestsThere are no conflicts of interest.

Author contributionsAll authors participated each in his specialty and responsibility:
• Dr. Ben Slama F.: Scientific Coordination and logistics between the different partner.
• Mr. Jdaoulia S. : Conducting the survey and participation in biological anlyse laboratory at the National Institute of Nutrition.
• Ms. Ben Hafsa F.: Realization of the nutrition survey in his capacity as Dietician at the National Institute of Nutrition.
• Prof. Ben Rayana Mr. CH.: He is the Director of the Laboratory of Clinical Biochemistry at the National Institute of Nutrition. He monitored the biochemical analyzes.
• Prof. Achour A. : He is the Head of the "C" department of Metabolic Diseases at the National Institute of Nutrition. He offered us obese patients seen in his service after their agreement.
• Pr Hsairi M. and Pr. Belhadj O. were scientific consultants of our work on the methodology and techniques of biological analyzes.

Corresponding authorBen Slama Fethi
Address67, Boulevard Hédi Saïdi, Bab Saadoun 1005, Tunis, Tunisie
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Introduction

Obesity is a chronic disease characterized by an increase in body weight due to excessive or abnormal accumulation of fat in the body. Long regarded as a mere cosmetic problem related to the sin of gluttony, obesity is now recognized as a real disease. Obesity has become the first "inflammatory" non-infectious in the history of humanity disease. Explosion epidemic, authentic chronic disease, obesity is especially preferred provider of many co-morbidities dominated by cardiovascular and metabolic diseases willingly entangled increasing the risk of morbidity and mortality and hinder the quality of life of obese patients 1. Based on this knowledge, the management of obesity has become a necessity. Indeed, in addition to medical and surgical treatment, the use of an individualized exercise program or taking unique nutritional support or association between physical exercise and diet are other tools supported. Our work will, in fact, the impact of a program of support combined with a twenty obese women, based on the association between physical activity (walking) and diet (appropriate diet) on metabolic parameters and anthropometric rate of two adipokines resistin, leptin house known both implicated in the genesis of obesity and insulin resistance2-5.

Material and Methods

Study Population

Our study was conducted from October 2009 to April 2010. It was conducted as part of a collaboration between the National Institute of Nutrition, Laboratory of Biochemistry and Biotechnology, Faculty of Sciences of Tunis, and the National Institute of Public Health. It involved a group of obese women who voluntarily agreed to participate in our survey and expressed a serious interest to lose weight. The group is composed of 20 obese women (BMI > 30kg/m2) recruited from the outpatient clinic of the National Institute of Nutrition and followed the "C" service of diseases nutrition and diet therapy at the Institute.

Tool and method of data collection

For data collection, we used:
A. A survey administered by us: It focuses on three areas:
1. The general characteristics of the respondent: age, sex, marital status, level of education, socioeconomic status.
2. The frequency of possible behaviors and eating habits.
3. Types and normal levels of the respondent practiced by physical activity, trying to assess the duration, rhythmicity of daily walking.
B. A record collection of anthropometric data:
Each woman was weighed two times in a row by the dietician of the service and a student of third year study in nutrition using a calibrated weighing scale. As for the height, was measured by the same procedure as taking weight using a micro fathom. The average of two weights and two sizes was used. The Waist and Hips were recorded using a tape measure and the measurement procedure was performed in the same manner as the weight and size. Thereafter, we calculated BMI expressed in kg/m2 which is the ratio of weight in kilograms to the square of height in meters. Anthropometric measurements were performed at each appointment with the woman who was set on average every 15 days.
(C). A dietary survey based on the method of 24-hour recall and food history.

Methods of treatment of patients

Our protocol support for obese women is essentially based on a rigorous monitoring and management of obese women from two pairs (Dietitian and Doctor) working in "C" service.
This protocol consists of:
(A). Prescription personalized diet: Following the results of the nutrition survey, each patient undergoes a personalized according to his eating habits regime and characterized by:
- Lower third of spontaneous caloric intake.
- Increase consumption of foods made fibers, vegetables and seasonal fruits with low glycemic, index available on the market and taking into count the purchasing power of the patient.
(B). Physical Activity: The practice of daily walk of 60 minutes. This method is facilitated by the willingness of women to reduce weight.
Each woman was followed every 15 days to outpatient to help overcome the difficulties of monitoring protocol.

