Effect of diet combined with exercise intervention on tumor necrosis factor α in overweight or obese groups: Based on the exercise dose-response relationship
DOI:
https://doi.org/10.12775/QS.2024.31.55767Keywords
Combination therapy, Exercise, relationships, obesity, Inflammatory responseAbstract
Background: Chronic low-grade systemic inflammation, often linked to obesity or being overweight, is associated with various complications and an increased risk of disease development. Tumor necrosis factor α (TNF-α) is a key inflammatory factor that significantly impacts various body functions.
Objective: 1) To assess whether combined interventions are more effective than single interventions in combining diet and exercise. 2) To assess the effectiveness of exercise dose in different interventions on tumor necrosis factor (TNF-α) levels in obese or overweight patients.
Methods: A thorough search was conducted across four electronic databases of randomized controlled trials that focus on exercise or dietary interventions for patients with obesity or overweight. This comprehensive review encompasses data collected up to August 2024. Two independent researchers conducted a thorough evaluation of the literature's quality. Network and dose-response analyses were performed using random effects models to examine the impact of diverse interventions on TNF-α.
Results: A total of 19 randomized controlled trials with 1479 patients with obesity or overweight were included. The meta-analysis showed that the hypocaloric diet combined with aerobic training (HDAT) possessed the highest ranking (SMD= -1.00,95%CI -1.51 to -0.49), followed by the hypocaloric diet (HD) (SMD= -0.40,95%CI -0.89 to 0.09), hypocaloric diet combined with resistance training (HDRT) (SMD= -0.48,95%CI- 1.43 to 0.48), and aerobic training combined with resistance training (ART) (SMD= -0.18,95%CI -0.92 to 0.57). Additionally, a notable improvement in TNF-α levels was observed in individuals adhering to a hypocaloric diet in conjunction with exercise when the cumulative exercise volume reached 150 metabolic equivalent of task minutes per week.
Conclusion: Based on the GRADE rating guidelines, moderate-quality research evidence indicates that a hypocaloric diet combined with aerobic training (HDAT) is the most effective intervention for enhancing tumor TNF-α levels in individuals with obesity or overweight. Additionally, the dose-response relationship was observed between the total exercise dose and TNF-α levels. Future research should investigate the specific effects of various aerobic exercise modalities on TNF-α levels in obese or overweight patients to develop a more personalized approach to exercise prescription.
References
Wang Youfa, Wang Siwen, Feng Zijian. The global and Chinese obesity problem is a serious challenge, requiring effective intervention measures and actions. Chinese Journal of Preventive Medicine 2024;25:385–7.
Taylor EB. The complex role of adipokines in obesity, inflammation, and autoimmunity. Clin Sci (Lond) 2021;135:731–52.
Dandona P. Inflammation: the link between insulin resistance, obesity and diabetes. Trends in Immunology 2004;25:4–7.
Guzik TJ, Mangalat D, Korbut R. Adipocytokines - novel link between inflammation and vascular function? J Physiol Pharmacol 2006;57:505–28.
Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol 2021;320:C375–91.
Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest 2017;127:1–4.
Andersen CJ, Murphy KE, Fernandez ML. Impact of Obesity and Metabolic Syndrome on Immunity. Adv Nutr 2016;7:66–75.
Rea IM, Gibson DS, McGilligan V et al. Age and Age-Related Diseases: Role of Inflammation Triggers and Cytokines. Front Immunol 2018;9:586.
De Martinis M, Franceschi C, Monti D et al. Inflamm-ageing and lifelong antigenic load as major determinants of ageing rate and longevity. FEBS Lett 2005;579:2035–9.
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685–95.
Blüher M. Adipokines – removing road blocks to obesity and diabetes therapy. Molecular Metabolism 2014;3:230–40.
Johnston RA, Zhu M, Rivera-Sanchez YM et al. Allergic airway responses in obese mice. Am J Respir Crit Care Med 2007;176:650–8.
Sutherland TJT, Cowan JO, Young S et al. The association between obesity and asthma: interactions between systemic and airway inflammation. Am J Respir Crit Care Med 2008;178:469–75.
Tylutka A, Walas Ł, Zembron-Lacny A. Level of IL-6, TNF, and IL-1β and age-related diseases: a systematic review and meta-analysis. Front Immunol 2024;15:1330386.
Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat Rev Rheumatol 2014;10:44–56.
Picca A, Coelho-Junior HJ, Calvani R et al. Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis. Ageing Research Reviews 2022;73:101530.
Pedersen LR, Olsen RH, Anholm C et al. Effects of 1 year of exercise training versus combined exercise training and weight loss on body composition, low-grade inflammation and lipids in overweight patients with coronary artery disease: a randomized trial. Cardiovasc Diabetol 2019;18:127.
Starkie R, Ostrowski SR, Jauffred S et al. Exercise and IL-6 infusion inhibit endotoxin-induced TNF-alpha production in humans. FASEB J 2003;17:884–6.
