RESUMEN
This qualitative research study highlights medical mistrust as a significant barrier to quality health care for Black women. Unraveling mistrust is essential for reducing health disparities and improving well-being for women and their families. Three research sites were included: Florida, Ohio, and the U.S. Virgin Islands. Three 90-minute focus groups were convened with 10 women in each of them. The discussions were recorded. Five themes will be discussed through the voices of women from each of the sites. Mistrust of healthcare professionals was associated with fears about being rejected, embarrassed, and misunderstood during the clinical encounter. Others reported that providers who were reluctant to make physical contact with them during the clinical visits provoked feelings that the color of their skin might seem "dirty." Finally, this research will help to inform discussions about COVID-19 vaccine hesitancy, which remains a critical health concern among Black women and healthcare providers.
Asunto(s)
COVID-19 , Confianza , Población Negra , Vacunas contra la COVID-19 , Femenino , Personal de Salud , HumanosRESUMEN
BACKGROUND/AIMS: The aim of this study was to assess the combined effects of exercise and dietary glycemic load on insulin resistance in older obese adults. METHODS: Eleven men and women (62 +/- 2 years; 97.6 +/- 4.8 kg; body mass index 33.2 +/- 2.0) participated in a 12-week supervised exercise program, 5 days/week, for about 1 h/day, at 80-85% of maximum heart rate. Dietary glycemic load was calculated from dietary intake records. Insulin resistance was determined using the euglycemic (5.0 mM) hyperinsulinemic (40 mU/m(2)/min) clamp. RESULTS: The intervention improved insulin sensitivity (2.37 +/- 0.37 to 3.28 +/- 0.52 mg/kg/min, p < 0.004), increased VO(2max) (p < 0.009), and decreased body weight (p < 0.009). Despite similar caloric intakes (1,816 +/- 128 vs. 1,610 +/- 100 kcal/day), dietary glycemic load trended towards a decrease during the study (140 +/- 10 g before, vs. 115 +/- 8 g during, p < 0.04). The change in insulin sensitivity correlated with the change in glycemic load (r = 0.84, p < 0.009). Four subjects reduced their glycemic load by 61 +/- 8%, and had significantly greater increases in insulin sensitivity (78 +/- 11 vs. 23 +/- 8%, p < 0.003), and decreases in body weight (p < 0.004) and plasma triglycerides (p < 0.04) compared to the rest of the group. CONCLUSION: The data suggest that combining a low-glycemic diet with exercise may provide an alternative and more effective treatment for insulin resistance in older obese adults.
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Carbohidratos de la Dieta , Ejercicio Físico/fisiología , Índice Glucémico , Resistencia a la Insulina/fisiología , Obesidad/terapia , Anciano , Índice de Masa Corporal , Terapia Combinada/estadística & datos numéricos , Diabetes Mellitus/prevención & control , Dieta , Femenino , Técnica de Clampeo de la Glucosa , Humanos , Lípidos/sangre , Masculino , Obesidad/complicaciones , Obesidad/fisiopatología , Consumo de Oxígeno , Aptitud FísicaRESUMEN
UNLABELLED: Nampt/pre-B-cell colony-enhancing factor/visfatin (visfatin) release from adipocytes has recently been suggested to be nutrient responsive and linked to systemic nicotinamide adenine dinucleotide biosynthesis and regulation of pancreatic beta-cell function. PURPOSE: We hypothesized that if visfatin does play a role in the insulin response, then the exercise training-induced reduction in insulin response to an oral glucose load would correlate with reduced plasma visfatin. METHODS: Sixteen obese men and women (age = 65 +/- 1 yr, body mass index = 33.4 +/- 