title: Increased sclerostin and bone turnover after diet-induced weight loss in type 2 diabetes: a post hoc analysis of the MADIAB trial.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Rocky
authors.initials: R
authors.lastname: Strollo
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Andreea
authors.initials: A
authors.lastname: Soare
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Yeganeh
authors.initials: Y
authors.lastname: Manon Khazrai
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Mauro
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Palermo
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Del Toro
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Fallucca
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Giovanna Belluomo
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Dugo
authors.affiliation: International Study Center for Environment, Agriculture, Food, Health and Economics, Tolentino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pianesi
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.|Centre for Immunobiology, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzilli
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy. n.napoli@unicampus.it.|Department of Medicine, Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA. n.napoli@unicampus.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Napoli
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001835:Body Weight / Q000502:physiology; D019485:Bone Morphogenetic Proteins / Q000097:blood*; D016723:Bone Remodeling / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D004038:Diet, Reducing; D005260:Female; D005819:Genetic Markers; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000178:diet therapy / Q000503:physiopathology; D050177:Overweight / Q000097:blood* / Q000178:diet therapy / Q000503:physiopathology; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D015415:Biomarkers; D019485:Bone Morphogenetic Proteins; D005819:Genetic Markers; C422903:SOST protein, human
keywords: Bone turnover; Macrobiotic Ma-Pi2 diet; Type 2 diabetes