Effect of Weight Loss and Lifestyle Changes on Vascular Inflammatory Markers in Obese Women: A Randomized Trial

Center for Obesity Management, Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2003; 289(14):1799-804. DOI: 10.1001/jama.289.14.1799
Source: PubMed


Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue.
To determine the effect of a program of changes in lifestyle designed to obtain a sustained reduction of body weight on markers of systemic vascular inflammation and insulin resistance.
Randomized single-blind trial conducted from February 1999 to February 2002 at a university hospital in Italy.
One hundred twenty premenopausal obese women (body mass index > or =30) aged 20 to 46 years without diabetes, hypertension, or hyperlipidemia.
The 60 women randomly assigned to the intervention group received detailed advice about how to achieve a reduction of weight of 10% or more through a low-energy Mediterranean-style diet and increased physical activity. The control group (n = 60) was given general information about healthy food choices and exercise.
Lipid and glucose intake; blood pressure; homeostatic model assessment of insulin sensitivity; and circulating levels of interleukin 6 (IL-6), interleukin 18 (IL-18), C-reactive protein (CRP), and adiponectin.
After 2 years, women in the intervention group consumed more foods rich in complex carbohydrates (9% corrected difference; P<.001), monounsaturated fat (2%; P =.009), and fiber (7 g/d; P<.001); had a lower ratio of omega-6 to omega-3 fatty acids (-5; P<.001); and had lower energy (-310 kcal/d; P<.001), saturated fat (-3.5%; P =.007), and cholesterol intake (-92 mg/d; P<.001) than controls. Body mass index decreased more in the intervention group than in controls (-4.2; P<.001), as did serum concentrations of IL-6 (-1.1 pg/mL; P =.009), IL-18 (-57 pg/mL; P =.02), and CRP (-1.6 mg/L; P =.008), while adiponectin levels increased significantly (2.2 microg/mL; P =.01). In multivariate analyses, changes in free fatty acids (P =.008), IL-6 (P =.02), and adiponectin (P =.007) levels were independently associated with changes in insulin sensitivity.
In this study, a multidisciplinary program aimed to reduce body weight in obese women through lifestyle changes was associated with a reduction in markers of vascular inflammation and insulin resistance.

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    • "This inflammatory state contributes to the development of T2 DM and the other components of the metabolic syndrome. Changes in body weight in obese patients are accompanied by parallel changes in the production and secretion of inflammatory markers, such as CRP, TNF-a, IL-6, and IL-8 [18] [55] [57] [58]. In obese subjects, adipose tissue is infiltrated by macrophages in response to cytokines, FFA, and complement factor C3 [59]. "
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    ABSTRACT: Objectives: Obesity is a significant quality of life-impairing health problem affecting industrialized nations. However, despite carrying a large fat mass, some very obese individuals exhibit normal metabolic profiles (metabolically healthy obesity). The physiological factors underlying their protective and favorable metabolic profiles remain poorly defined. Methods: A search of the National Library of Medicine PubMed database was performed using the following keywords: Metabolically healthy obese, metabolically normal obese, insulin resistance, metabolically unhealthy normal weight, and uncomplicated obesity. Results: This article reviewed factors associated with severe obesity that lacks complications, and suggests putative activities by which these obese individuals avoid developing the clinical features of metabolic syndrome, or the metabolic complications associated with severe obesity. Conclusions: Despite the knowledge that visceral fat deposition is the seminal factor that ultimately causes insulin resistance (IR) and the detrimental inflammatory and hormonal profile that contributes to increase risk for cardiovascular disease, it remains unknown whether metabolically healthy obesity (MHO) has genetic predisposing factors, and whether MHO ultimately succumbs to IR and the metabolic syndrome, indicating a need for prophylatic bariatric surgery.
    Nutrition 10/2015; DOI:10.1016/j.nut.2015.07.010 · 2.93 Impact Factor
    • "Training studies have shown that exercise might not be a significant factor towards adiponectin modifications (Marcell et al. 2005; Ryan et al. 2003). It seems that modifications in body weight or body composition might be responsible for alterations in adiponectin levels (Esposito et al. 2003; Hulver et al. 2002; Monzillo et al. 2003). Recent reports indicate that in young obese men, adiponectin levels are increased following an improvement of the body composition and this is more important than the way training is performed (Hara et al. 2005). "
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    • "Recently, low-grade inflammation has been recognized as an integral part of the development and progression of atherosclerosis (Hansson, 2005). On the other hand, research suggests that the levels of local and systemic inflammation can be reduced by different lifestyles and pharmacological interventions including drugs, weight loss, smoking cessation or exercise (Esposito et al., 2003; Petersen et al., 1995). "
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