Hypertriglyceridemia, Insulin Resistance
Conditions
Brief summary
The focus of this cross-sectional study is to determine the effects of tissue-specific (adipose tissue or muscle) vs global (combined) insulin resistance (IR) on hepatic triglyceride biosynthesis in humans, and to determine differential effects of an acute exercise intervention on hepatic triglyceride biosynthesis in these groups.
Detailed description
Hypothesis: Patients who primarily have muscle IR will have a greater percentage of lipids derived from de novo lipogenesis (DNL) than patients with combined muscle and adipose IR, and these subjects will respond more robustly to the effects of premeal exercise. With this study, the investigators will demonstrate that the mechanisms that drive triglyceride overproduction in insulin-resistant humans are dependent on which tissues are insulin resistant. To this end, investigators will determine whether subjects with muscle insulin resistance and adipose tissue insulin resistance utilize different mechanisms of triglyceride biosynthesis to assemble hepatic very low density lipoprotein (VLDL), as compared with individuals with muscle insulin resistance but relative adipose tissue insulin sensitivity. Additionally, investigators will see if adipose tissue insulin sensitivity predicts exercise responsiveness of hepatic triglyceride production. Main study parameters/endpoints: Difference in %DNL between subjects with global vs muscle-only insulin resistance as well as the differential effects of premeal exercise on %DNL in these groups.
Interventions
BEHAVIORALStandardized Dinner
De novo lipogenesis (DNL) will be assessed in all participants with a standardized dinner
BEHAVIORALPremeal exercise
DNL will be assessed in all participants with short bouts of premeal exercise with a standardized dinner
Sponsors
Yale University
Amsterdam UMC
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
NONE
Intervention model description
Glucose tolerance, skeletal muscle/whole-body insulin sensitivity and adipose tissue insulin sensitivity will be evaluated prior to intervention. Plasma deuterium will be allowed to wash out over several weeks, and the 2nd deuterated water study will be performed. Randomized crossover within group design.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Ability to give informed consent * Overweight, defined as BMI 25-30 kg/m2 * Modest hypertriglyceridemia, defined as fasting plasma triglycerides 1.5-3.0mM * High risk of insulin resistance, defined as fasting plasma insulin \>64pM * Stable weight for at least 3mo prior to participation
Exclusion criteria
* Active or chronic liver disease, kidney disease, congestive heart failure, unstable angina, history of acute cardiovascular events within 6mo of screening, history of seizures or syncope, or an active infection requiring antimicrobial therapy; * Use of insulin, thiazolidinediones, SGLT2 inhibitors, or sulfonylureas; * Use of fibrates, omega 3 (fish oil), niacin, or PCSK9 antagonists; * Use of systemic glucocorticoids within 60d prior to participation; * Hematocrit \<35%; * Pregnancy of breastfeeding; * Active tobacco use, excessive alcohol intake (\>14U/wk), or history of drug abuse.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect of tissue-specific insulin resistance on contribution of DNL to plasma triglyceride | Baseline | The amount of de novo lipogenesis (DNL) in VLDL-triglycerides after a standard meal will be measured in plasma from whole blood. Relationship between DNL and 1) whole body (skeletal muscle) insulin resistance and 2) white adipose tissue insulin resistance will be assessed individually. |
| Change in DNL in VLDL-triglycerides after a standard meal compared to a standard meal with premeal exercise. | study visit 1 and study visit 2, up to 8 weeks | The amount of de novo lipogenesis (DNL) in VLDL-triglycerides after a standard meal vs after a standard meal with premeal exercise will be measured in plasma from whole blood. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in plasma triglycerides after a standard meal compared to a standard meal with premeal exercise | study visit 1 and study visit 2, up to 8 weeks | Plasma triglycerides will be measured under both conditions. |
| Baseline plasma triglycerides | baseline | Plasma triglycerides will be measured at the screening visit to determine eligibility for the study |
| Adipose insulin sensitivity | Baseline | Both nonesterified fatty acids and insulin will be measured in the plasma at baseline to calculate Adipo-IR, a measure of adipose tissue insulin sensitivity. |
| Skeletal muscle/whole-body insulin sensitivity assessed by oral glucose tolerance test (OGTT) | Baseline | Matsuda index will be used to evaluate whole body physiological insulin sensitivity from the data obtained by OGTT. Insulin sensitivity as calculated by the Matsuda index: \[10,000 / √glucose minute 0 x insulin minute 0) (mean glucose (OGTT) x mean insulin OGTT)\]. A higher result indicates less IR. |
Countries
Netherlands
Contacts
CONTACTDaniel F Vatner, MD, PhD
PRINCIPAL_INVESTIGATORDaniel F Vatner, MD, PhD
Yale University
Outcome results
None listed