Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 10;6(11):1411-1421.
doi: 10.1016/j.cjco.2024.07.018. eCollection 2024 Nov.

Cardiac Rehabilitation for Prediabetes and Metabolic Syndrome Remission: Impact of Ultraprocessed Food-Intake Reduction and Time-Restricted Eating in the DIABEPIC-1 Study

Josep Iglesies-Grau  1   2 , Valérie Dionne  1   2 , Élise Latour  1 , Mathieu Gayda  1   2 , Florent Besnier  1   2 , Daniel Gagnon  1   3 , Amélie Debray  1   3 , Christine Gagnon  1 , Anne-Julie Tessier  1 , Andréanne Paradis  1 , Chiheb Klai  1 , Nicolas Martin  1 , Véronique Pelletier  1 , François Simard  1   2 , Anil Nigam  1   2 , Philippe L L'Allier  1   2 , Martin Juneau  1   2 , Nadia Bouabdallaoui  1   2 , Louis Bherer  1   2   4
Affiliations

Cardiac Rehabilitation for Prediabetes and Metabolic Syndrome Remission: Impact of Ultraprocessed Food-Intake Reduction and Time-Restricted Eating in the DIABEPIC-1 Study

Josep Iglesies-Grau et al. CJC Open. .

Abstract
in English, French

Background: Cardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVDs) and metabolic comorbidities, including metabolic syndrome and prediabetes. However, strategies to reverse these conditions remain to be explored. The DIABEPIC-1 study aimed to assess the feasibility of an enhanced 6-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and metabolic syndrome remission.

Methods: The study combined exercise training with a comprehensive nutritional intervention, emphasizing reduction in intake of ultraprocessed foods, adoption of a Mediterranean diet, and implementation of time-restricted eating. Baseline, 3-month, and 6-month assessments included segmental body-composition measurements, blood analysis, maximal exercise testing, nutritional diaries recorded with the Keenoa AI app, and lifestyle questionnaires. Remission criteria included a return to an HbA1c level of < 5.7%, and < 3 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) criteria for prediabetes and metabolic syndrome, respectively.

Results: A total of 36 participants were recruited. The study demonstrated completion rates of 94.4% at 3 months, and 88.9% at 6 months, and a mean compliance rate of 92.5% for planned clinical appointments. Significant reductions in waist circumference (-9.2 cm, P < 0.001) and weight (-8.0 kg, P < 0.001) were observed. Improvement in glycemic and lipid profiles, insulin-resistance marker levels, and liver health were noted. Participants enhanced their cardiorespiratory fitness, reduced their consumption of ultraprocessed food, and increased their adherence to the Mediterranean diet and time-restricted eating. Notably, 50% achieved prediabetes remission, and 70% with metabolic syndrome at baseline achieved remission.

Conclusions: The study demonstrates the possibility of enhancing cardiac rehabilitation with an intensive nutritional intervention, yielding clinically significant outcomes, including remission of key risk factors in a substantial number of ASCVD patients.

Clinical trial registration: ClinicalTrials.gov, NCT05459987.

Contexte: Les programmes de réadaptation cardiaque offrent une occasion précieuse de promouvoir l'adoption d'un mode de vie sain chez les patients atteints de maladies cardiovasculaires athéroscléreuses (MCVA) et de comorbidités métaboliques, notamment le syndrome métabolique et le prédiabète. Cependant, les stratégies visant à inverser ces conditions restent à explorer. L'étude DIABEPIC-1 visait à évaluer la faisabilité d'un programme de réadaptation cardiaque renforcé de 6 mois pour les patients atteints de MCVA tout en examinant la rémission du prédiabète et du syndrome métabolique.

Méthodes: L'étude a combiné un entraînement physique avec une intervention nutritionnelle complète, mettant l'accent sur la réduction de la consommation d'aliments ultra-transformés, l'adoption d'un régime méditerranéen et la mise en œuvre d'une alimentation restreinte dans le temps. Les évaluations de base, à 3 mois et à 6 mois, comprenaient des mesures de la composition corporelle par segments, des analyses sanguines, des tests d'exercice maximal, la tenue de journaux nutritionnels enregistrés avec l'application Keenoa AI et des questionnaires sur le mode de vie. Les critères de rémission comprenaient un retour à un niveau d'hémoglobine glyquée HbA1c < 5,7 %, et < 3 critères de la table du « National Cholesterol Education Program Adult Treatment Panel III » (NCEP/ATP-III) pour le prédiabète et le syndrome métabolique, respectivement.

