Short-term High-intensity Interval Training Reduces the Accumulation of Advanced Glycation End Products and the Risk of Cardiovascular Disease in Normal Weight Obese Female University Students: a Randomized Controlled Trial

doi:10.12114/j.issn.1007-9572.2022.0803

Abstract

Abstract:

Background

People with normal weight obesity (NWO) are prone to cardiovascular diseases in their middle and old age. High-intensity interval training (HIIT) has been demonstrated to effectively improve cardiovascular health. However, whether HIIT can decrease the risk of cardiovascular diseases in NWO population is not clear.

Objective

To explore the effects of HIIT on the advanced glycation end-products (AGEs) and the risk of cardiovascular disease in NWO female university students.

Methods

From November to December 2020, 137 female college students were recruited in Shanghai University of Medicine & Health Sciences, among whom 40 NWO cases were screened out as subjects by the Asian female NWO standard. They were equally and randomly divided into a control group (n=20) and a HIIT intervention group (n=20) to receive no interventions or weekly five-day interventions, for consecutive four weeks after one-week adaptive training. Body weight, body mass index (BMI) , body fat percentage (BF%) , visceral fat level (VFL) , visceral fat area (VFA) , waist circumference, levels of four blood lipids 〔high-density lipoprotein (HDL) , low-density lipoprotein (LDL) , triglyceride (TG) , and total cholesterol (TC) 〕, cardiovascular disease risk (assessed by the China-PAR model) , AGEs, and fasting blood glucose of two groups were observed before and after intervention. The correlation between AGEs and cardiovascular disease risk was analyzed.

Results

Except for 10 dropouts, the remaining 30 cases (13 in the control group and 17 in the HIIT intervention group) were finally included for analysis. After intervention, the average BMI, BF%, VFA, VFL, waist circumference, TC/HDL ratio, LDL/HDL ratio, TG/HDL ratio, AGEs and fasting blood glucose in HIIT intervention group were lower than those in control group (P<0.05) . Nine subjects in the HIIT intervention group were evaluated for the risk of cardiovascular and cerebrovascular diseases as the China-PAR model was applicable to subjects aged 20 years or older. The risk of cardiovascular disease was (11.82±0.47) % and (9.79±0.57) % in control group and HIIT intervention group, respectively, before intervention, and (14.13±0.97) % and (6.93±1.17) % in the two groups, respectively, after intervention. The post-intervention risk of cardiovascular disease in HIIT intervention group was lower than that in control group (P<0.05) . Spearman rank correlation analysis showed that AGEs were not correlated with cardiovascular disease risk (r_s=-0.006, P=0.979) .

Conclusion

The four-week HIIT can effectively reduce the body fat, the levels of AGEs and fasting blood glucose as well as the risk of cardiovascular disease in NWO female university students.

Key words: High intensity interval training, Normal weight obese female university students, Obesity management, Advanced glycation end-products, Cardiovascular disease, Randomized controlled trial

摘要：

背景

隐性肥胖（NWO）人群在中老年阶段易发生心血管疾病，高强度间歇训练（HIIT）被证明可提高心血管健康，但目前HIIT对NWO人群心血管疾病风险改善效果的研究较少。

目的

探究短期HIIT对NWO女大学生机体内晚期糖基化终产物（AGEs）和心血管疾病风险的影响。

方法

2020年11—12月在上海健康医学院招募137名女大学生，根据亚洲女性NWO标准筛选出40名NWO者，采用随机数字表法将受试者随机分为对照组（n=20）和HIIT干预组（n=20）。HIIT干预组在进行1周的适应性训练后，完成为期4周、5 d/周的HIIT训练。对照组不进行任何运动训练。观察两组受试者干预前、后体质量、体质指数（BMI）、体脂百分比（BF%）、内脏脂肪等级（VFL）、内脏脂肪面积（VFA）、腰围、血脂四项、心血管疾病风险（应用China-PAR模型评估）、AGEs、空腹血糖，并分析AGEs与心血管疾病风险的相关性。

