Effects of 5 % weight loss through diet or diet plus exercise on cardiovascular parameters of obese: a randomized clinical trial
Tóm tắt
To evaluate the effects of 5 % weight loss, through diet only or diet plus exercise, on lipid profile, inflammation and endothelial function in obese individuals. In this randomized clinical trial, 48 obese individuals were randomized to either a diet only group (DI) or a diet and exercise group (DI + EXE). Treatment was maintained until 5 % of the initial body weight was lost. At baseline and upon completion, the following parameters were analyzed: total cholesterol and fractions, triglycerides, fibrinogen, von Willebrand factor, high-sensitive C-reactive protein (hs-CRP) and endothelial function (brachial artery flow-mediated vasodilation—FMD). Thirteen individuals dropped out before completing the weight loss intervention. The median time required for reduction of 5 % of initial body weight was 79.7 days for the DI group and 65.9 days for the DI + EXE group (P = 0.16). In both DI (n = 18) and DI + EXE (n = 17), total cholesterol (−15.8 ± 4.8 and −10.5 ± 4.9 mg/dL, respectively), triglycerides (−33.8 ± 10.0 and −39.4 ± 10.3 mg/dL, respectively) and hs-CRP (−1.35 ± 0.41 and −0.45 ± 0.43 mg/L, respectively) decreased significantly, and in a similar response (repeated measures ANOVA). Weight loss did not change significantly the fibrinogen and FMD in both groups. A 5 % weight loss improves lipid profile and reduces inflammation in obese individuals. Endothelial function did not change significantly. Weight loss has a significant impact on these cardiovascular risk factors, and this is independent of physical training.
Tài liệu tham khảo
National Task Force on the Prevention, Treatment of Obesity (2000) Overweight, obesity and health risk. Arch Intern Med 160:898–904
Funahashi T, Nakamura T, Shimomura I, Maeda K, Kuriyama H, Takahashi M, Arita Y, Kihara S, Matsuzawa Y (1999) Role of adipocytokines on the pathogenesis of atherosclerosis in visceral obesity. Intern Med 38:202–206
Keogh JB, Brinkworth GD, Clifton PM (2007) Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin. Br J Nutr 98:852–859
de Jongh S, Lilien MR, Bakker HD, Hutten BA, Kastelein JJ, Stroes ES (2002) Family history of cardiovascular events and endothelial dysfunction in children with familial hypercholesterolemia. Atherosclerosis 163:193–197
Sposito AC, Caramelli B, Fonseca FA, Bertolami MC, Afiune Neto A, Souza AD, Lottenberg AM et al (2007) IV Diretriz Brasileira sobre Dislipidemias e Prevenção da Aterosclerose: Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 88:2–19
Rossi R, Nuzzo A, Origliani G, Modena MG (2008) Prognostic role of flow-mediated dilation and cardiac risk factors in post-menopausal women. J Am Coll Cardiol 51:997–1002
Mombouli JV, Vanhoutte PM (1999) Endothelial dysfunction: from physiology to therapy. J Mol Cell Cardiol 31:61–74
Jialal I, Devaraj S, Venugopal SK (2004) C-reactive protein: risk marker or mediator in atherosclerosis? Hypertension 44:6–11
Koenig W (2005) Predicting risk and treatment benefit in atherosclerosis: the role of C-reactive protein. Int J Cardiol 98:199–206
Danesh J, Collins R, Appleby P, Peto R (1998) Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 279:1477–1482
Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET (2002) Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation 105:564–569
Ziccardi P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M, D’Andrea F, Molinari AM, Giugliano D (2002) Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 105:804–809
LaMonte MJ, Durstine JL, Yanowitz FG, Lim T, DuBose KD, Davis P, Ainsworth BE (2002) Cardiorespiratory fitness and C-reactive protein among a tri-ethnic sample of women. Circulation 106:403–406
Church TS, Barlow CE, Earnest CP, Kampert JB, Priest EL, Blair SN (2002) Associations between cardiorespiratory fitness and C-reactive protein in men. Arterioscler Thromb Vasc Biol 22:1869–1876
Hammett CJ, Prapavessis H, Baldi JC, Varo N, Schoenbeck U, Ameratunga R, French JK, White HD, Stewart RA (2006) Effects of exercise training on 5 inflammatory markers associated with cardiovascular risk. Am Heart J 151:367.e7–367.e16
Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica (2009) Diretrizes brasileiras de obesidade, 3rd edn. AC Farmacêutica, Itapevi
Karvonen JJ, Kentala E, Mustala O (1957) The effects of training on heart rate: a “longitudinal” study. Ann Med Exp Biol Fenn 35:307–315
McGuire DK, Levine BD, Williamson JW, Snell PG, Blomqvist CG, Saltin B, Mitchell JH (2001) A 30-year follow-up of the Dallas Bed Rest and Training Study: I. Effect of age on the cardiovascular response to exercise. Circulation 104:1350–1357
