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Metabolic Disease Puts Up a Fight: Are diet and exercise helpful for the heart?

Nature Medicine volume 19, pages 1216–1217 (2013)Cite this article

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Given the multisystemic nature of the metabolic syndrome, the field is now aiming at perusing both intrinsic and environmental factors from a biological and therapeutic standpoint. Physicians often advise obese individuals suffering from type 2 diabetes to lose weight through exercise and healthy diets. Although it may be an obvious recommendation, a large study has recently shown that weight loss achieved through these lifestyle changes does not significantly reduce cardiovascular disease events in these patients compared to conventional diabetes care. In 'Bedside to Bench', Julie A. Lovshin and Daniel J. Drucker discuss the limitations of this study, the conclusions that can be drawn regarding the true benefit of weight loss in this context and the molecular factors that deserve further attention at the bench in light of this trial. In 'Bench to Bedside', Eleftheria Maratos-Flier examines the role of antidiabetic drugs in both host and gut microbiota metabolism. These effects in the intestinal flora support advocating an increase in our understanding of how the gut microbiome affects obesity for finding the means to harness its therapeutic potential.

Type 2 diabetes and its associated complications are a threat to our public health, and the rising incidence of diabetes is linked, in many regions, to the obesity epidemic1 and society's drift toward sedentariness2. Patients diagnosed with type 2 diabetes are routinely counseled on the importance of adopting healthier lifestyles and are encouraged to follow healthy diets, pursue weight loss and increase physical fitness. It is widely accepted that weight loss can provide metabolic benefits, including reduced blood pressure and improved lipid profiles, insulin sensitivity and beta cell function. Weight loss also results in better quality of life, reduced fat mass, decreased organ steatosis, and lower levels of tissue and circulating markers of inflammation. Although several treatment modalities can be used to reduce body weight (such as diet, exercise, medications and surgery), caloric restriction and increased physical activity through lifestyle changes is universally used as the initial approach to the management of individuals with type 2 diabetes.

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Figure 1: Possible benefits and risks associated with various BMI body weight categories.

Katie Vicari

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Authors and Affiliations

  1. Julie A. Lovshin and Daniel J. Drucker are at the Department of Medicine, Lunenfeld Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,

    Julie A Lovshin & Daniel J Drucker

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  1. Julie A Lovshin
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  2. Daniel J Drucker
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Correspondence to Daniel J Drucker.

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The authors declare no competing financial interests.

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Lovshin, J., Drucker, D. Metabolic Disease Puts Up a Fight: Are diet and exercise helpful for the heart?. Nat Med 19, 1216–1217 (2013). https://doi.org/10.1038/nm.3370

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