Behavioral determinants of insulin resistance in non-diabetic patients with coronary artery disease Public Deposited

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  • Greater degrees of insulin resistance are associated with increased rates of coronary artery disease (CAD) progression. However, the specific behavioral determinants of insulin resistance are not well known in patients with CAD. Although abdominal obesity contributes to insulin resistance, the extent to which abdominal obesity may modify the relationship between health behaviors and insulin resistance is unclear in coronary patients. Thus, the aims of this study are to determine whether selected health behaviors (physical activity, dietary patterns, and psychosocial indexes) are associated with insulin resistance and whether the associations differ between those with and those without abdominal obesity in 26 non-diabetic patients (19 men and 7 women, aged 43-82 years) with CAD after physician referral yet prior to participation in a cardiac rehabilitation program. Greater degrees of insulin resistance were quantified as higher areas under the insulin response curve over a 75g 2-hour oral glucose tolerance test. The Stanford Physical Activity Recall and the Ainsworth Compendium of Physical Activities were used to estimate physical activity energy expenditures. The Block 95 Food Frequency Questionnaire was used to estimate nutrient and vitamin intakes from foods. The Center for Epidemiologic Studies Depression Scale was used to quantify symptoms of depression, and the Cook-Medley Questionnaire was used to quantify feelings of hostility. Abdominal obesity was defined by gender-specific National Institutes of Health criteria (waist circumference ≥102cm for men and ≥88cm for women). The patients with abdominal obesity (N=14) had a higher insulin response (Insulin AUC) to the oral glucose load (p=0.020), weighed more (p<0.001), and reported lower physical activity energy expenditures (p=0.017), and lower dietary fat intakes (p=0.041) than the patients without abdominal obesity. Taken together, the similar self-reported energy intakes and lower physical activity energy expenditures are suggestive of a more positive energy balance in the patients with abdominal obesity. Higher insulin AUC values were associated with heavier body weights (r=0.57, p=0.002), lower dietary vegetable intakes (r=-0.45, p=0.023), lower dietary (i.e., from foods rather than supplements) vitamin C (r=-0.40, p=0.027) and vitamin E (r=-0.43, p=0.044) intakes, and higher depression scores (r=0.47, p=0.016). After adjusting for abdominal obesity, higher insulin AUC remained associated with heavier body weights (partial r=0.43, p=0.034), lower dietary vegetable intakes (partial r=-0.51, p=0.011), and lower dietary vitamin C (partial r=-0.48, p=0.019) and vitamin E (partial r=-0.54, p=0.007) intakes. Insulin AUC was independently associated (p≤0.039) with the interactions of body weight, dietary vegetable intake, and dietary vitamin E intake with abdominal obesity, indicating a stronger association between insulin resistance and these health behaviors in patients with versus those without abdominal obesity. We conclude that higher self-reported depression scores, lower dietary vegetable, fruit and vitamin E intakes, and lower physical activity levels may be important behaviors to identify for better managing insulin resistance and abdominal obesity in non-diabetic patients with CAD who are referred to cardiac rehabilitation.
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