Organização Mundial da Saúde/Organização Pan-Americana da Saúde (2003) Doenças crônico-degenerativas e Obesidade: estratégia mundial sobre alimentação saudável, atividade física e saúde. Brasília. Available in: http://www.opas.org.br/sistema/arquivos/d_cronic.pdf. Access 2 Maio 2009
Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R, International Brachial Artery Reactivity Task Force (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 39:257–265
Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502
Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, Bowman JD, Pronk NP (2007) Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 107:1755–1767
National Institute of Health. National Heart, Lung and Blood Institute. North American Association for the Study of Obesity. The practical guide identification, evaluation, and treatment of overweight and obesity in adults. Available in http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf. Access 1 Set 2009
Leung FP, Yung LM, Laher I, Yao X, Chen ZY, Huang Y (2008) Exercise, vascular wall and cardiovascular diseases: an update (part 1). Sports Med 38:1009–1024
Barbato KBG, Martins RCV, Rodrigues MLG, Braga JU, Francischetti EA, Genelhu V (2006) Effects of greater-than 5% weight reduction on hemodynamic, metabolic and neuroendocrine profiles of grade I obese subjects. Arq Bras Cardiol 87:12–21
Bobbert T, Rochlitz H, Wegewitz U, Akpulat S, Mai K, Weickert MO, Möhlig M, Pfeiffer AF, Spranger J (2005) Changes of adiponectin oligomer composition by moderate weight reduction. Diabetes 54:2712–2719
Aronson D, Sella R, Sheikh-Ahmad M, Kerner A, Avizohar O, Rispler S, Bartha P, Markiewicz W, Levy Y, Brook GJ (2004) The association between cardiorespiratory fitness and C-reactive protein in subjects with the metabolic syndrome. J Am Coll Cardiol 44:2003–2007
National Cholesterol Education Program (NCEP) (2002) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) final report. Circulation 106:3143–3421
Yasmin, McEniery CM, Wallace S, Mackenzie IS, Cockcroft JR, Wilkinson IB (2004) C-reactive protein is associated with arterial stiffness in apparently healthy individuals. Arterioscler Thromb Vasc Biol 24:969–974
Pirro M, Schillaci G, Savarese G, Gemelli F, Vaudo G, Siepi D, Bagaglia F, Mannarino E (2004) Low-grade systemic inflammation impairs arterial stiffness in newly diagnosed hypercholesterolaemia. Eur J Clin Invest 34:335–341
Montero I, Orbe J, Varo N, Beloqui O, Monreal JI, Rodríguez JA, Díez J, Libby P, Páramo JA (2006) C-reactive protein induces matrix metalloproteinase-1 and -10 in human endothelial cells: implications for clinical and subclinical atherosclerosis. J Am Coll Cardiol 47:1369–1378
Mavri A, Poredoš P, Suran D, Gaborit B, Juhan-Vague I, Poredoš P (2011) Effect of diet-induced weight loss on endothelial dysfunction: early improvement after the first week of dieting. Heart Vessels 26:31–38
Hamdy O, Ledbury S, Mullooly C, Jarema C, Porter S, Ovalle K, Moussa A, Caselli A, Caballero AE, Economides PA, Veves A, Horton ES (2003) Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 26:2119–2125
Raitakari M, Ilvonen T, Ahotupa M, Lehtimäki T, Harmoinen A, Suominen P, Elo J, Hartiala J, Raitakari OT (2004) Weight reduction with very-low-caloric diet and endothelial function in overweight adults: role of plasma glucose. Arterioscler Thromb Vasc Biol 24:124–128
Williams IL, Wheatcroft SB, Shah AM, Kearney MT (2002) Obesity, atherosclerosis and the vascular endothelium: mechanisms of reduced nitric oxide bioavailability in obese humans. Int J Obes Relat Metab Disord 26:754–764
Kim K, Valentine RJ, Shin Y, Gong K (2008) Associations of visceral adiposity and exercise participation with C-reactive protein, insulin resistance, and endothelial dysfunction in Korean healthy adults. Metabolism 57:1181–1189
Kuvin JT, Patel AR, Sliney KA, Pandian NG, Karas RH (2005) Comparison of flow-mediated dilatation of the brachial artery in coronary patients with low-density lipoprotein cholesterol levels 80 mg/dl versus patients with levels <80 to 100 mg/dl. Am J Cardiol 95:93–95
Wicherley TP, Brinkworth GD, Keogh JB, Noakes M, Buckley JD, Clifton PM (2010) Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. J Intern Med 267:452–461
Cangemi R, Angelico F, Loffredo L, Del Ben M, Pignatelli P, Martini A, Violi F (2007) Oxidative stress-mediated arterial dysfunction in patients with metabolic syndrome: effect of ascorbic acid. Free Radic Biol Med 43:853–859
Dandona P, Mohanty P, Ghanim H, Aljada A, Browne R, Hamouda W, Prabhala A, Afzal A, Garg R (2001) The suppressive effect of dietary restriction and weight loss in the obese on the generation of reactive oxygen species by leukocytes, lipid peroxidation, and protein carbonylation. J Clin Endocrinol Metab 86:355–362