1.5 kg x m(-2)) volunteered to participate in a 12-wk supervised exercise program (5 d x wk(-1), 60 min x d(-1) at 85% of HRmax). Visceral (VAT) and subcutaneous adipose tissue (SAT) were measured by computed tomographic scans. A 2-h 75-g oral glucose tolerance test was performed to determine the effect of exercise training on the insulin response to a glucose load. Fasting plasma visfatin was measured by enzyme-linked immunosorbent assay. RESULTS: Exercise training resulted in an increase in (.)VO2max (21.1 +/- 0.9 vs 24.2 +/- 1.1 mL x kg(-1) x min(-1), P < 0.001), a decrease in body weight (96.4 +/- 4.1 vs 92.4 +/- 3.7 kg, P < 0.001), VAT (191 +/- 16 vs 144 +/- 16 cm, P < 0.001), and SAT (369 +/- 34 vs 309 +/- 41 cm, P < 0.02). Area under the glucose (450 +/- 31 vs 392 +/- 33 mmol x L(-1) x 2 h(-1), P < 0.01) and insulin (45,767 +/- 6142 vs 35,277 +/- 4997 pmol x L(-1) x 2 h(-1), P < 0.003) response curves were decreased after training. After intervention, plasma visfatin levels were significantly reduced (16.9 +/- 2.2 vs 14.5 +/- 1.8 ng x mL(-1), P < 0.05), and the change in visfatin was associated with the corresponding change in insulin (r = 0.56, P < 0.05) and glucose AUC (r = 0.53, P < 0.05). CONCLUSION: The exercise-induced reduction of plasma visfatin is most likely the result of weight loss and body composition changes. The potential regulatory role of visfatin in mediating the pancreatic insulin response to oral glucose requires further investigation.
Asunto(s)
Glucemia , Ejercicio Físico , Prueba de Tolerancia a la Glucosa , Grasa Intraabdominal , Nicotinamida Fosforribosiltransferasa/sangre , Obesidad/sangre , Adipoquinas , Anciano , Femenino , Humanos , Resistencia a la Insulina , Masculino , Actividad Motora , Nicotinamida Fosforribosiltransferasa/biosíntesis , Obesidad/fisiopatología , Aptitud Física , Estadística como AsuntoRESUMEN
Aging and obesity are characterized by decreased beta-cell sensitivity and defects in the potentiation of nutrient-stimulated insulin secretion by GIP. Exercise and diet are known to improve glucose metabolism and the pancreatic insulin response to glucose, and this effect may be mediated through the incretin effect of GIP. The purpose of this study was to assess the effects of a 12-wk exercise training intervention (5 days/wk, 60 min/day, 75% Vo(2 max)) combined with a eucaloric (EX, n = 10) or hypocaloric (EX-HYPO, pre: 1,945 +/- 190, post: 1,269 +/- 70, kcal/day; n = 9) diet on the GIP response to glucose in older (66.8 +/- 1.5 yr), obese (34.4 +/- 1.7 kg/m(2)) adults with impaired glucose tolerance. In addition to GIP, plasma PYY(3-36), insulin, and glucose responses were measured during a 3-h, 75-g oral glucose tolerance test. Both interventions led to a significant improvement in Vo(2 max) (P < 0.05). Weight loss (kg) was significant in both groups but was greater after EX-HYPO (-8.3 +/- 1.1 vs. -2.8 +/- 0.5, P = 0.002). The glucose-stimulated insulin response was reduced after EX-HYPO (P = 0.02), as was the glucose-stimulated GIP response (P < 0.05). Furthermore, after the intervention, changes in insulin (DeltaI(0-30)/DeltaG(0-30)) and GIP (Delta(0-30)) secretion were correlated (r = 0.69, P = 0.05). The PYY(3-36) (Delta(0-30)) response to glucose was increased after both interventions (P < 0.05). We conclude that 1) a combination of caloric restriction and exercise reduces the GIP response to ingested glucose, 2) GIP may mediate the attenuated glucose-stimulated insulin response after exercise/diet interventions, and 3) the increased PYY(3-36) response represents an improved capacity to regulate satiety and potentially body weight in older, obese, insulin-resistant adults.