Chen Xiaoke, Li Jianyu, Chen Chaofan et al. Network Meta-analysis of the effects of different types of exercise on inflammatory factors in overweight or obese people. Chinese Journal of Evidence-Based Medicine 2024;24:565–71.
Pedersen LR, Olsen RH, Anholm C et al. Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease: A randomized trial. Atherosclerosis 2016;246:221–8.
Lam YY, Ghosh S, Civitarese AE et al. Six-month Calorie Restriction in Overweight Individuals Elicits Transcriptomic Response in Subcutaneous Adipose Tissue That is Distinct From Effects of Energy Deficit. J Gerontol A Biol Sci Med Sci 2016;71:1258–65.
You T, Berman DM, Ryan AS et al. Effects of hypocaloric diet and exercise training on inflammation and adipocyte lipolysis in obese postmenopausal women. J Clin Endocrinol Metab 2004;89:1739–46.
Moro T, Tinsley G, Pacelli FQ et al. Twelve Months of Time-restricted Eating and Resistance Training Improves Inflammatory Markers and Cardiometabolic Risk Factors. Med Sci Sports Exerc 2021;53:2577–85.
Salas-Salvadó J, Díaz-López A, Ruiz-Canela M et al. Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial. Diabetes Care 2019;42:777–88.
Giannopoulou I, Fernhall B, Carhart R et al. Effects of diet and/or exercise on the adipocytokine and inflammatory cytokine levels of postmenopausal women with type 2 diabetes. Metabolism 2005;54:866–75.
Rokling-Andersen MH, Reseland JE, Veierød MB et al. Effects of long-term exercise and diet intervention on plasma adipokine concentrations. Am J Clin Nutr 2007;86:1293–301.
Yu N, Ruan Y, Gao X et al. Systematic Review and Meta-Analysis of Randomized, Controlled Trials on the Effect of Exercise on Serum Leptin and Adiponectin in Overweight and Obese Individuals. Horm Metab Res 2017;49:164–73.
Khalafi M, Symonds ME, Akbari A. The impact of exercise training versus caloric restriction on inflammation markers: a systemic review and meta-analysis. Crit Rev Food Sci Nutr 2022;62:4226–41.
Tang L, Zhang L, Liu Y et al. Optimal dose and type of exercise to improve depressive symptoms in older adults: a systematic review and network meta-analysis. BMC Geriatr 2024;24:505.
Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021:n71.
Ardern CL, Büttner F, Andrade R et al. Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. Br J Sports Med 2022;56:175–95.
Guyatt GH, Oxman AD, Vist GE et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6.
Luo D, Wan X, Liu J et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 2018;27:1785–805.
Shi J, Luo D, Wan X et al. Detecting the skewness of data from the five-number summary and its application in meta-analysis. Stat Methods Med Res 2023;32:1338–60.
Leal-Martín J, Muñoz-Muñoz M, Keadle SK et al. Resting Oxygen Uptake Value of 1 Metabolic Equivalent of Task in Older Adults: A Systematic Review and Descriptive Analysis. Sports Med 2022;52:331–48.
Matthews CE, Moore SC, Arem H et al. Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk. J Clin Oncol 2020;38:686–97.
Jeong S-W, Kim S-H, Kang S-H et al. Mortality reduction with physical activity in patients with and without cardiovascular disease. Eur Heart J 2019;40:3547–55.
Higgins JPT, Jackson D, Barrett JK et al. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 2012;3:98–110.
Cumpston M, Li T, Page MJ et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019;10:ED000142.
Higgins JP, Del Giovane C, Chaimani A et al. Evaluating the Quality of Evidence from a Network Meta-Analysis. Value Health 2014;17:A324.
Owen RK, Bradbury N, Xin Y et al. MetaInsight: An interactive web‐based tool for analyzing, interrogating, and visualizing network meta‐analyses using R‐shiny and netmeta. Research Synthesis Methods 2019;10:569–81.
Salanti G, Ades AE, Ioannidis JPA. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 2011;64:163–71.
Mawdsley D, Bennetts M, Dias S et al. Model-Based Network Meta-Analysis: A Framework for Evidence Synthesis of Clinical Trial Data. CPT Pharmacometrics Syst Pharmacol 2016;5:393–401.
Wheeler DC, Hickson DA, Waller LA. Assessing Local Model Adequacy in Bayesian Hierarchical Models Using the Partitioned Deviance Information Criterion. Comput Stat Data Anal 2010;54:1657–71.
Pedder H, Dias S, Bennetts M et al. Modelling time-course relationships with multiple treatments: Model-based network meta-analysis for continuous summary outcomes. Res Synth Methods 2019;10:267–86.
Borg DN, Impellizzeri FM, Borg SJ et al. Meta-analysis prediction intervals are under reported in sport and exercise medicine. Scand J Med Sci Sports 2024;34:e14603.
Nicklas BJ, Ambrosius W, Messier SP et al. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr 2004;79:544–51.
Ben Ounis O, Elloumi M, Lac G et al. Two-month effects of individualized exercise training with or without caloric restriction on plasma adipocytokine levels in obese female adolescents. Ann Endocrinol (Paris) 2009;70:235–41.
