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ABSTRACT: Objective: To describe gestational weight gain during pregnancy, adherence to Health Canada 2010 Gestational Weight Gain Guidelines, and the effects of weight gain on postpartum weight retention in women with different pre-pregnancy body mass indices. Method: Body weight data were collected from women during pregnancy and in the early postpartum period as part of this prospective cohort study; analyses are presented for the first 600 women recruited. Multilinear regression was used to assess associations between pre-pregnancy BMI, total gestational weight gain, and postpartum weight retention. Multinomial regression was used to assess adherence to guidelines for total weight gain and rates of weekly weight gain. Results: Women who gained above recommendations were more likely to be overweight (OR 5.5; 95% CI 2.7 to 10.9, P < 0.001) or obese (OR 6.5; 95% CI 2.5 to 16.5, P < 0.001) before pregnancy, to have a history of smoking (OR 1.96; 95% CI 1.18 to 3.26, P = 0.01), or to be nulliparous (OR 2.23; 95% CI 0.99 to 5.05, P = 0.054). Women who gained weight above recommendations (P < 0.001) and women with low income (P < 0.01) were more likely to retain higher body weight at three months postpartum. Seventy-one percent of participants exceeded recommended rates of weekly weight gain; average weekly weight gain of these women was 0.65 ± 0.17 kg. Conclusion: Pre-pregnancy BMI is a significant predictor of excessive weight gain in pregnancy. Higher gestational weight gain predisposes women to higher postpartum weight retention across all BMI categories. Future studies are warranted to design tools and intervention programs to monitor weight gain during pregnancy.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 07/2012; 34(7):637-47.
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ABSTRACT: The purpose of this consensus conference was to have a lay panel of persons with type 2 diabetes (T2D) work in collaboration with an expert panel of diabetes professionals to develop strategies designed to improve dietary and physical activity adherence in persons with T2D. Lay panel participants were 15 people living with T2D. The seven experts had expertise in exercise management, cardiovascular risk factors, community-based lifestyle interventions, healthy weight strategies, the glycemic index, exercise motivation, and social, environmental and cultural interactions. All meetings were facilitated by a professional, neutral facilitator. During the conference each expert gave a 15-min presentation answering questions developed by the lay panel and all panel members worked to generate suggestions for programs and ways in which the needs of persons with T2D may be better met. A subgroup of the lay panel used the suggestions created from the conference to generate a final list of recommendations. Recommendations were categorized into (1) diagnosis/awareness (e.g., increasing awareness about T2D in the general public, need for lifelong self-monitoring post-diagnosis); (2) education for the person with diabetes (e.g., periodic "refresher" courses), professionals (e.g., regular interactions between researchers and persons with T2D so researchers better understand the needs of the affected population), and the community (e.g., support for families and employers); and (3) ongoing support (e.g., peer support groups). The recommendations from the conference can be used by researchers to design and evaluate physical activity and nutrition programs. The results can also be of use to policy makers and health promoters interested in increasing adherence to physical activity and nutrition guidelines among persons with T2D.
Frontiers in endocrinology. 01/2012; 3:161.
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ABSTRACT: Glucocorticoid excess induces marked insulin resistance and glucose intolerance. A recent study has shown that antioxidants prevent dexamethasone (DEX)-induced insulin resistance in cultured adipocytes. The purpose of this investigation was to examine the effects of dietary vitamin E and C (Vit E/C) supplementation on DEX-induced glucose intolerance in rats. We hypothesized that feeding rats a diet supplemented with Vit E/C would improve glucose tolerance and restore insulin signaling in skeletal muscle, adipose, and liver and prevent alterations in AMPK signaling in these tissues. Male Wistar rats received either a control or Vit E/C-supplemented diet (0.5 g/kg diet each of L-ascorbate and DL-all rac-alpha-tocopherol) for 9 days prior to, and during, 5 days of daily DEX treatment (subcutaneous injections 0.8 mg/g body wt). DEX treatment resulted in increases in the glucose and insulin area under the curve (AUC) during an intraperitoneal glucose tolerance test. The glucose, but not insulin, AUC was lowered with Vit E/C supplementation. Improvements in glucose tolerance occurred independent of a restoration of PKB phosphorylation in tissues of rats stimulated with an intraperitoneal injection of insulin but were associated with increases in AMPK signaling in muscle and reductions in AMPK signaling and the expression of fatty acid oxidation enzymes in liver. There were no differences in mitochondrial enzymes in triceps muscles between groups. This study is the first to report that dietary Vit E/C supplementation can partially prevent DEX-induced glucose intolerance in rats.
