| Description |
- Background. Persons with rheumatoid arthritis (RA) have increased risk of cardiometabolic disease. The Supervised Weight loss and Exercise Training for Rheumatoid Arthritis (SWET-RA) trial demonstrated improved RA cardiometabolic risk with a weight loss and exercise intervention. This study aims to understand underlying effects of the intervention on RA cardiometabolic risk and clinical outcomes using mass spectroscopy (MS) and nuclear magnetic resonance (NMR) metabolites and lipoproteins.
Methods. Older adults with RA and overweight/obesity (n=20) underwent 16 weeks of SWET (hypocaloric diet and aerobic and resistance training) or lifestyle counseling. Baseline MS and NMR measures were logarithmically transformed. “Change” scores were calculated. Principal components analysis (PCA) reduced MS baseline measures and change scores into respective factors (Table 1). Spearman’s rank correlations assessed baseline and change associations with cardiometabolic risk and RA clinical outcomes. T-tests and linear regression models compared group differences for MS change factors and NMR change scores, respectively.
Results. Greater PCA Baseline Factor 2 (large neutral amino acids) associated with greater peak and average knee extension torque, grip strength, and fasting insulin (ρ=0.57, p=0.01; ρ=0.50, p=0.04; ρ=0.52, p=0.03; ρ=0.56, p=0.02; ρ=0.53, p=0.02) (Table 2). Increases in PCA Change Factor 1 (short- and medium-chain acylcarnitines) associated with triglyceride (TG) and fatigue improvements (ρ=-0.50, p=0.03; ρ=-0.69, p<0.001) (Table 3). Increases in ketone bodies associated with metabolic syndrome score improvements (ρ=-0.45, p=0.049) (Table 4). Reductions in total high-density lipoprotein (HDL) particle and apolipoprotein A1 associated with fat mass reductions (ρ=-0.52, p=0.02; ρ=-0.47, p=0.04) (Table 4).
Conclusions. Exercise may help mitigate fatigue through enhanced whole-body metabolism and beta-oxidation. Caloric restriction induces ketone body production, which may improve lipid handling. Decreased HDL may be a favorable outcome affected by dietary composition.
Lifestyle interventions may have the potential to target specific metabolic pathways and improve RA health.
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