Silverman NE, Nicklas BJ, Ryan AS. Addition of aerobic exercise to a weight loss program increases BMD, with an associated reduction in inflammation in overweight postmenopausal women. Calcif Tissue Int 2009;84:257–65.
Fisher G, Hyatt TC, Hunter GR et al. Effect of diet with and without exercise training on markers of inflammation and fat distribution in overweight women. Obesity (Silver Spring) 2011;19:1131–6.
Snel M, van Diepen JA, Stijnen T et al. 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. Food Chem Toxicol 2011;49:3104–11.
Auerbach P, Nordby P, Bendtsen LQ et al. Differential effects of endurance training and weight loss on plasma adiponectin multimers and adipose tissue macrophages in younger, moderately overweight men. Am J Physiol Regul Integr Comp Physiol 2013;305:R490-498.
Lakhdar N, Denguezli M, Zaouali M et al. Diet and diet combined with chronic aerobic exercise decreases body fat mass and alters plasma and adipose tissue inflammatory markers in obese women. Inflammation 2013;36:1239–47.
Loria-Kohen V, Fernández-Fernández C, Bermejo LM et al. Effect of different exercise modalities plus a hypocaloric diet on inflammation markers in overweight patients: a randomised trial. Clin Nutr 2013;32:511–8.
Oh S, Tanaka K, Tsujimoto T et al. Regular exercise coupled to diet regimen accelerates reduction of hepatic steatosis and associated pathological conditions in nonalcoholic fatty liver disease. Metab Syndr Relat Disord 2014;12:290–8.
Yoshimura E, Kumahara H, Tobina T et al. Aerobic exercise attenuates the loss of skeletal muscle during energy restriction in adults with visceral adiposity. Obes Facts 2014;7:26–35.
Moro T, Tinsley G, Bianco A et al. Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males. J Transl Med 2016;14:290.
Liu Jiafen, Song Wenjun. Effects of comprehensive exercise and diet intervention on lipid metabolism, insulin sensitivity and micro-inflammatory status in obese children. Journal of Hainan Medical College 2017;23:2240-2242+2246.
Freitas PD, Ferreira PG, Silva AG et al. The Role of Exercise in a Weight-Loss Program on Clinical Control in Obese Adults with Asthma. A Randomized Controlled Trial. Am J Respir Crit Care Med 2017;195:32–42 .
Tong Yongqing, Cai Ning. Effects of exercise combined with nutritional intervention on body mass index, blood sugar and blood lipids in adolescent obese patients. Chinese School Health 2019;40:1046–9.
Ainsworth BE, Haskell WL, Herrmann SD et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 2011;43:1575–81.
Christiansen T, Paulsen SK, Bruun JM et al. Exercise training versus diet-induced weight-loss on metabolic risk factors and inflammatory markers in obese subjects: a 12-week randomized intervention study. Am J Physiol Endocrinol Metab 2010;298:E824-831.
Koenen M, Hill MA, Cohen P et al. Obesity, Adipose Tissue and Vascular Dysfunction. Circ Res 2021;128:951–68.
Yarizadeh H, Eftekhar R, Anjom-Shoae J et al. The Effect of Aerobic and Resistance Training and Combined Exercise Modalities on Subcutaneous Abdominal Fat: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Adv Nutr 2021;12:179–96.
Merlotti C, Ceriani V, Morabito A et al. Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis. Int J Obes (Lond) 2017;41:672–82.
Zhan Xiaomei, Pan Shanshan, Chen Wenhe. Effects of exercise intervention on body composition, blood lipids, insulin resistance and high-sensitivity C-reactive protein in obese adolescents. Journal of Shanghai Institute of Sport 2012;36:62–6.
Broholm C, Mortensen OH, Nielsen S et al. Exercise induces expression of leukaemia inhibitory factor in human skeletal muscle. J Physiol 2008;586:2195–201.
Pedersen BK. Exercise-induced myokines and their role in chronic diseases. Brain Behav Immun 2011;25:811–6.
Pedersen BK. The diseasome of physical inactivity--and the role of myokines in muscle--fat cross talk. J Physiol 2009;587:5559–68.
Pedersen BK. The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control. Essays Biochem 2006;42:105–17.
Kawanishi N, Yano H, Mizokami T et al. Exercise training attenuates hepatic inflammation, fibrosis and macrophage infiltration during diet induced-obesity in mice. Brain Behav Immun 2012;26:931–41.
Curat CA, Wegner V, Sengenès C et al. Macrophages in human visceral adipose tissue: increased accumulation in obesity and a source of resistin and visfatin. Diabetologia 2006;49:744–7.
Straznicky NE, Lambert EA, Nestel PJ et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes 2010;59:71–9.
Rejeski WJ, Marsh AP, Fanning J et al. Dietary Weight Loss, Exercise, and Inflammation in Older Adults with Overweight or Obesity and Cardiometabolic Disease. Obesity (Silver Spring) 2019;27:1805–11.
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