Effect of Weight Loss and Nutritional Intervention on Arterial Stiffness in Type 2 Diabetes

Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Diabetes Care (Impact Factor: 8.42). 10/2006; 29(10):2218-22. DOI: 10.2337/dc06-0665
Source: PubMed


There is increased stiffness of the large central arteries in type 2 diabetic patients, and obesity is a risk factor. However, the effect of intentional weight loss on arterial stiffness is uncertain, and the purpose of the current study was to assess this effect.
Arterial stiffness was assessed by measuring aortic pulse wave velocity (aPWV) at baseline and at completion of a 1-year weight loss intervention. Metabolic control of type 2 diabetes was also appraised.
Mean weight loss at 1 year in 38 volunteers with type 2 diabetes was 7.8%. There were improvements in HbA1c, LDL cholesterol, homeostasis model assessment of insulin resistance, and inflammatory markers (plasminogen activator inhibitor-1, tumor necrosis factor-alpha, interleukin-6, and C-reactive protein). There was also a significant improvement in aPWV at completion of weight loss intervention, from 740 to 690 cm/s (P < 0.05).
Moderate weight loss improves arterial stiffness in type 2 diabetes.

25 Reads
  • Source
    • "Brachial ankle PWV Diet+Exercise -0.626 -1.245 -0.008 0.047 Satoh 2008 Brachial ankle PWV Diet+Exercise -0.189 -0.523 0.145 0.267 Brachial ankle PWV -0.483 -0.784 -0.182 0.002 Dengo 2010 Carotid femoral PWV Diet -0.900 -1.639 -0.161 0.017 Barinas-Mitchell 2006 Carotid femoral PWV Diet+Exercise+drugs -0.455 -0.789 -0.121 0.008 Blumenthal 2010 Carotid femoral PWV Diet+Exercise -0.642 -1.048 -0.236 0.002 Chakera 2010 Carotid femoral PWV Diet+drugs -0.173 -0.540 0.193 0.354 Clifton 2005 Carotid femoral PWV Diet -0.384 -0.790 0.022 0.064 Clifton 2005 Carotid femoral PWV Diet -0.589 -1.089 -0.089 0.021 Howden 2013 Carotid femoral PWV Diet+Exercise 0.174 -0.289 0. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective—To conduct a systematic review and meta-analysis of clinical trials involving adults, to determine the effect of weight loss induced by energy restriction with or without exercise, antiobesity drugs or bariatric surgery on pulse wave velocity (PWV) measured at all arterial segments. Approach and Results—A systematic search of Pubmed (1966 to 2014), EMBASE (1947 to 2014), MEDLINE (1946 to 2014), and the Cochrane Library (1951 to 2014) was conducted and the reference lists of identified articles were searched to find intervention trials (randomized/nonrandomzsed) that aimed to achieve weight loss and included PWV as an outcome. The search was restricted to human studies. Two independent researchers extracted the data. Data were analyzed using Comprehensive Meta Analysis version 2 using random effects analysis. A total of 22 studies were included in the qualitative synthesis and 20 studies (3 randomized controlled trials), involving 1259 participants, were included in the meta-analysis. The standardized mean difference for the overall effect of weight loss on PWV measured at all sites was −0.32 (95% confidence interval, −0.41, −0.24; P=0.0001). Carotid femoral pulse wave velocity (standardized mean difference, −0.35; 95% confidence interval, −0.44, −0.26; P=0.0001; 16 studies) and brachial ankle PWV (standardized mean difference, −0.48; 95% confidence interval, −0.78, −0.18; P=0.002; 5 studies) were improved with weight loss. Meta-regression showed that change in blood pressure was a predictor of change in PWV (P<0.01). Conclusion—Modest weight loss (mean 8% of initial body weight) achieved with diet and lifestyle measures improved PWV. The results of this meta-analysis suggest that weight loss may reduce PWV, although future research is required.
    Arteriosclerosis Thrombosis and Vascular Biology 11/2014; 35(1). DOI:10.1161/ATVBAHA.114.304798 · 6.00 Impact Factor
  • Source
