Influence of Interval Hypoxic Training on Indicators of Nutritional Status in Morbid Obesity

Aim. To analyze the effect of intermittent hypoxic-hyperoxic training (IHHT) on nutritional status indicators in individuals with morbid obesity.

Design. Prospective, single-center, non-randomized study.

Materials and methods. The study included 40 patients with morbid obesity, who were divided into two groups: Group 1 (control) — 20 individuals (10 men and 10 women) adhering to a high-protein diet (HPD) variant and general recommendations for optimal physical activity; Group 2 (main) — 20 individuals (10 men and 10 women) who were prescribed HPD in combination with IHHT. All patients underwent an assessment of clinical status, body composition analysis (bioimpedance analysis), and determination of biochemical markers of protein, lipid, and carbohydrate metabolism in blood plasma.

Results. IHHT was associated with a significant decrease in low-density lipoprotein levels and a more pronounced reduction in glucose levels (5.25 and 5.63 mmol/L, respectively; p = 0.021), a smaller decrease in the percentage of body fat (45.6 and 53.5%, respectively; p = 0.012), and an increase in basal metabolic rate (2314 and 1804, respectively; p = 0.001) compared to patients prescribed HPD alone. In addition, the control group showed a significant increase in uric acid, erythrocyte, and hemoglobin levels (p < 0.05), which was not observed in the main group (p > 0.05).

Conclusions. The addition of IGHT to HPD in the course of therapy of patients with morbid obesity is safe and promotes a more pronounced improvement of blood biochemical parameters, bioimpedanceometry indices and increase in basal metabolism, compared to isolated HPD.

1. Sørensen T.I.A., Martinez A.R., Jørgensen T.S.H. Epidemiology of obesity Handb. Exp. Pharmacol. 2022;274:3–27. DOI:10.1007/164_2022_581

2. Anthony S.R., Tranter M. Metabolically stressed adipocytes: mediators of cardioprotection via extracellular vesicle-mediated transport of oxidatively damaged mitochondria. ExRNA. 2022;4:3. DOI: 10.21037/exrna-21-31

3. Huang Y.C., Huang J.C., Lin C.I., Chienet H.H. et al. Comparison of innovative and traditional cardiometabolic indices in estimating atherosclerotic cardiovascular disease risk in adults. Diagnostics. 2021;11(4):603. DOI: 10.3390/diagnostics11040603

4. Dikaiou P., Björck L., Adiels M., Lundberg C.E. et al. Obesity, overweight and risk for cardiovascular disease and mortality in young women. Eur. J. Prev. Cardiol. 2021;28(12):1351–9. DOI:10.1177/2047487320908983

5. Lempesis I.G., van Meijel R.L.J., Manolopoulos K.N., Goossens G.H. Oxygenation of adipose tissue: a human perspective. Acta Physiol. (Oxf.). 2020;228(1):e13298. DOI:10.1111/apha.13298

6. Wang R., Sun Q., Wu X., Zhang Y. et al. Hypoxia as a double-edged sword to combat obesity and comorbidities. Cells. 2022;11(23):3735. DOI: 10.3390/cells11233735

7. van Hulten V., van Meijel R.L., Goossens G.H. The impact of hypoxia exposure on glucose homeostasis in metabolically compromised humans: a systematic review. Rev. Endocr. Metab. Disord. 2021;22(2):471–83 DOI: 10.1007/s11154-021-09654-0

8. Neubauer J.A. Invited review: physiological and pathophysiological responses to intermittent hypoxia. J. Appl. Physiol. (1985). 2001;90(4):1593–9. DOI: 10.1152/jappl.2001.90.4.1593

9. El'chaninova S.A., Korenyak N.A., Pavlovskaya L.I., Smagina I.V. et al. The effect of interval hypoxic hypoxia on the vascular endothelial growth factor and basic fibroblast growth factor concentrations in the peripheral blood. Human Physiology. 2004;30(6):93–5. (in Russian)

10. Abebe M.S., Asres K., Bekuretsion Y., Abebe A. et al. Sub-chronic toxicity of ethanol leaf extract of Syzygium guineense on the biochemical parameters and histopathology of liver and kidney in the rats. Toxicol. Rep. 2021;8:822– 8. DOI: 10.1016/j.toxrep.2021.03.032

11. Susta D., Dudnik E., Glazachev O.S. A programme based on repeated hypoxiahyperoxia exposure and light exercise enhances performance in athletes with overtraining syndrome: a pilot study. Clin. Physiol. Funct. Imaging. 2017;37(3):276–81. DOI: 10.1111/cpf.12296

12. Glazachev O.S., Kryzhanovskaya S.Y., Zapara M.A., Dudnik E.N. et al. Safety and efficacy of intermittent hypoxia conditioning as a new rehabilitation/ secondary prevention strategy for patients with cardiovascular diseases: a systematic review and meta-analysis. Curr. Cardiol. Rev. 2021;17(6):e051121193317. DOI: 10.2174/1573403X17666210514005235

13. Behrendt T., Bielitzki R., Behrens M., Herold F. et al. Effects of intermittent hypoxia-hyperoxia on performance- and health-related outcomes in humans: a systematic review. Sports Med. Open. 2022;8(1):70. DOI: 10.1186/s40798-022-00450-x

14. Bestavashvili A.A., Glazachev O.S., Bestavashvili A.A., Dhif I. et al. The effects of intermittent hypoxic-hyperoxic exposures on lipid profile and inflammation in patients with metabolic syndrome. Front. Cardiovasc. Med. 2021;8:700826. DOI: 10.3389/fcvm.2021.700826

15. Bestavashvili A., Glazachev O., Bestavashvili A., Suvorov А. et al. Intermittent hypoxic-hyperoxic exposures effects in patients with metabolic syndrome: correction of cardiovascular and metabolic profile. Biomedicines. 2022;10(3):566. DOI: 10.3390/biomedicines10030566

16. Dudnik E., Zagaynaya E., Glazachev O.S., Susta D. Intermittent hypoxiahyperoxia conditioning improves cardiorespiratory fitness in older comorbid cardiac outpatients without hematological changes: a randomized controlled trial. High Alt. Med. Biol. 2018;19(4):339–43. DOI: 10.1089/ham.2018.0014

17. Wang R., Liu D., Wang X., Xiao W. et al. The effect of 'sleep high and train low' on weight loss in overweight Chinese adolescents: study protocol for a randomized controlled trial. Trials. 2014;15:250. DOI: 10.1186/1745-6215-15-250