ROLE OF DIET AND EXERCISE IN THE MANAGEMENT OF HYPERINSULINEMIA AND ASSOCIATED ATHEROSCLEROTIC RISK-FACTORS

Hyperinsulinemia, hypertension, hypertriglyceridemia and obesity are independent risk factors for coronary artery disease and are often found in the same person. This study investigated the effects of an intensive, 3-week, dietary and exercise program on these risk factors. The group was divided into diabetic patients (non-insulin-dependent diabetes mellitus [NIDDM], n = 13), insulin-resistant persons (n = 29) and those with normal insulin, less-than-or-equal-to 10-mu-U/ml, (n = 30). The normal groups had very small but statistically significant decreases in all of the risk factors. The patients with NIDDM had the greatest decreases. Insulin was reduced from 40 +/- 15 to 27 +/- 11-mu-U/ml, blood pressure from 142 +/- 9/83 +/- 3 to 132 +/- 6/71 +/- 3 mm Hg, triglycerides from 353 +/- 76 to 196 +/- 31 mg/dl and body mass index from 31.1 +/- 4.0 to 29.7 +/- 3.7 kg/m2. Although there was a significant weight loss for the group with NIDDM, resulting in the decrease in body mass index, 8 of 9 patients who were initially overweight were still overweight at the end of the program, and 5 of the 8 were still obese (body mass index > 30 kg/m2), indicating that normalization of body weight is not a requisite for a reduction or normalization of other risk factors. Insulin was reduced from 18.2 +/- 1.8 to 11.6 +/- 1.2-mu-U/ml in the insulin-resistant group, with 17 of the 29 subjects achieving normal fasting insulin (< 10-mu-U/ml). Blood pressure was reduced from 129 +/- 4/84 +/- 3 to 124 +/- 5/78 +/- 2 mm Hg, while triglycerides were reduced from 204 +/- 17 to 162 +/- 15 mg/dl. Body mass index was reduced from 32.6 +/- 5.3 to 31.2 +/- 5.1 kg/m2, with only 4 of 24 who were overweight reaching a normal weight.