Immediate and long-term effects of addition of exercise to a 16-week very low calorie diet on low-grade inflammation in obese, insulin-dependent type 2 diabetic patients

ObjectiveTo assess the short- and long-term effects of addition of exercise to a very low calorie diet (VLCD) on low-grade inflammation in obese patients with type 2 diabetes mellitus (T2DM).MethodsTwenty seven obese, insulin-dependent T2DM patients followed a 4-month VLCD with (n = 13) or without (n = 14) exercise and were followed up to 18 months. Anthropometric measurements, metabolic and inflammatory parameters were assessed before, directly after the intervention and at 6 and 18 months follow-up. The same measurements were performed only once in 56 healthy lean and 56 healthy obese controls.ResultsAt baseline hsCRP, IL10 and IL8 were significantly elevated in obese T2DM compared to lean healthy controls. After 4 months, despite substantial weight loss (−25.4 ± 1.3 kg), neither the VLCD nor VLCD + exercise had an effect on plasma cytokines. At 6 months, in the weight-stabilizing period, measures of low-grade inflammation had decreased substantially and equally in both intervention groups. Despite subsequent weight regain, beneficial effect was sustained up to 18 months in both groups, except for IL1 and hsCRP which had returned to baseline in the VLCD-only group.ConclusionOur findings suggest that severe caloric restriction increases cytokine production by adipose tissue macrophages and that the beneficial effects of weight loss become apparent only in the eucaloric state.

► Low-grade inflammation in T2DM patients is higher than in healthy control subjects. ► Using a 16-week VLCD + exercise reverses low-grade inflammation in T2DM patients even after 18 weeks of follow-up. ► Beneficial effects of weight loss through caloric restriction on inflammation become apparent in the eucaloric state. ► Severe caloric restriction increases cytokine production by adipose tissue macrophages directly after the diet.