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Clinical Trial
, 11 (7)

Nutrient Intake Prior to Exercise Is Necessary for Increased Osteogenic Marker Response in Diabetic Postmenopausal Women

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Clinical Trial

Nutrient Intake Prior to Exercise Is Necessary for Increased Osteogenic Marker Response in Diabetic Postmenopausal Women

Katarina T Borer et al. Nutrients.

Abstract

Type 2 diabetes increases bone fracture risk in postmenopausal women. Usual treatment with anti-resorptive bisphosphonate drugs has some undesirable side effects, which justified our interest in the osteogenic potential of nutrition and exercise. Since meal eating reduces bone resorption, downhill locomotion increases mechanical stress, and brief osteogenic responsiveness to mechanical stress is followed by several hours of refractoriness, we designed a study where 40-min of mechanical stress was manipulated by treadmill walking uphill or downhill. Exercise preceded or followed two daily meals by one hour, and the meals and exercise bouts were 7 hours apart. Fifteen subjects each performed two of five trials: No exercise (SED), uphill exercise before (UBM) or after meals (UAM), and downhill exercise before (DBM) or after meals (DAM). Relative to SED trial, osteogenic response, defined as the ratio of osteogenic C-terminal propeptide of type I collagen (CICP) over bone-resorptive C-terminal telopeptide of type-I collagen (CTX) markers, increased in exercise-after-meal trials, but not in exercise-before-meal trials. CICP/CTX response rose significantly after the first exercise-after-meal bout in DAM, and after the second one in UAM, due to a greater CICP rise, and not a decline in CTX. Post-meal exercise, but not the pre-meal exercise, also significantly lowered serum insulin response and homeostatic model (HOMA-IR) assessment of insulin resistance.

Keywords: HOMA-IR; cortisol; exercise and meal timing; markers of bone formation and resorption; nutrient intake; osteogenesis; parathyroid hormone.

Conflict of interest statement

The authors declare no conflict of interest

Figures

Figure 1
Figure 1
Treadmill elevator. A lever arm, powered by a mechanical jack, raises the rear end of the treadmill to a −6° slope.
Figure 2
Figure 2
Percent changes in serum C-terminal propeptide of type I collagen (CICP) between sedentary trial and exercise trials performed before meals is shown at the top (left: uphill exercise before meal (UBM), right: downhill exercise before meal (DBM)), and after exercise trials performed after eating, is shown at the bottom (left: uphill exercise after meal (UAM), right: downhill exercise after meal (DAM)). CICP rose relative to no exercise (SED) trials in both exercise-after-meal trials (lower panels) and showed little change in the two exercise-before-meal trials (top panels).
Figure 3
Figure 3
Postprandial CICP areas under the curve (AUCs) after the morning and afternoon meals with the two AUCs combined (left) and the morning (center) and afternoon (right) AUCs shown individually. Greatest increases in CICP AUCs were seen in the two exercise-after-meals trials (UAM and DAM) relative to sedentary trials, both for combined AUCs (left) and morning postprandial AUCs (center). Only UAM CICP AUC remained higher than the SED trial after the afternoon meal. Combined CICP AUC in the UBM trial also was significantly higher than in the DBM trial. * indicates significant difference relative to groups marked by the overhead bracket.
Figure 4
Figure 4
Percent changes in serum C-terminal telopeptide of type-I collagen (CTX) between sedentary trial and exercise trials performed before meals is shown at the top (left: UBM, right: DBM), and after exercise trials performed after eating, is shown at the bottom (left: UAM, right: DAM).
Figure 5
Figure 5
Percent changes in serum CICP/CTX ratio between sedentary trial and exercise trials performed before meals is shown at the top (left: UBM, right: DBM), and after exercise trials performed after eating, is shown at the bottom (left: UAM, right: DAM). CICP/CTX AUCs were significantly higher after second exercise bout after the meals in the UAM trial (bottom, left) and after first such bout in the DAM trial (bottom, right).
Figure 6
Figure 6
Postprandial CICP/CTX AUCs after the morning and afternoon meals combined (left) and after the morning (center) and afternoon (right) meals individually. Greatest increases in CICP/CTX AUCs were seen for the two exercise-after-meals trials (UAM and DAM) relative to sedentary trials both in the combined AUCs (left) and afternoon AUCs (right). The morning CICP/CTX AUCs remained higher only in the DAM relative to SED trial and two exercise-before-meals trials. Afternoon AUCs in UBM trial were also higher than in the DBM trial. * indicates significant difference relative to groups marked by the overhead bracket.
Figure 7
Figure 7
The change in serum glucose concentration in the four exercise relative to sedentary trials.
Figure 8
Figure 8
The changes in serum insulin concentration in the four exercise relative to sedentary trials. The largest insulin decline occurred in the UAM trial relative to sedentary and exercise-before-meal trials.
Figure 9
Figure 9
Postprandial insulin AUCs after the morning and afternoon meals combined (left) and after the morning (center) and afternoon (right) meals individually. Greatest decreases in insulin AUCs were in the exercise-after-meal trials (UAM) relative to sedentary trials and relative to exercise-before-meals trials in combined (left) as well as individual AUCs (center and right). In addition, within the exercise-after-meal condition, afternoon UAM AUC was lower than the DAM AUC. * indicates significant difference relative to groups marked by the overhead bracket.
Figure 10
Figure 10
Postprandial homeostatic model (HOMA-IR) AUCs after the morning and afternoon meals combined (left) and after the morning (center) and afternoon (right) meals individually. A consistent reduction in HOMA-IR AUCs was seen only for the UAM exercise-after-meal trial in comparison to SED, two exercise-before-meal trials, and in the afternoon also relative to DAM, the other exercise-after-meal trial. * indicates significant difference relative to groups marked by the overhead bracket.
Figure 11
Figure 11
Percent changes in serum parathyroid hormone (PTH) between sedentary trial and exercise trials performed before meals is shown at the top (left: UBM, right: DBM), and after exercise trials performed after eating, is shown at the bottom (left: UAM, right: DAM). PTH response was higher after both exercise trials performed before eating than during the sedentary trial and did not change during two exercise-after-meal trials.
Figure 12
Figure 12
Total postprandial PTH AUCs in the five trials. AUCs in the two exercise-before-meal trials were significantly higher than in the SED trial, and total PTH AUC in the DAM exercise-after-meal trial was significantly higher than in the UAM trial. PTH AUCs in the morning and afternoon postprandial periods were not significantly different. * indicates significant difference relative to groups marked by the overhead bracket.
Figure 13
Figure 13
Percent changes in serum cortisol between sedentary trial and exercise-before-meal trials is shown at the top (left: UBM, right: DBM), and after exercise trials performed after eating, is shown at the bottom (left: UAM, right: DAM).
Figure 14
Figure 14
Total postprandial cortisol AUCs in the five trials. The AUCs in the two exercise-after-meals trials were higher than in the SED trial, and combined cortisol AUC in the UAM exercise-after-meal trial was higher than the exercise-before-meal UBM trial. There were no treatment differences within morning and afternoon cortisol AUCs. * indicates significant difference relative to groups marked by the overhead bracket.

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