Razi Journal of Medical Sciences

fa بررسی اثرات مصرف خوراکی عصاره هسته انگور با و بدون تمرین هوازی بر سطوح برخی شاخص‌های قلبی عروقی و متابولیکی در زنان میانسال چاق مبتلا به دیابت نوع دو Evaluation of Oral Consumption of Grape Seed Extract Effect with and without Aerobic Training on the Some of the Cardiovascular and Metabolic Indicators Levels in Obese Middle-aged Women with Type 2 Diabetes فیزیولوژی ورزش Exercise Physiology پژوهشي Research <div style="text-align: justify;">زمینه و هدف: فعالیت ورزشی و عوامل آنتیاکسیدانی نقش چشمگیری در کاهش عوارض ناشی از بیماری دیابت دارند. بنابراین، هدف از مطالعه حاضر بررسی اثرات مصرف خوراکی عصاره هسته انگور با و بدون تمرین هوازی بر سطوح برخی شاخصهای قلبی عروقی و متابولیکی در زنان میانسال چاق مبتلا به دیابت نوع دو بود. روش کار: در این مطالعه نیمه تجربی، 36 زن مبتلا به دیابت به‌صورت هدفمند و در دسترس انتخاب و بهطورتصادفی به 4 گروه تمرین+ مکمل عصاره هسته انگور، تمرین+دارونما، دارونما و مکمل عصاره هسته انگور تقسیم شدند. شرکتکنندگان 4 هفته تمرین هوازی با شدت 75-70 درصد ضربان قلب ذخیره، 5 روز در هفته انجام دادند. گروههای تمرین مکمل و مکمل دوز روزانه یک عدد کپسول عصاره هسته انگور و گروه تمرین دارونما و دارونما پودر نشاسته مصرف کردند. دادهها به روش تحلیل واریانس یکراهه و آزمون تعقیبی بانفرونی در سطح معنیداری 05/0P< تجزیه و تحلیل شدند. یافته ها: نتایج نشان داد که سطوح گلوکز، انسولین، LDL-C، VCAM-1، ICAM1، CRP، هموسیستئین نسبت به قبل از آزمون کاهش معنادار و HDL-C افزایش معناداری داشت (05/0P<). در گروه تمرین مکمل، تمرین دارونما و مکمل نسبت به گروه دارونما سطوح گلوکز، انسولین، LDL-C، VCAM-1، ICAM1، CRP و هموسیستئین کاهش معنادار وHDL-C  افزایش معناداری داشت (05/0P<). نتیجه‌گیری: بهنظر میرسد که مصرف عصاره انگور و تمرین هر یک به تنهایی بهعنوان یک روش بهبود دهنده شاخصهای قلبی عروقی و متابولیکی میتوانند اثر مثبتی بر کنترل بیماری دیابت داشته باشند. هرچند هنگامی که همزمان با هم باشند، تاثیرگذاری بهتری مشاهده میشود. </div> <div style="text-align: justify;">Background & Aims: In recent years, the role of obesity and diabetes in the development of inflammation and its relationship with adhesive molecules has been established. Accordingly, inflammatory indicators such as ICAM1 and VCAM1 are considered strong predictors of cardiovascular events in diabetes due to their key role in the atherosclerosis process (6). Various studies have emphasized the positive impact of sports training on these inflammatory indicators, particularly on the level of adhesive molecules in both healthy and diabetic subjects (6-8). However, in some cases, noticeable changes have not been observed following exercise (9). Another cause of cardiovascular disease in obese or diabetic individuals is an increased concentration of homocysteine and C-reactive protein (CRP). High homocysteine levels in women have shown an inverse relationship with cardiovascular fitness (10), and its increase may stem from genetic defects or nutritional deficiencies (11). CRP, a biomarker secreted in response to inflammatory cytokines, is found at higher levels in diabetic patients than in healthy people (12). Studies have shown the positive effects of aerobic exercise on these markers; for instance, Hijazi et al. (2013) observed improvements in homocysteine and CRP in female diabetic patients (14), and De Oliveira et al. (2021) reported a significant decrease in homocysteine levels in diabetic women (15). Furthermore, it is critical to monitor LDL-C and HDL-C levels, as dyslipidemia in these patients is often caused by improper control of blood sugar (16). Aerobic exercise is considered a suitable treatment method for type 2 diabetes due to its positive metabolic effects. Additionally, antioxidant agents play a significant role in reducing diabetes-related consequences like cardiovascular diseases. Grape seed extract appears particularly important, as its role in reducing blood sugar and oxidative stress has been proven (17). While past research has investigated the short- and long-term effects of exercise and grape seed supplementation, the medium-term impact of these combined interventions has not been thoroughly explored. Therefore, the present study aims to investigate the effects of oral consumption of grape seed extract, with and without aerobic exercise, on the levels of key cardiovascular and metabolic indicators in obese, middle-aged women with type 2 diabetes. Methods: In this semi-experimental study, 36 women with diabetes were purposefully selected as an available sample and randomly divided into four groups: exercise + grape seed extract supplement, exercise + placebo, supplement of grape seed extract, and placebo. For 4 weeks, participants in the exercise groups performed aerobic training 5 days a week at an intensity of 70-75% of their reserve heart rate. The supplement and exercise+supplement groups took one capsule of grape seed extract daily, while the placebo groups consumed starch powder. Data were analyzed by one-way ANOVA and a Bonferroni post hoc test at P<0.05. Results: The results showed that compared to the pre-test, the levels of