结果

10名受试者在干预期间因个人原因退出研究（其中对照组7例，HIIT组3例）。干预后，HIIT干预组BMI、BF%、VFA、VFL、腰围、总胆固醇（TC）/高密度脂蛋白（HDL）、低密度脂蛋白（LDL）/HDL、三酰甘油（TG）/HDL、AGEs、空腹血糖均低于对照组（P<0.05）。由于心脑血管病风险评估工具适用于20岁及以上受试者，因此对HIIT干预组中9例受试者进行了评估。干预前对照组和HIIT干预组受试者心血管疾病风险分别为（11.82±0.47）%、（9.79±0.57）%，干预后分别为（14.13±0.97）%、（6.93±1.17）%。干预后HIIT干预组心血管疾病风险低于对照组（P<0.05）。Spearman秩相关分析结果显示，AGEs与心血管疾病风险无相关关系（r_s=-0.006，P=0.979）。

结论

短期（4周）HIIT可减少NWO女大学生的体脂，降低AGEs和空腹血糖水平，降低心血管疾病风险。

关键词: 高强度间歇训练, 隐性肥胖女大学生, 肥胖管理, 晚期糖基化终产物, 心血管疾病, 随机对照试验

CAI Ming,WANG Liyan,YANG Ruoyu, et al. Short-term High-intensity Interval Training Reduces the Accumulation of Advanced Glycation End Products and the Risk of Cardiovascular Disease in Normal Weight Obese Female University Students: a Randomized Controlled Trial[J]. Chinese General Practice, 2023, 26(12): 1472-1478. DOI: 10.12114/j.issn.1007-9572.2022.0803.
蔡明,王丽岩,杨若愚等. 短期高强度间歇训练减少隐性肥胖女大学生晚期糖基化终产物堆积和心血管疾病风险的随机对照试验[J]. 中国全科医学, 2023, 26(12): 1472-1478. DOI: 10.12114/j.issn.1007-9572.2022.0803.