Laboratory tests performed

For each woman participating in our survey, we performed a blood sample at the beginning of the treatment and a second about 7 months. We analyzed lipid parameters, glucose and two adipokines leptin and resistin. Cholesterol, triglycerides and glucose were measured by enzymatic method on the controller KIT Beckman Beckman Synchron Cx7 USA, while the values of HDL-cholesterol were measured after selective precipitation (Kit Randox UK). LDL concentrations were calculated by the Friedewald formula in accordance with the conditions of application (triglycerides less than 4 mmol / L). For biochemical analysis, résistinémie was determined by ELISA "Millipore # EZHR-95K with a sensitivity ranging from 0.16 ng / ml to 10 ng." The dosing of leptin is produced by the radioimmunoassay method with competition "RIA Millipore # HL-81HK with a sensitivity of 0.5 ng / ml to 100ng/ml." Biological analyzes were performed at the Laboratory of Clinical Biochemistry at the National Institute of Nutrition.

Analysis of food consumption survey

The survey data were coded according to the directory "BILNUT" computer software 1991 version, which was added to a list of 235 foods and dishes specific to our country.

Statistical Analysis

Data were entered using the "Excel 2007 version" software and statistical analysis using the SPSS 11.5 software.
(A). For comparison averages paired series, we used nonparametric tests (Wilcoxon tests).
(B). Comparisons of percentages of independent groups were performed by the chi-square test of Pearson, and in case of non-validity of the test or the comparison of two percentages, the bilateral Fisher's exact test.
(C) The agreement between two quantitative variables was assessed by the intraclass correlation coefficient "r" class. This coefficient is interpreted as follows:
- <0.20: no matching or very bad;
- 0.21 to 0.41: poor agreement;
- 0.41-0.60: medium consistency;
- 0.61-0.80: good agreement;
- 0.81 and higher: very good agreement.
In all statistical tests, the significance level "p" was set at 0.05.

Ethics statement

Before the start of our investigation, we have obtained the informed consent of women volunteers who were motivated to participate in our work and looking for lose weight. Our sheets surveys included numbers to not write the names to respect the confidentiality of individual data for each obese woman.

Results

The average age of women surveyed is (31.9 ± 10.3) years. The majority of women are married (65%) and others are young unmarried girls. The occupational status revealed proportions close as 30% questions are unemployed, 30% have a liberal function, 30% are senior and middle managers. Furthermore, our results showed that 35% of respondents said that it is the physical aesthetics motivates them to follow a weight loss protocol against 65% who are motivated by preventing their health. Regarding the eating disorder, 80% of women have the habit of snacking especially in the evening after dinner. The results of the survey of food surveyed before management are shown in Table 1.

It is clear from this table that for all, it is a super power and low lipid dietary fiber. Tables 2 and 3 present respectively the mean anthropometric parameters before and after treatment of patients and the mean of the differences between these different parameters.

The findings of both Tables 2 and 3 show that anthropometric parameters improved after 7 months of care according to the pre established protocol. The study of changes in metabolic parameters after treatment of 20 women showed a significant decrease in serum cholesterol, triglycerides, Ldl cholesterol, leptin and resistin. A non-significant decrease in HDL-cholesterol was observed.

In addition, we studied the correlation of leptin and resistin with BMI. Table 6 shows the values of correlation coefficients before support.

The results of our work show the existence of a positive and significant as well between resistin and BMI and leptin and resistin before support. These correlations persist after support marked by the significant decrease of the measured parameters. Figures 1 and 2 illustrate these results.