AJP Regulatory Integrative and Comparative Physiology 01/2012; 302(1):R49-58. · 3.34 Impact Factor
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ABSTRACT: The majority of people with type 2 diabetes do not meet dietary and physical activity recommendations. It is not well understood how diabetes educators translate diet and physical guidelines for their clients and if diabetes educators have sufficient resources to promote healthy eating and physical activity. This research addressed these questions through exploratory qualitative interviews.
A total of 13 diabetes educators who work in Alberta, Canada, were interviewed.
The reasons for lack of client uptake of lifestyle recommendations were complex and interwoven. The strongest theme to emerge was the clients' prior knowledge and skills affecting their ability to uptake knowledge. However, educators recognized that clients are affected by social, environmental, cultural, and personal factors.
Health system and societal issues cause a cascade effect resulting in difficulties for both educators and clients. To achieve appropriate treatment of type 2 diabetes, changes need to occur at a health systems level.
Health Promotion Practice 10/2011; 13(3):388-94.
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Catrine Tudor-Locke,
Cora L Craig,
Yukitoshi Aoyagi, Rhonda C Bell,
Karen A Croteau,
Ilse De Bourdeaudhuij,
Ben Ewald,
Andrew W Gardner,
Yoshiro Hatano,
Lesley D Lutes,
Sandra M Matsudo,
Farah A Ramirez-Marrero,
Laura Q Rogers,
David A Rowe,
Michael D Schmidt,
Mark A Tully,
Steven N Blair
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ABSTRACT: Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.
International Journal of Behavioral Nutrition and Physical Activity 07/2011; 8:80. · 3.83 Impact Factor
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ABSTRACT: To determine the effect of metformin on the acute metabolic response to submaximal exercise, the effect of exercise on plasma metformin concentrations, and the interaction between metformin and exercise on the subsequent response to a standardized meal.
Ten participants with type 2 diabetes were recruited for this randomized crossover study. Metformin or placebo was given for 28 days, followed by the alternate condition for 28 days. On the last 2 days of each condition, participants were assessed during a nonexercise and a subsequent exercise day. Exercise took place in the morning and involved a total of 35 min performed at three different submaximal intensities.
Metformin increased heart rate and plasma lactate during exercise (both P≤0.01) but lowered respiratory exchange ratio (P=0.03) without affecting total energy expenditure, which suggests increased fat oxidation. Metformin plasma concentrations were greater at several, but not all, time points on the exercise day compared with the nonexercise day. The glycemic response to a standardized meal was reduced by metformin, but the reduction was attenuated when exercise was added (metformin×exercise interaction, P=0.05). Glucagon levels were highest in the combined exercise and metformin condition.
This study reveals several ways by which metformin and exercise therapies can affect each other. By increasing heart rate, metformin could lead to the prescription of lower exercise workloads. Furthermore, under the tested conditions, exercise interfered with the glucose-lowering effect of metformin.
Diabetes care 05/2011; 34(7):1469-74. · 8.09 Impact Factor
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Rhonda C Bell
Evidence-based nursing 01/2011; 14(1):26-7.
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ABSTRACT: The WHO Child Growth Standards (CGS) which were recently adopted by the Canadian Pediatric Society were used to assess the relative size of Cree newborns.
Birth weight, length, and head circumference, and growth indices of 2,127 Cree newborns were compared with the CGS. Maternal characteristics of pregnancy and infant birth outcomes were recorded and stratified by birth weight category.
Among Cree newborns, 2.4% were low birth weight (LBW) (<2,500 g) and 36.5% were high birth weight (≥4,000 g). The median birth weight (g) for Cree male (4,030) and female (3,900) term newborns was higher than for male (3,346) and female (3,232) newborns of the CGS. Fewer than 1.5% of Cree infants had z-scores <-2SD from the WHO CGS median for BMI-for-age, length-for-age, weight-for-age, or head circumference-for-age whereas 4.6, 7.8, and 23.4% percent had z-scores >+2SD from the WHO CGS median for weight-for-length-for-age, BMI-for-age and head circumference-for-age, respectively. The majority (53.4%) of pregnancies was complicated by obesity and 10.3% were complicated by gestational diabetes mellitus (GDM). Infants weighing 4,000-4,499 g had a comparable prevalence of operative delivery (15.4%) as infants weighing 2,500-3,999 g (13.7%). Infants weighing ≥4,500 g had the highest prevalence of birth injuries (14.0%) and being born to women whose pregnancies were complicated by GDM (20%).