Figures/Tables 5

References 34

[1]	KARELIS A D，ST-PIERRE D H，CONUS F，et al. Metabolic and body composition factors in subgroups of obesity：what do we know? [J]. J Clin Endocrinol Metab，2004，89（6）：2569-2575. DOI：10.1210/jc.2004-0165.
[2]	OLIVEROS E，SOMERS V K，SOCHOR O，et al. The concept of normal weight obesity[J]. Prog Cardiovasc Dis，2014，56（4）：426-433. DOI：10.1016/j.pcad.2013.10.003.
[3]	WAJCHENBERG B L. Subcutaneous and visceral adipose tissue：their relation to the metabolic syndrome[J]. Endocr Rev，2000，21（6）：697-738. DOI：10.1210/edrv.21.6.0415.
[4]	DE LORENZO A，MARTINOLI R，VAIA F，et al. Normal weight obese （NWO） women：an evaluation of a candidate new syndrome[J]. Nutr Metab Cardiovasc Dis，2006，16（8）：513-523. DOI：10.1016/j.numecd.2005.10.010.
[5]	MAITINIYAZI G，CHEN Y，QIU Y Y，et al. Characteristics of body composition and lifestyle in Chinese university students with normal-weight obesity：a cross-sectional study[J]. Diabetes Metab Syndr Obes，2021，14：3427-3436. DOI：10.2147/DMSO.S325115.
[6]	BETTIGA A，FIORIO F，DI MARCO F，et al. The modern western diet rich in advanced glycation end-products （AGEs）：an overview of its impact on obesity and early progression of renal pathology[J]. Nutrients，2019，11（8）：1748. DOI：10.3390/nu11081748.
[7]	LI J，SCHMIDT A M. Characterization and functional analysis of the promoter of RAGE，the receptor for advanced glycation end products[J]. J Biol Chem，1997，272（26）：16498-16506. DOI：10.1074/jbc.272.26.16498.
[8]	WAUTIER M P，CHAPPEY O，CORDA S，et al. Activation of NADPH oxidase by AGE links oxidant stress to altered gene expression via RAGE[J]. Am J Physiol Endocrinol Metab，2001，280（5）：E685-694. DOI：10.1152/ajpendo.2001.280.5.E685.
[9]	VLASSARA H，STRIKER G E. AGE restriction in diabetes mellitus：a paradigm shift[J]. Nat Rev Endocrinol，2011，7（9）：526-539. DOI：10.1038/nrendo.2011.74.
[10]	YUBERO-SERRANO E M，PÉREZ-MARTÍNEZ P. Advanced glycation end products and their involvement in cardiovascular disease[J]. Angiology，2020，71（8）：698-700. DOI：10.1177/0003319720916301.
[11]	BAYE E，KIRIAKOVA V，URIBARRI J，et al. Consumption of diets with low advanced glycation end products improves cardiometabolic parameters：meta-analysis of randomised controlled trials[J]. Sci Rep，2017，7（1）：2266. DOI：10.1038/s41598-017-02268-0.
[12]	STEFAN N，HÄRING H U，HU F B，et al. Metabolically healthy obesity：epidemiology，mechanisms，and clinical implications[J]. Lancet Diabetes Endocrinol，2013，1（2）：152-162. DOI：10.1016/S2213-8587(13)70062-7.
[13]	YUSUF S，HAWKEN S，OUNPUU S，et al. Obesity and the risk of myocardial infarction in 27，000 participants from 52 countries：a case-control study[J]. Lancet，2005，366（9497）：1640-1649. DOI：10.1016/s0140-6736(05)67663-5.
[14]	DESPRÉS J P，LEMIEUX I. Abdominal obesity and metabolic syndrome[J]. Nature，2006，444（7121）：881-887. DOI：10.1038/nature05488.
[15]	ROBINSON M M，LOWE V J，NAIR K S. Increased brain glucose uptake after 12 weeks of aerobic high-intensity interval training in young and older adults[J]. J Clin Endocrinol Metab，2017，103（1）：221-227. DOI：10.1210/jc.2017-01571.
[16]	GIBALA M J，LITTLE J P，MACDONALD M J，et al. Physiological adaptations to low-volume，high-intensity interval training in health and disease[J]. J Physiol，2012，590（5）：1077-1084. DOI：10.1113/jphysiol.2011.224725.