Discussion

Obesity is considered to be among the most common non-infectious diseases worldwide. Given its explosion and its disastrous consequences, prevention and management of this disease has become a necessity. The combination of diet and physical activity is one of the strategies supported. This strategy was the focus of our study. Indeed, our study involved 20 obese adult women highlighted the impact of the management program combined load on the anthropometric and metabolic parameters in particular resistin and adipokine involved in the complication of obesity and insulin resistance. For technical and financial reasons, we have not been able to analyze and measure the adiponection and PAI-1 (plasminogen inhibitor actinator 1) to evaluate the effect of our programming on this parameter.Obese patients in our study population have benefited over a suitable diet and taking into account the needs of the subject and its previous energy intake, physical activity-based walking for 60 minutes a day.
Before the treatment, we conducted a nutritional survey in obese women. This survey has allowed us to know the qualitative and quantitative spontaneous feeding those following characteristics. The results of this survey showed a fairly high frequency of behavioral problems up to 80%. Other causes could explain the high incidence of behavioral problems such as stress experienced by all people and fatigue that cause hunger. Snacking, classified as an eating disorder, was also high frequency. This habit is more practiced that our way of life accelerates, prompting a breakdown of meals, and the constant temptations are facing a very diverse and easily accessible food supply.
In the second part of our study, we are interested in evaluating the changes achieved in anthropometric and metabolic parameters following a program of care based on a combination of diet and physical activity monitored. Our main results have shown that diet and walking at 60 minutes per day for 7 months have concomitant improvement in anthropometric and metabolic parameters in obese women.
A significant decrease in all measured anthropometric parameters was recorded. The measured biological parameters have also undergone changes. Indeed, our results showed a significant decrease of 0.64 mmol / l total cholesterol, 0.53 mmol / l Low-density lipoprotein (LDL)-cholesterol, 0.43 mmol / l triglycerides, 2.89 mmol / l glucose, 2.37 ng / ml plasma resistin, 4.00 ng / ml of leptin with an increase of 0.34 mmol / l of High-density lipoprotein (HDL)-cholesterol.
Moreover, the study of the impact of diet and physical activity on anthropometric and metabolic parameters was the focus of several studies. The word of Wycherley and al. 6 on 83 obese patients with diabetes type 2 and whose age is about 56.1 ± 7.5 years, showed that a combination of resistance training and a diet high in protein resulted in a loss of 13.8 kg of weight, a decrease of 13, 7 cm of waist, 11 kg of total body fat. These reported values exceed those recorded in our group. However, other studies show a small improvement in these parameters on these alternatives. Indeed, Castres and al 7 have experienced a combination based diet and walking due to 10,000 steps per day in 69 obese. Reported results show a significant decrease in weight (-3.7 kg), waist (- 4.6 cm), -2.6% fat with a significant increase in the percentage of lean body mass. These results are very much lower than those reported in our surveyed population. Also according Straight and collaborators, small changes were also observed during the implementation of a program of support including diet and resistance training leading to a significant loss of 1 kg of body weight, a significant decrease of 4.5 cm from the waist with a decrease 0.5% fat in subjects whose age is between 55 and 80 years 8. In addition, some authors have studied the application of these types of protocol support for obesity in child population. At the end of the study by Lazzer and employees with a group of boys and obese girls, following a program of adapted physical activity, BMI decreased slightly by an average of 0.6 and 0.5 kg/m2, respectively 9 . An improvement in BMI significantly higher than that recorded in the previous study was found by Lemoine and collaborators among both boys and girls participants (10 kg /m2 for Boys - 8.9 kg/m2 for females) 10.
However, the beneficial interest of taking combined load (adapted diet and physical activity) on biological parameters was also observed in several studies. In this sense, we cite the work of the Faculty of Medicine in Sousse Ben Ounis al.qui and showed significant improvement in all metabolic parameters measured (Total cholesterol, Triglyceride, LDL-cholesterol) in obese adolescents following a program includes a diet and endurance training 11. A prospective study in Sfax by Kaffel and al.sur a period of 3 years shows a significant improvement in glucose and lipid profile in obese patients undergoing low-calorie diet and enjoying an aerobic exercise associated with muscle-strengthening exercises 12 . Also Fayh et al suggest an improvement in metabolic parameters measured by significant reduction in Total cholesterol and Triglyceride (-10.5 mg / dl, 39.4 mg / dl, respectively)13.