Cree newborns were larger than newborns of the CGS. The appropriateness for Cree infants of defining low and high birth weight from the WHO CGS is uncertain and may lead to inaccurate prognosis of postnatal health.
American Journal of Human Biology 11/2010; 23(1):126-31. · 2.27 Impact Factor
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ABSTRACT: Dietary fiber reduces the intestinal absorption of nutrients and the blood concentrations of cholesterol and triglycerides.
We wished to test the hypothesis that high-viscosity (HV) and low-viscosity preparations of barley and oat beta-glucan modify the expression of selected genes of lipid-binding proteins in the intestinal mucosa and reduce the intestinal in vitro uptake of lipids.
Five different beta-glucan extracts were separately added to test solutions at concentrations of 0.1-0.5% (wt/wt), and the in vitro intestinal uptake of lipids into the intestine of rats was assessed. An intestinal cell line was used to determine the effect of beta-glucan extracts on the expression of intestinal genes involved in lipid metabolism and fatty acid transport.
All extracts reduced the uptake of 18:2 when the effective resistance of the unstirred water layer was high. When the unstirred layer resistance was low, the HV oat beta-glucan extract reduced jejunal 18:2 uptake, while most extracts reduced ileal 18:2 uptake. Ileal 18:0 uptake was reduced by the HV barley extract, while both jejunal and ileal cholesterol uptakes were reduced by the medium-purity HV barley extract. The inhibitory effect of HV barley beta-glucan on 18:0 and 18:2 uptake was more pronounced at higher fatty acid concentrations. The expression of genes involved in fatty acid synthesis and cholesterol metabolism was down-regulated with the HV beta-glucan extracts. beta-Glucan extracts also reduced intestinal fatty-acid-binding protein and fatty acid transport protein 4 mRNA.
The reduced intestinal fatty acid uptake observed with beta-glucan is associated with inhibition of genes regulating intestinal uptake and synthesis of lipids. The inhibitory effect of beta-glucan on intestinal lipid uptake raises the possibility of their selective use to reduce their intestinal absorption.
The Journal of nutritional biochemistry 09/2009; 21(8):695-701. · 4.29 Impact Factor
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ABSTRACT: Practical lifestyle interventions are needed to help people with type 2 diabetes increase their physical activity and follow nutrition therapy guidelines. This study examined whether combining instructions to walk more and to eat more low-glycemic index (GI) foods (First Step First Bite Program) improved hemoglobin A1c and anthropometric and cardiovascular health outcomes in people with type 2 diabetes vs the First Step Program (instruction only on walking). Subjects were randomly assigned to the First Step Program or First Step First Bite Program (n=22 in each group) and attended four weekly group meetings with minimal follow-up during weeks 5 to 16. All subjects monitored steps per day throughout the study; First Step First Bite Program subjects also monitored daily intake of low-GI foods. At week 16 (n=19 per group), both groups had increased steps per day by approximately 3,000 compared with baseline (P<0.01). In the First Step Program vs First Step First Bite Program groups, respectively, waist girth decreased by 5.9+/-0.9 cm vs 3.7+/-0.5 cm and hip decreased by 3.7+/-0.6 cm vs 2.2+/-0.5 cm (P<0.01 over time, both groups). There was no significant difference between groups at week 16 for anthropometric or metabolic variables measured, including hemoglobin A1c. Both the First Step First Bite Program and First Step Program resulted in increased physical activity; First Step First Bite Program also increased daily intake of low-GI foods. Both groups experienced similar significant reductions in waist and hip girth. Thus, adding a low-GI component to a walking program in people with type 2 diabetes in good glycemic control did not improve anthropometric or metabolic outcomes. A great number and/or longer duration of low-GI foods may be required to observe improved clinical outcomes.
