Context: Short-term aerobic exercise training can improve whole-body insulin sensitivity in humans with type 2 diabetes mellitus; however, the contributions of peripheral and hepatic tissues to these improvements are not known.Objective: Our objective was to determine the effect of 7-d aerobic exercise training on peripheral and hepatic insulin sensitivity during isoglycemic/hyperinsulinemic clamp conditions. Design: Subjects were randomly assigned to one of two groups. The energy balance group consumed an isocaloric diet consisting of 50% carbohydrate, 30% fat, and 20% protein for 15 d. The energy balance plus exercise group consumed a similar diet over the 15 d and performed 50-min of treadmill walking at 70% of maximum oxygen consumption maximum during the second 7 d of the 15-d study period. Each subject underwent an initial isoglycemic/hyperinsulinemic clamp after 1-wk dietary control and a second clamp after completing the study. Setting:The study was performed at Ohio State University's General Clinical Research Center.Participants: There were 18 obese, mildly diabetic humans included in the study.Intervention: Aerobic exercise training was performed for 7 d. Main Outcome Measures:Whole-body, peripheral, and hepatic insulin sensitivity were measured.Results: Exercise training did not have an impact on peripheral glucose uptake or endogenous glucose production during the basal state or low-dose insulin. Likewise, it did not alter endogenous glucose production during high-dose insulin. However, 1-wk of exercise training increased both whole-body (P Ͻ 0.05) and peripheral insulin sensitivity (P Ͻ 0.0001) during high-dose insulin.Conclusion: Improvements to whole body insulin sensitivity after short-term aerobic exercise training are due to gains in peripheral, not heptic insulin sensitivity. T ype 2 diabetes mellitus (DM) is a metabolic disease characterized by insulin resistance, relative ␤-cell dysfunction, and resultant hyperglycemia that can contribute to the development of both microvascular and macrovascular disease. Despite an apparently strong genetic influence on the development of DM, environmental factors such as obesity and physical inactivity can hasten this process in humans (1-3), while interven-

Background Longitudinal studies have implicated both marital distress and depression in the development of the metabolic syndrome, a risk factor for diabetes and cardiovascular disease. This study addressed the impact of hostile marital interactions and a mood disorder history on obesity-related metabolic responses to high-fat meals. Methods This double-blind, randomized crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, insulin, glucose, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) before and after two high-fat meals. During two separate 9.5 hour visits, 43 healthy married couples, ages 24 to 61 (mean=38.22), received either a high saturated fat meal or a high oleic sunflower oil meal, both 930 kcal and 60 g fat. The Structured Diagnostic Interview for DSM-IV assessed mood disorder history. Couples discussed a marital disagreement during both visits; behavioral coding of these interactions provided data on hostile marital behaviors. Results Men and women who displayed more hostile behaviors and who also had a mood disorder history had significantly lower post-meal REE, higher insulin, and higher peak triglyceride responses than other participants, with nonsignificant effects for fat and carbohydrate oxidation. Participants with a mood disorder history had a steeper rise in postprandial IL-6 and glucose than those without a past history. Higher levels of hostile behaviors were associated with higher post-meal TNF-α. The two meals did not differ on any outcome assessed. Conclusions People spend about 18 of every 24 hours in a postprandial state, and dining with one’s partner is a common daily event. Among subjects with a mood disorder history, the cumulative 6.75-hour difference between high and low hostile behaviors translates into 128 kcal, a difference that could add 7.6 pounds/year. Our findings illustrate novel pathways through which chronic marital stress and a mood disorder history synergistically heighten the risk for obesity, metabolic syndrome, and cardiovascular disease.

Background Depression and stress promote obesity. This study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on obesity-related metabolic responses to high-fat meals. Methods This double-blind, randomized crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, cortisol, insulin and glucose before and after two high-fat meals. During two separate 9.5 hour admissions, 58 healthy women (38 breast cancer survivors and 20 demographically-similar controls), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. Prior day stressors were assessed by the Daily Inventory of Stressful Events and MDD history by the Structured Clinical Interview for DSM-IV. Results Greater numbers of stressors were associated with lower post-meal REE (P=.008), lower fat oxidation (P=.04), and higher insulin (P=.01), with nonsignificant effects for cortisol (P=.25) and glucose (P=.33). Women with prior MDD had higher cortisol (P=.008), and higher fat oxidation (P=.004), without significant effects for REE (P=.26), insulin (P=.25), and glucose (P=.38). Women with a depression history who also had more prior day stressors had a higher peak triglyceride response than other participants (P=.01). The only difference between meals was higher postprandial glucose following sunflower oil compared to saturated fat (P=.03). Conclusions The cumulative 6-hour difference between one prior day stressor and no stressors translates into 104 kcal, a difference that could add almost 11 pounds/year. These findings illustrate how stress and depression alter metabolic responses to high-fat meals in ways that promote obesity.

We have previously shown that 12 wk of endurance training reduces the rate of glucose appearance (Ra) during submaximal exercise (Coggan, A. R., W. M. Kohrt, R. J. Spina, D. M. Bier, and J. O. Holloszy. J. Appl. Physiol. 68: 990-996, 1990). The purpose of the present study was to examine the time course of and relationship between training-induced alterations in glucose kinetics and endocrine responses during prolonged exercise. Accordingly, seven men were studied during 2 h of cycle ergometer exercise at approximately 60% of pretraining peak oxygen uptake on three occasions: before, after 10 days, and after 12 wk of endurance training. Ra was determined using a primed, continuous infusion of [6,6-2H]glucose. Ten days of training reduced mean Ra during exercise from 36.9 +/- 3.3 (SE) to 28.5 +/- 3.4 mumol.min-1.kg-1 (P < 0.001). Exercise-induced changes in insulin, C-peptide, glucagon, norepinephrine, and epinephrine were also significantly blunted. After 12 wk of training, Ra during exercise was further reduced to 21.5 +/- 3.1 mumol.min-1.kg-1 (P < 0.001 vs. 10 days), but hormone concentrations were not significantly different from 10-day values. The lower glucose Ra during exercise after short-term (10 days) training is accompanied by, and may be due to, altered plasma concentrations of the major glucoregulatory hormones. However, other adaptations must be responsible for the further reduction in Ra with more prolonged training.