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Background:  Obesity is the main risk factor of cardiovascular diseases (CVD) and metabolic diseases. The middle-aged population is the age group with the highest prevalence of obesity. Thus, improving cardiometabolic health is important to prevent CVD and metabolic diseases in middle-aged obese adults. The aim of this study was to examine the effects of exercise alone or in combination with a high-protein diet on markers of cardiometabolic health in middle-aged adults with obesity.   Methods:  Sixty-nine middle-aged adults with obesity were assigned randomly to the control group (C;  n  = 23), exercise group (E;  n  = 23), or exercise combined with high-protein diet group (EP;  n  = 23). Individuals in the E and EP groups received supervised exercise training and individuals in the EP group received high-protein diet intervention. Body composition (assessed by dual-energy X-ray absorptiometry), oral glucose tolerance test (OGTT), lipid profiles, and inflammatory markers were determined before and after 12 weeks of intervention. Insulin sensitivity index (ISI 0,120 ) was calculated from values of fasting and 2-h insulin and glucose concentration of OGTT. Insulin-peak-time during the OGTT was recorded to reflect β-cell function. Analysis of covariance with baseline values as covariates was used to examine the effects of the intervention. The significant level was set at 0.05.   Results:  After 12 weeks of intervention, the E group had a greater percentage of individuals with early insulin-peak-time during the OGTT than that in the C and EP groups ( p  = 0.031). EP group had lower total cholesterol and triglycerides than that in the C group ( p  = 0.046 and 0.014, respectively). Within-group comparisons showed that the 2-h glucose of OGTT and C-reactive protein decreased in the EP group ( p  = 0.013 and 0.008, respectively) but not in the E and C groups; insulin sensitivity improved in the EP group ( p  = 0.016) and had a trend to improve in the E group ( p  = 0.052); and abdominal fat mass and total body fat mass decreased in both intervention groups ( p  < 0.05).   Conclusion:  Combined high-protein diet and exercise intervention significantly decreased fat mass and improved lipid profiles, insulin sensitivity, glucose tolerance, and inflammation in middle-aged adults with obesity.   Clinical Trial Registration:  Thai Clinical Trials Registry, TCTR20180913003, 13-09-2018.

Effects of Combined High-Protein Diet and Exercise Intervention on Cardiometabolic Health in Middle-Aged Obese Adults: A Randomized Controlled Trial