Journal of the American Dietetic Association 08/2009; 109(8):1411-6. · 3.59 Impact Factor
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ABSTRACT: To compare the effectiveness of a theory-based lifestyle physical activity (PA) program delivered to individuals with type 2 diabetes in diabetes education centers by professionals and peers.
Changes over 16 weeks in PA (steps/day) and related variables (weight, waist girth, resting heart rate, systolic and diastolic blood pressures) were compared (RMANOVA) for two groups: 157 participants led by 13 different professionals versus 63 participants led by 5 peer leaders.
Overall, the 81 male and 139 female participants (age = 55.7 +/- 7.3 years, BMI = 35.2 +/- 6.6) showed an incremental change of 4,059 +/- 3,563 steps/day, which translates into an extra 37 minutes of daily walking (P < .001). Statistically significant improvements were also seen in weight, waist girth, and blood pressure (all P < .001) and resting heart rate (P < .05). There were no significant differences in outcomes between professional and peer-led groups.
A theory-based behavior modification program featuring simple feedback and monitoring tools, and with a proven element of flexibility in delivery, can be effective under real-world conditions while addressing inevitable concerns about resource allocation. Program delivery by peer leaders, in particular, could address a potential obstacle to dissemination by helping to alleviate existing high caseload demands on diabetes educators.
Journal of physical activity & health 07/2009; 6(4):456-62. · 1.95 Impact Factor
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ABSTRACT: Increasing evidence suggests that reduced adipose tissue mitochondrial content is associated with the pathogenesis of type 2 diabetes. These investigations have utilized severely insulin-resistant rodent models. Thus, it is difficult to ascertain the potential mechanisms that initiate these changes and whether reductions in adipose mitochondria are an initiating event in the development of impaired glucose homeostasis. Thus, we sought to determine the time course of high-fat diet-induced reductions of mitochondrial content in epididymal adipose tissue in relation to changes in purported mediators of mitochondrial biogenesis and the development of impaired glucose homeostasis. Male Wistar rats were fed a high-fat diet ( approximately 59% of kcals from fat) for 2, 4, or 6 wk. Six weeks of high-fat feeding resulted in reductions in CORE I, COX IV, cytochrome c, HSP60, relative mtDNA copy number, and PGC-1alpha expression. These changes were not associated with decreases in eNOS and AMPK or increases in markers of oxidative stress. Interestingly, ex vivo treatment of adipose tissue cultures with palmitate led to decreases in PGC-1alpha expression and COX IV and CORE I protein content as observed in vivo. Thus, the high-fat diet-induced reductions in adipose tissue mitochondrial proteins may be mediated by increases in plasma fatty acids. Importantly, reductions in adipose tissue mitochondrial content occurred after the development of impaired glucose homeostasis. Thus, reductions in adipose tissue mitochondrial proteins are most likely not a causal event in the development of impaired glucose homeostasis.
AJP Endocrinology and Metabolism 10/2008; 295(5):E1076-83. · 4.75 Impact Factor
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ABSTRACT: Walking is often prescribed as a mode of physical activity for people with type 2 diabetes (T2D). We and others have found that although people with T2D may increase the amount that they walk (e.g., more steps per day), improvements in key health outcomes are rarely achieved. We agree that walking is an acceptable approach for people with T2D to meet current clinical practice guidelines, but consideration of both the total number of daily steps and the walking speed of a portion of those total daily steps are necessary to gain health benefit.
Applied Physiology Nutrition and Metabolism 08/2008; 33(4):797-801. · 2.13 Impact Factor
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ABSTRACT: The suckling period is one potentially "critical" period during which nutritional intake may permanently "program" metabolism to promote increased adult body weight and insulin resistance in later life. This study determined whether fructose introduced during the suckling period altered body weight and induced changes in fatty acid transport leading to insulin resistance in adulthood in rats.
Pups were randomly assigned to one of four diets: suckle controls (SCs), rat milk substitute formula (Rat Milk Substitute), fructose-containing formula (Fructose), or galactose-containing formula (Galactose). Starting at weaning, all pups received the same diet; at 8 weeks of age, half of the SC rats began ingesting a diet containing 65% kcal fructose (SC-Fructose). This continued until animals were 12 weeks old and the study ended.