However, other studies show that the observed response to these types of care improvement of obesity may not affect all biological parameters. Engelson and collaborators demonstrate the absence of changes in the lipid profile, the lack of improvement in blood glucose and insulin sensitivity after a program of physical activity and diet combined 4 months 14. Yancy and colleagues compared the effect of two different types of diets (low-fat diet and low carbohydrate diet) associated with physical activity. The results of this study showed that the impact of support on biological parameters differ depending on the type of plan. A significant decline was only the total cholesterol and triglycerides without significant improvement in LDL-cholesterol and HDL-cholesterol in the group receiving a low fat diet. While the low-carb diet along with physical exercise led to a significant reduction in triglycerides and a significant increase in HDL-cholesterol in the absence of significant improvement in total cholesterol and LDL-cholesterol 15.
In addition to the improvement of anthropometric and metabolic parameters, our study also showed a significant improvement in serum leptin and resistin. Indeed, our results showed that in the two groups significantly decreased their serum concentrations of leptin and resistin.
Several studies confirm the results of our study regarding changes in leptin levels after combined management. De Luis and al 16 showed a reduction in obese than 12% of the base value of serum leptin following a treatment of 3 months. Sartorio and al.ont also recorded an improvement in leptin in 54 obese patients with morbid obesity. A significant decrease in leptin levels of 7.8 ng / ml in men and 10.2 ng / ml in women has been noted 17. Monzillo and colleagues suggest a more marked improvement in plasma leptin concentration after 6 months program of diet and exercise (27.8 ± 3 ng / ml, p <0.01) 18.
The results of studies concerned with plasma resistin vary between improving and non varaiation rate of this adipokine. The results of Azuma and collaborators’s study, consistent with those of our study. Indeed, these authors showed in 64 obese adults, a decrease in resistin after a combined program for 18 months 19. Other studies have shown that the use of diet alone did not lead to improvement in plasma resistin 20-22.
In addition, some studies have examined the effect of physical activity associated with on other adipokines regime. In this context, we cite the work of Dutheil and al, Ben Ounis and al, who are interested in the study of adiponectin and the results show a significant improvement in adiponectin 23-24. However, other studies such as those of Rockling-Anderson and collaborators, and Figueroa and al. reported no change 25-26.
Our study identified several correlations between resistin, leptinemia and some anthropometric parameters in obese women. A study of Norata and collaborators in subjects with metabolic syndrome showed that plasma resistin was strongly positively correlated with Triglycerides, waist, systolic blood pressure and the ratio of Apolipoprotein (Apo) AI /Apo B, so that it was inversely correlated with HDL-C and Apo AI 27. This pendant, Janowska and al. Showed the presence of correlations between resistin, body fat levels, and LDL-C in the absence of correlation between resistin and BMI, HOMA-IR and glucose 28. Another study of Abd Elghaffar and collaborators which aims to explore the possible relationship between resistin and anthropometric parameters showed no significant correlation between resistin, BMI, body fat percentage and waist 29. The lack of correlation between resistin and BMI was found by Silha and collaborators’s study 30.

Conclusions

The combination of diet and physical activity is undeniably useful in the treatment of obesity. Indeed, encouraging results have characterized the combined model of care provided in our study consisted of obese women who were closely monitored during seven months population. This success in addition to its impact on mental patients has been the significant reduction in anthropometric parameters, metabolic parameters, including their modification resulted in an improvement in lipid profile, blood glucose and hormonal parameters represented in our study by leptin and resistin. Our results also showed that walking was very beneficial for women surveyed and has allegedly confirmed the sentence pronounced by Hippocrates two thousand years ago that "Walking is the best remedy for the man."

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