glucose, insulin, LDL-C, VCAM-1, ICAM1, CRP, and homocysteine significantly decreased, while HDL-C significantly increased (P<0.05). In the three intervention groups (supplement training, placebo training, and supplement only) compared to the placebo group, the levels of glucose, insulin, LDL-C, VCAM-1, ICAM1, CRP, and homocysteine significantly decreased, and HDL-C significantly increased (P<0.05). Conclusion: The results of this study showed that grape seed supplementation alone, in addition to the exercise-based interventions, decreased levels of glucose, insulin, ICAM1, VCAM1, homocysteine, CRP, and LDL-C, while increasing HDL-C in women with type 2 diabetes. The improvement in blood glucose and insulin levels aligns with previous studies suggesting an increase in glucose transporters. The reduction in glucose following grape seed extract consumption is also in accordance with past findings, which state that some of its derivatives reduce lipid oxidative damage in the liver, brain, and digestive tract (17). Furthermore, this extract appears to positively affect hyperglycemia and insulin levels due to its antioxidant properties and ingredients that influence insulin secretion, a theory confirmed by other research (21, 22). Our study also showed that consuming grape seed extract alone decreased ICAM1 and VCAM1 levels. Grape seed extract is known to increase the body's antioxidant defense, largely due to the flavonoid delphinidin (23). The observed decrease in ICAM1 and VCAM1 levels following 4 weeks of exercise training is also consistent with the results of Silva et al. (2015), Atshak et al. (2021), and Zhao et al. It is possible that the antioxidant effects of aerobic exercise served as a mechanism for reducing VCAM1 and ICAM1 in these patients (27). Other indicators measured, homocysteine and CRP, decreased in all three intervention groups, with the most significant reduction in the combined exercise-supplement group. A primary reason for the homocysteine reduction is likely the increase in antioxidant enzymes and immune function after supplementation. This is because proanthocyanidin, a component of grape seed extract, is a strong antioxidant compound with protective flavonoid properties (32). The effect of sports activity on these indicators is in line with studies by Tan et al. (2021) and Olivera et al. (2021) (15, 33). LDL-C and HDL-C levels also improved, with a significant decrease in LDL-C and a significant increase in HDL-C in all three intervention groups. The consumption of grape seed extract reduced LDL-C compared to the placebo group, which aligns with the study of Sano et al. (2007) (40). These changes may be because proanthocyanidin accumulates in blood vessel walls, binds to active oxygen, and prevents LDL-C oxidation. Regarding the significant increase in HDL-C, it is noteworthy that while high-intensity exercise is often cited for this effect, the moderate-intensity protocol used here was also effective for women with type 2 diabetes. This suggests that other factors—such as subject weight, physical fitness level, gender, and exercise protocol duration—are also important. Study limitations include the lack of measurement of other variables related to cardiovascular function and no control over the subjects' nutrition and sleep. According to the research findings, 4 weeks of aerobic training and grape seed supplementation, alone or combined, can be effective non-pharmacological strategies for improving the physical condition of obese women with type 2 diabetes, although exercising while taking the supplement is more effective.</div> تمرین هوازی, عصاره هسته انگور, VCAM-1, ICAM1, دیابت نوع 2 Aerobic training, Grape seed extract, I Cam-1, Vcam-1, Type 2 diabetes 1 14 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7008-1&slc_lang=fa&sid=1 Seyed Mojtaba Seid سید مجتبی صید 3900319475328460089455 3900319475328460089455 No PhD student in Sport Physiology, Department of Exercise Physiology, Alborz Campus, University of Tehran, Tehran, Iran دانشجوی دکتری فیزیولوژی ورزشی، پردیس البرز، دانشگاه تهران، تهران، ایران Ali Akbarnezhad علی اکبرنژاد aakbarnejad@ut.ac.ir 3900319475328460089456 3900319475328460089456 Yes Associate Professor, Department of Exercise Physiology, Faculty of Physical Education and Sport Science, University of Tehran, Tehran, Iran دانشیار، گروه فیزیولوژی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه تهران، تهران، ایران Rahman Soori رحمن سوری 3900319475328460089457 3900319475328460089457 No Professor, Department of Exercise Physiology, Faculty of Physical Education and Sport Science, University of Tehran, Tehran, Iran استاد، گروه فیزیولوژی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه تهران، تهران، ایران Ali Rajabi علی رجبی 3900319475328460089458 3900319475328460089458 No Postdoctoral Research of Exercise Physiology, Faculty of Physical Education and Sport Science, University of Tehran, Tehran, Iran پسا دکتری فیزیولوژی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه تهران، تهران، ایران