[17]	HARAM P M，KEMI O J，LEE S J，et al. Aerobic interval training vs. continuous moderate exercise in the metabolic syndrome of rats artificially selected for low aerobic capacity[J]. Cardiovasc Res，2009，81（4）：723-732. DOI：10.1093/cvr/cvn332.
[18]	NOKIA M S，LENSU S，AHTIAINEN J P，et al. Physical exercise increases adult hippocampal neurogenesis in male rats provided it is aerobic and sustained[J]. J Physiol，2016，594（7）：1855-1873. DOI：10.1113/jp271552.
[19]	OLIVEROS E，SOMERS V K，SOCHOR O，et al. The concept of normal weight obesity[J]. Prog Cardiovasc Dis，2014，56（4）：426-33. DOI：10.1016/j.pcad.2013.10.003.
[20]	中国心血管病风险评估和管理指南编写联合委员会. 中国心血管病风险评估和管理指南[J]. 中华预防医学杂志，2019，53（1）：13-35. DOI：10.3760/cma.j.issn.0253-9624.2019.01.004.
[21]	心脑血管病风险评估[EB/OL].[2022-08-01].
[22]	YANG X L，LI J X，HU D S，et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population：the China-PAR project （prediction for ASCVD risk in China）[J]. Circulation，2016，134（19）：1430-1440. DOI：10.1161/CIRCULATIONAHA.116.022367.
[23]	KEATING S E，JOHNSON N A，MIELKE G I，et al. A systematic review and meta-analysis of interval training versus moderate-intensity continuous training on body adiposity[J]. Obes Rev，2017，18（8）：943-964. DOI：10.1111/obr.12536.
[24]	HU J Y，LIU M，YANG R Y，et al. Effects of high-intensity interval training on improving arterial stiffness in Chinese female university students with normal weight obese：a pilot randomized controlled trial[J]. J Transl Med，2022，20（1）：60. DOI：10.1186/s12967-022-03250-9.
[25]	KIM S，KYUNG C，PARK J S，et al. Normal-weight obesity is associated with increased risk of subclinical atherosclerosis[J]. Cardiovasc Diabetol，2015，14：58. DOI：10.1186/s12933-015-0220-5.
[26]	KANG S，KYUNG C，PARK J S，et al. Subclinical vascular inflammation in subjects with normal weight obesity and its association with body fat：an 18F-FDG-PET/CT study[J]. Cardiovasc Diabetol，2014，13：70. DOI：10.1186/1475-2840-13-70.
[27]	SU L Q，FU J M，SUN S L，et al. Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity：a meta-analysis[J]. PLoS One，2019，14（1）：e0210644. DOI：10.1371/journal.pone.0210644.
[28]	AROOR A R，JIA G H，SOWERS J R. Cellular mechanisms underlying obesity-induced arterial stiffness[J]. Am J Physiol Regul Integr Comp Physiol，2018，314（3）：R387-398. DOI：10.1152/ajpregu.00235.2016.
[29]	RUIZ H H，RAMASAMY R，SCHMIDT A M. Advanced glycation end products：building on the concept of the "common soil" in metabolic disease[J]. Endocrinology，2020，161（1）：bqz006. DOI：10.1210/endocr/bqz006.
[30]	ROJAS A，MERCADAL E，FIGUEROA H，et al. Advanced Glycation and ROS：a link between diabetes and heart failure[J]. Curr Vasc Pharmacol，2008，6（1）：44-51. DOI：10.2174/157016108783331312.
[31]	PRASAD K，TIWARI S. Therapeutic interventions for advanced glycation-end products and its receptor-mediated cardiovascular disease[J]. Curr Pharm Des，2017，23（6）：937-943. DOI：10.2174/1381612822666161006143032.
[32]	JEAN N，SOMERS V K，SOCHOR O，et al. Normal-weight obesity：implications for cardiovascular health[J]. Curr Atheroscler Rep，2014，16（12）：464. DOI：10.1007/s11883-014-0464-7.
[33]	COQUART J B J，LEMAIRE C，DUBART A E，et al. Intermittent versus continuous exercise：effects of perceptually lower exercise in obese women[J]. Med Sci Sports Exerc，2008，40（8）：1546-1553. DOI：10.1249/MSS.0b013e31816fc30c.
[34]	BUCHHEIT M，LAURSEN P B. High-intensity interval training，solutions to the programming puzzle：part I：cardiopulmonary emphasis[J]. Sports Med，2013，43（5）：313-338. DOI：10.1007/s40279-013-0029-x.

