4. Discussion
cardiovascular disease, Weight reduction, abdominal obesity, adiposity, weight loss
OBESE, CARDIOVASCULAR DISEASE, INSULIN RESISTANCE, ADIPOSITY, INSULIN RESISTANCE, REGRESSION, TYPE 2 DIABETES, INSULIN SENSITIVITY
The transition to menopause is associated with adipose tissue storage changes that lead to android body composition, increasing the risk of cardiovascular disease and type 2 diabetes in postmenopausal women [In this study, the effects of CAST with calorie restriction on HOMA-IR, anthropometric measures, abdominal adiposity, and metabolic parameters in obese premenopausal women were compared to those of the control group who received aerobic exercise in addition to caloric restriction. Following 12 weeks of intervention compared to baseline, both groups exhibited a significant enhancement in the selected parameters, with the CAST-CR group showing higher improvement. Between-group differences were noteworthy (The improvement in HOMA-IR observed following exercise and calorie restriction may be attributed to the changes in anthropometric measures, abdominal adiposity, and metabolic markers. In multiple regression analyses, HOMA-IR at baseline and changes in BMI, LDL cholesterol, triglycerides, ALT, VAT, and fasting insulin were the best predictors of HOMA-IR improvement.Exercise in women is related to a remarkable increment in lipolysis of abdominal adipose tissue relative to femoral adipose tissue [Our findings revealed a significant reduction in both visceral adiposity and subcutaneous fat post-intervention, with the CAST-CR exhibiting the most significant changes. These results are consistent with previous reports demonstrating that weight loss using exercise and a low-calorie diet reduces subcutaneous and intra-abdominal fat in obese women [Cross-sectional studies have shown that abdominal obesity is a strong predictor of the development of IR [Abdominal adipose tissue can be regarded as an endocrine organ because of its ability to release adipokines and different substances which are intimately related to IR [It has been proven that AT and dietary interventions are effective strategies for regulating inflammatory processes from visceral elements, including a rise in adiponectin and a decrease in adult inflammatory markers [Weight reduction through lowering fat mass decreases the systemic free-fatty acid content in the bloodstream, consequently diminishing its accessibility to skeletal muscle tissue [Furthermore, expanded utilization of substrates [The effect of aerobic training on insulin resistance has been extensively studied, and it has been found to improve muscle insulin sensitivity by increasing the number of insulin receptors [Furthermore, a resistive exercise involving independent, brief activation of single muscle groups leads to an increase in glucose transporter type 4 (GLUT-4) content and insulin receptors due to muscle mass outgrowth [Additionally, the restoration of insulin sensitivity through aerobic and resistance training might be attributed to the adenosine monophosphate-activated protein kinase (AMPK) pathway [One of the key advantages of our experiment is the use of magnetic resonance imaging (MRI), a precise and widely accepted standard method for determining changes in abdominal adiposity. Additionally, we meticulously examined a number of intermediate parameters that could potentially elucidate the effect of exercise and calorie restriction on insulin resistance (IR). However, it is important to acknowledge the limitations of our trial. We evaluated insulin resistance using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) test, which is widely used in clinical research, but the hyperinsulinemic–euglycemic clamp is considered the gold standard for assessing insulin action. Nevertheless, it is also a more invasive and expensive procedure. Furthermore, we did not investigate the long-term effects of caloric restriction with adequate protein and exercise (CAST) on IR in obese premenopausal women, which would be valuable to investigate in future studies.