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Increased sclerostin and bone turnover after diet-induced weight loss in type 2 diabetes: a post hoc analysis of the MADIAB trial

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Abstract

Background

Sclerostin has been directly related to bone turnover increase in dietary-induced weight loss in non-diabetics. This has not been studied in type 2 diabetes, a condition characterized by increased circulating sclerostin and impaired bone turnover.

Purpose

To study the effect of dietary weight loss and quality of the dietary intervention on changes of sclerostin and bone turnover markers in type 2 diabetes.

Methods

This was a post-hoc analysis of the MADIAB trial, a 21-day randomized controlled trial on overweight/obese type 2 diabetes patients. Patients were randomly assigned 1:1 to the Ma-Pi2 macrobiotic diet or a control diet based on dietary guidelines for type 2 diabetes. Serum sclerostin and circulating markers of bone resorption and formation (P1NP) were measured by enzyme linked immunosorbent assay in 40 subjects (1:1) at baseline and after 21 days treatment.

Results

Both Ma-Pi2 and the control diet groups had significant decreases in body weight (6.0 ± 0.2 vs. 3.2 ± 0.1 %, p < 0.001). Sclerostin increased significantly in the two groups (all p < 0.001) but Ma-Pi2 diet group experienced a greater increase in sclerostin (34.5 vs. 15 %; p = 0.024). Serum circulating markers of bone resorption increased in the two groups (all p < 0.001); circulating markers of bone resorption at the end of the treatment tended to be higher in Ma-Pi2 diet than the control diet group (p = 0.06). P1NP did not change significantly in the two group compared to baseline. Sclerostin changes were related to body mass index reduction (r = −0.37; p = 0.02).

Conclusions

Diet-induced weight loss may induce significant and rapid changes in bone turnover and sclerostin levels. These changes may further impair bone health in subjects with type 2 diabetes.

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Acknowledgment

The research was sponsored by Un Punto Macrobiotico Association

Authors’ contributions

RS was responsible for the analysis and interpretation of data, writing the manuscript and revising it critically for important intellectual content. AS collected data and contributed to write the manuscript. YMK revised the manuscript critically for important intellectual content. ADM contributed to the writing of the manuscript and revised it critically for important intellectual content. RDT and SF collected data. MGB and LD contributed to the acquisition of data and analysis. MP made substantial contribution to interpretation of data and revising the manuscript critically for important intellectual content. PP collected data, made substantial contribution to interpretation of data and revising the manuscript critically for important intellectual content and, being the guarantor of this work, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. NN designed this post-hoc analysis, made substantial contribution to interpretation of data, contributed to the writing of the manuscript and revised it critically for important intellectual content. All authors read and approved the final manuscript.

Funding

This study was supported by Un Punto Macrobiotico Association, a charity/not-for-profit organization that provided the food required for the trial and supported the cost of CGM analyses. The research sponsors played no role in the design or conduct of the study, collection, management, analysis or interpretation of the data.

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Authors and Affiliations

  1. Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy

    Rocky Strollo, Andreea Soare, Yeganeh Manon Khazrai, Antonio Di Mauro, Andrea Palermo, Rossella Del Toro, Sara Fallucca, Maria Giovanna Belluomo, Laura Dugo, Paolo Pozzilli & Nicola Napoli

  2. International Study Center for Environment, Agriculture, Food, Health and Economics, Tolentino, Italy

    Mario Pianesi

  3. Centre for Immunobiology, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK

    Paolo Pozzilli

  4. Department of Medicine, Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA

    Nicola Napoli

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  1. Rocky Strollo
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Correspondence to Nicola Napoli.

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Strollo, R., Soare, A., Manon Khazrai, Y. et al. Increased sclerostin and bone turnover after diet-induced weight loss in type 2 diabetes: a post hoc analysis of the MADIAB trial. Endocrine 56, 667–674 (2017). https://doi.org/10.1007/s12020-016-1171-7

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