부산대학교 도서관

Objective: Prolonged caloric restriction of obese type 2 diabetes mellitus (T2DM) patients has been shown to improve the systemic inflammatory state. We tested whether obese T2DM patients on a very-low caloric diet (VLCD) with or without exercise for 16 weeks also show improved endothelial glycocalyx health. Methods: Plasma levels of syndecan-1 and thrombomodulin, as a marker of glycocalyx health, was measured in plasma sample of obese T2DM patients (n = 27) along with lean and obese controls (n = 56, 52, respectively) at baseline, directly after VLCD (4 months), and during follow-up period (6 month and 18 month post baseline). Results: At baseline, shed syndecan-1 and thrombomodulin levels were not different between the obese diabetic subjects and non-diabetic lean- or obese controls. However, repeated measurements of the syndecan-1 levels in time showed a significant decrease after intervention, which sustained up to 14 months after VLCD and returning to a eu-caloric diet (mean difference: -21.98 ± 4.91 ng/mL [P < 0.001], -13.24 ± 3.91 ng/mL [P = 0.014], and -10.68 ± 3.74 ng/mL [P = 0.051] respectively for 4-, 6-, and 18 months post baseline). Although thrombomodulin decreased non-significantly after intervention (-0.86 ± 0.31 ng/mL, P = 0.064), it steadily returned to baseline during follow-up. Even though syndecan-1 is localized in both the vascular endothelium and liver sinusoids, no interaction between shed syndecan-1 levels and liver enzyme markers (AST, ALT) was observed, suggesting a vascular origin. Conclusion: In conclusion, prolonged very low caloric restriction diet in obese T2DM patients improves glycocalyx health which in turn results in a sustained protective effect, even after returning to a eu-caloric diet.