组别	例数	年龄（岁）	身高（cm）
对照组	13	20.2±0.4	160.9±1.1
HIIT干预组	17	19.2±1.1	163.8±1.0
t值		3.366	-1.959
P值		0.057	0.060

组别	例数	年龄（岁）	身高（cm）
对照组	13	20.2±0.4	160.9±1.1
HIIT干预组	17	19.2±1.1	163.8±1.0
t值		3.366	-1.959
P值		0.057	0.060

组别	例数	体质量（kg）		BMI（kg/m²）		BF%
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	13	58.3±1.2	59.8±1.2^a	22.1±0.3	23.2±0.5^a	33.93±0.72	35.55±0.56^a
HIIT干预组	17	58.6±1.0	57.6±1.1^a	21.9±0.3	21.0±0.4^ab	33.52±0.62	28.34±0.49^ab
F值		F_交互=21.348，F_时间=0.673，F_组间=0.407		F_交互=11.249，F_时间=0.076，F_组间=7.533		F_交互=46.558，F_时间=12.819，F_组间=30.014
P值		P_交互<0.001，P_时间=0.419，P_组间=0.529		P_交互=0.002，P_时间=0.784，P_组间=0.010		P_交互<0.001，P_时间=0.001，P_组间<0.001
组别	VFA（cm²）		VFL		腰围（cm）
组别	干预前	干预后	干预前	干预后	干预前	干预后
对照组	104.36±4.22	93.28±3.56^a	9.92±0.42	8.85±0.37^a	81.63±1.10	80.16±0.94
HIIT干预组	95.07±3.69	66.40±3.12^ab	8.94±0.37	6.18±0.32^ab	79.31±0.96	75.59±0.82^ab
F值	F_交互=15.575，F_时间=79.592，F_组间=14.893		F_交互=16.330，F_时间=84.601，F_组间=14.319		F_交互=3.107，F_时间=16.582，F_组间=8.270
P值	P_交互<0.001，P_时间<0.001，P_组间=0.001		P_交互<0.001，P_时间<0.001，P_组间=0.001		P_交互=0.089，P_时间<0.001，P_组间=0.008

组别	例数	体质量（kg）		BMI（kg/m²）		BF%
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	13	58.3±1.2	59.8±1.2^a	22.1±0.3	23.2±0.5^a	33.93±0.72	35.55±0.56^a
HIIT干预组	17	58.6±1.0	57.6±1.1^a	21.9±0.3	21.0±0.4^ab	33.52±0.62	28.34±0.49^ab
F值		F_交互=21.348，F_时间=0.673，F_组间=0.407		F_交互=11.249，F_时间=0.076，F_组间=7.533		F_交互=46.558，F_时间=12.819，F_组间=30.014
P值		P_交互<0.001，P_时间=0.419，P_组间=0.529		P_交互=0.002，P_时间=0.784，P_组间=0.010		P_交互<0.001，P_时间=0.001，P_组间<0.001
组别	VFA（cm²）		VFL		腰围（cm）
组别	干预前	干预后	干预前	干预后	干预前	干预后
对照组	104.36±4.22	93.28±3.56^a	9.92±0.42	8.85±0.37^a	81.63±1.10	80.16±0.94
HIIT干预组	95.07±3.69	66.40±3.12^ab	8.94±0.37	6.18±0.32^ab	79.31±0.96	75.59±0.82^ab
F值	F_交互=15.575，F_时间=79.592，F_组间=14.893		F_交互=16.330，F_时间=84.601，F_组间=14.319		F_交互=3.107，F_时间=16.582，F_组间=8.270
P值	P_交互<0.001，P_时间<0.001，P_组间=0.001		P_交互<0.001，P_时间<0.001，P_组间=0.001		P_交互=0.089，P_时间<0.001，P_组间=0.008

组别	例数	TC/HDL		LDL/HDL		TG/HDL
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	13	6.52±0.42	6.89±0.28	4.36±0.29	4.66±0.19	2.51±0.19	2.75±0.12
HIIT干预组	17	6.29±0.37	3.36±0.25^ab	4.12±0.25	1.93±0.17^b	2.33±0.16	1.08±0.10^ab
F值		F_交互=81.708，F_时间=49.284，F_组间=18.129		F_交互=90.098，F_时间=51.426，F_组间=25.342		F_交互=70.763，F_时间=32.466，F_组间=23.667
Ｐ值		P_交互<0.001，P_时间<0.001，P_组间<0.001		P_交互<0.001，P_时间<0.001，P_组间=<0.001		P_交互<0.001，P_时间<0.001，P_组间<0.001