Résultats: Au total, 36 participants ont été recrutés. L'étude a montré des taux d'achèvement de 94,4 % à 3 mois et de 88,9 % à 6 mois, ainsi qu'un taux de conformité moyen de 92,5 % pour les rendez-vous cliniques planifiés. Des réductions significatives du tour de taille (-9,2 cm, p < 0,001) et du poids (-8,0 kg, p < 0,001) ont été observées. Une amélioration des profils glycémiques et lipidiques, des niveaux de marqueurs de résistance à l'insuline et de la santé hépatique a été constatée. Les participants ont amélioré leur condition cardiorespiratoire, réduit leur consommation d'aliments ultra-transformés et augmenté leur adhésion au régime méditerranéen et à l'alimentation restreinte dans le temps. Notamment, 50 % des participants ont obtenu une rémission du prédiabète et 70 % des participants atteints du syndrome métabolique au début de l'étude ont atteint la rémission.

Conclusions: L'étude démontre la possibilité d'améliorer la réadaptation cardiaque par une intervention nutritionnelle intensive, produisant des résultats cliniquement significatifs, y compris la rémission des principaux facteurs de risque chez un nombre substantiel de patients atteints de MCVA.

Enregistrement de l'essai clinique: ClinicalTrials.gov, NCT05459987.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Following the inclusion process and the initial baseline assessment, patients with coronary heart disease who had recently been diagnosed with prediabetes (defined by a glycated hemoglobin (HbA1c) level between 5.7% and 6.4%) participated in a 3-pronged intervention. This intervention encompassed nutritional guidance, exercise training, and educational support, all delivered simultaneously. These patients were evaluated after 3 months of this intervention, and once more after an additional 3 months, during which they transitioned to training independently and adopted time-restricted eating practices. carb, carbohydrate; HIIT: high-intensity interval training; HOMA-IR, Homeostatic Model Assessment for Insulin Resistance; MedDiet, Mediterranean diet; MET, metabolic equivalent; TRE, time-restricted eating.
Figure 2
Figure 2
Prediabetes and metabolic syndrome remission rates after 6 months of intervention. (A) All study participants met the American Diabetes Association (ADA) criteria for prediabetes, at the beginning of the study. Among these individuals, 16 participants (50.0%, 95% confidence interval: 32.7%-67.3%) met either of the remission criteria definitions for prediabetes after 6 months of the intervention. (B) Of the 32 participants, 20 (62.5%) initially met the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) criteria for metabolic syndrome. Among these individuals, 14 (70%, 95% confidence interval: 45.7%-86.6%) met at least one of the remission criteria definitions for metabolic syndrome by the end of the study. HbA1c, glycated hemoglobin.
See this image and copyright information in PMC

References

    1. Cosentino F., Verma S., Ambery P., et al. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J. 2023;44:4141–4156. - PubMed
    1. Honigberg M.C., Zekavat S.M., Pirruccello J.P., Natarajan P., Vaduganathan M. Cardiovascular and kidney outcomes across the glycemic spectrum: insights from the UK Biobank. J Am Coll Cardiol. 2021;78:453–464. - PMC - PubMed
    1. Rossello X., Raposeiras-Roubin S., Oliva B., et al. Glycated hemoglobin and subclinical atherosclerosis in people without diabetes. J Am Coll Cardiol. 2021;77:2777–2791. - PubMed
    1. Riddle M.C., Cefalu W.T., Evans P.H., et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44:2438–2444. - PMC - PubMed
    1. MacKay D., Chan C., Dasgupta K., et al. Remission of type 2 diabetes: Diabetes Canada Clinical Practice Guidelines Expert Working Group. Can J Diabetes. 2022;46:753–761.e8. - PubMed

Associated data

LinkOut - more resources