J Lipid Res：锻炼促进脂连素产生和提高HDL水平

根据一项于9月5日在线发表在Journal of Lipid Research期刊上的研究，为了减肥而接受的强化生活方式干预(Intensive lifestyle intervention, ILI)显著性地改善超重和肥胖的II型糖尿病患者体内的高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)水平，而且促进脂联素(adiponectin)产生能够部分上调节这种改善。

来自美国加尔维斯敦德州大学医疗分部的L. Maria Belalcazar博士和同事们开展这项Look AHEAD研究。它涉及1397名超重和肥胖的II型糖尿病成年患者。通过这项研究，他们想确定相比于标准的糖尿病治疗与教育(diabetes support and education, DSE)方法，ILI是否会改变脂联素产生和潜在地调控低水平HDL-C的增加。脂联素变化与HDL-C变化显著性相关联，即便是调整潜在的混淆变量(confounding variable)之后，也是如此。利用ILI实现的HDL-C水平改善归因于高分子量脂联素和非高分子量脂联素的变化。

作者们写道，“总之，我们报道，当与常规治疗相比时，ILI导致高分子量脂联素和非高分子量脂联素的水平发生重要变化，而且它们的组合效应容易通过测量总脂联素变化来进行评估。这种组合效应可能部分上调节着ILI导致的HDL-C增加，而与甘油三酸酯、体重、健康和葡萄糖控制的变化不相关。我们的发现提示着脂肪组织功能在调节HDL代谢中发挥着积极作用。”

与HDL相关的拓展阅读：

• J Lipid Res：锻炼促进脂连素产生和提高HDL水平
• 高血压患者治疗时HDL低预示新发糖尿病风险更高
• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• Lancet：遗传引起的血浆HDL胆固醇升高与心肌梗塞风险无关
• 专家观点：放弃HDL研究尚言之过早
• JAMA：好胆固醇HDL-C亦可能伤害心脏
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Adiponectin and the mediation of HDL cholesterol change with improved lifestyle: The Look AHEAD Study

Adipose tissue dysfunction plays a key role in the development of the metabolic abnormalities characteristic of type 2 diabetes (T2DM) and participates actively in lipid metabolism. Adiponectin, found abundantly in circulation and a marker of adipose health, is decreased in obese persons with T2DM. We investigated if the changes in adiponectin with an intensive lifestyle intervention for weight loss (ILI) could potentially mediate the increase in low HDL cholesterol (HDL-C) with ILI. Adiponectin and its fractions were determined using an ELISA with selective protease treatment in 1,397 participants from Look AHEAD, a trial examining whether ILI will reduce cardiovascular events in overweight/obese subjects with T2DM when compared to a control arm, Diabetes Support and Education arm (DSE). Multivariable regression and mediational analyses were performed for adiponectin and its high molecular weight (HMW) and non-HMW fractions. ILI increased baseline HDL-C by 9.7% and adiponectin by 11.9%; changes with DSE were 1.3% and 0.2%, respectively (p<0.0001). In a model including changes in weight, fitness, triglycerides and glucose control and that adjusted for demographics and medical history, adiponectin changes remained significantly associated with HDL-C change. Data supported the contribution of changes in both HMW- and non-HMW-adiponectin to the improvement in HDL-C with ILI.