At weeks 8, 10, and 11, the Fructose group weighed more than SC and SC-Fructose groups (P < 0.05). At weeks 8 and 10 of age, the Fructose group had significantly higher insulin concentrations vs. rats in the SC-Fructose group. (3)H-Palmitate transport into vesicles from hind limb skeletal muscle was higher in Fructose vs. SC rats (P < 0.05). CD36 expression was increased in the sarcolemma but not in whole tissue homogenates from skeletal muscle from Fructose rats (P < 0.05) suggesting a redistribution of this protein associated with fatty acid uptake across the plasma membrane. This change in subcellular localization of CD36 is associated with insulin resistance in muscle.
Consuming fructose during suckling may result in lifelong changes in body weight, insulin secretion, and fatty acid transport involving CD36 in muscle and ultimately promote insulin resistance.
Obesity 05/2008; 16(8):1755-62. · 4.28 Impact Factor
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Diabetes Care 08/2006; 29(7):1654-5. · 8.09 Impact Factor
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Annals of internal medicine 06/2006; 144(9):699; author reply 699-700. · 16.73 Impact Factor
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Diabetes Care 07/2005; 28(6):1503-4. · 8.09 Impact Factor
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ABSTRACT: Diet is known to modulate the development of diabetes in diabetes-prone BioBreeding (BBdp) rats. The objective of the present study was to determine the effect of fermentable fibre (FF) on immune function in BBdp and diabetes-resistant BioBreeding (BBdr) rats after weaning. Weanling BBdp (thirty-six to thirty-eight per diet) and BBdr rats (thirty to thirty-two per diet) were fed a nutritionally complete, semi-purified, casein-based diet containing either cellulose (control diet, 8 % w/w) or FF (3.2 % cellulose+4.8 % w/w inulin). At 35 d, the small intestine was excised and lymphocytes isolated from spleen, mesenteric lymph nodes and Peyer's patches. Feeding FF to both BBdr and BBdp rats affected the production of anti-inflammatory cytokines (P=0.02). In BBdr rats, feeding FF compared with cellulose resulted in an increased small intestinal length (P=0.0031), higher proliferative (stimulation) index from both splenocytes (P=0.001) and mesenteric lymph nodes (P=0.04), and an increased proportion of CD8+ T-cells in the Peyer's patches (P=0.003). We did not observe an effect of diet on the number of IgA-bearing cells in the jejunum from BBdr rats. Feeding FF to BBdp rats did not affect the same parameters. BBdp rats had both a higher proportion of B-cells in the Peyer's patches (P=0.01) and a higher number of IgA+ cells in the jejunum (P=0.0036) when fed a diet containing FF, a response not observed in BBdr rats. We demonstrate that several aspects of the BBdp immune system respond differently than that of BBdr rats when challenged at weaning with FF.
British Journal Of Nutrition 06/2005; 93(5):645-53. · 3.01 Impact Factor
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ABSTRACT: Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.
Canadian Journal of Dietetic Practice and Research 02/2004; 65(4):154-60. · 0.81 Impact Factor
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ABSTRACT: We have examined the effects of streptozotocin (STZ)-induced diabetes (moderate and severe) on fatty acid transport and fatty acid transporter (FAT/CD36) and plasma membrane-bound fatty acid binding protein (FABPpm) expression, at the mRNA and protein level, as well as their plasmalemmal localization. These studies have shown that, with STZ-induced diabetes, 1) fatty acid transport across the plasma membrane is increased in heart, skeletal muscle, and adipose tissue and is reduced in liver; 2) changes in fatty acid transport are generally not associated with changes in fatty acid transporter mRNAs, except in the heart; 3) increases in fatty acid transport in heart and skeletal muscle occurred with concomitant increases in plasma membrane FAT/CD36, whereas in contrast, the increase and decrease in fatty acid transport in adipose tissue and liver, respectively, were accompanied by concomitant increments and reductions in plasma membrane FABPpm; and finally, 4) the increases in plasma membrane transporters (FAT/CD36 in heart and skeletal muscle; FABPpm in adipose tissue) were attributable to their increased expression, whereas in liver, the reduced plasma membrane FABPpm appeared to be due to its relocation within the cell in the face of slightly increased expression. Taken together, STZ-induced changes in fatty acid uptake demonstrate a complex and tissue-specific pattern, involving different fatty acid transporters in different tissues, in combination with different underlying mechanisms to alter their surface abundance.
AJP Endocrinology and Metabolism 10/2002; 283(3):E612-21. · 4.75 Impact Factor