    • "These results suggest that low-grade systemic inflammation plays a significant role in the pathobiology of obesity, type 2 diabetes mellitus, and metabolic syndrome X [1-9]. This is supported by the observation that weight loss achieved by type 2 diabetes subjects was associated not only with a decrease in glycosylated hemoglobin (HbA1c), LDL cholesterol, insulin resistance, plasminogen activator inhibitor-1, CRP, IL-6, and TNF-α but also with significant improvements in arterial stiffness [21] suggesting that endothelial nitric oxide (eNO) production is increased whereas oxidative stress is decreased. Thus, the results of the present study and other investigations indicate the genes concerned with inflammation and immune response are differentially regulated in subjects with obesity and type 2 diabetes mellitus. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is an important component of metabolic syndrome X and predisposes to the development of type 2 diabetes mellitus. The incidence of obesity, type 2 diabetes mellitus and metabolic syndrome X is increasing, and the cause(s) for this increasing incidence is not clear. Although genetics could play an important role in the higher prevalence of these diseases, it is not clear how genetic factors interact with environmental and dietary factors to increase their incidence. We performed gene expression profile in subjects with obesity and type 2 diabetes mellitus with and without family history of these diseases. It was noted that genes involved in carbohydrate, lipid and amino acid metabolism pathways, glycan of biosynthesis, metabolism of cofactors and vitamin pathways, ubiquitin mediated proteolysis, signal transduction pathways, neuroactive ligand-receptor interaction, nervous system pathways, neurodegenerative disorders pathways are upregulated in obesity compared to healthy subjects. In contrast genes involved in cell adhesion molecules, cytokine-cytokine receptor interaction, insulin signaling and immune system pathways are downregulated in obese. Genes involved in signal transduction, regulation of actin cytoskeleton, antigen processing and presentation, complement and coagulation cascades, axon guidance and neurodegenerative disorders pathways are upregulated in subjects with type 2 diabetes with family history of diabetes compared to those who are diabetic but with no family history. Genes involved in oxidative phosphorylation, immune, nervous system, and metabolic disorders pathways are upregulated in those with diabetes with family history of diabetes compared to those with diabetes but with no family history. In contrast, genes involved in lipid and amino acid pathways, ubiquitin mediated proteolysis, signal transduction, insulin signaling and PPAR signaling pathways are downregulated in subjects with diabetes with family history of diabetes. It was noted that genes involved in inflammatory pathway are differentially expressed both in obesity and type 2 diabetes. These results suggest that genes concerned with carbohydrate, lipid and amino acid metabolic pathways, neuronal function and inflammation play a significant role in the pathobiology of obesity and type 2 diabetes.
    Lipids in Health and Disease 02/2007; 6(1):35. DOI:10.1186/1476-511X-6-35 · 2.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this thesis we aimed to expand our knowledge on the pathophysiological aspects of the metabolic syndrome in transgenic mice. The metabolic syndrome involves multiple aspects and has a major impact on cardiovascular diseases. In the first part of thesis the role of PAI-1 in the development of insulin resistance will addressed. This part will also focus on the mechanism of plasma PAI-1 clearance. In the second part of this thesis, the roles of LRP in atherosclerosis and LPL activity in lipid metabolism are addressed. In this thesis we showed the PAI-1 catabolism is facilitated by a RAP-sensitive mechanism other than LRP, LDLR and VLDLR. The increased plasma PAI-1 levels observed in insulin resistance and obesity is not explained by impaired clearance of PAI-1. The increased plasma PAI-1 levels might be an epiphenomenon of the chronic inflammatory state of insulin resistance or obesity. Furthermore, alternative pathways other than the traditional lipoprotein receptors are involved in the regulation of plasma cholesterol and triglyceride levels. The development of atherosclerosis is multi-factorial in which the balance between the antiand pro-inflammatory processes plays a central role. Macrophage LRP might be one of the features that control this balance. Inflammation not only promotes to the development of atherosclerosis, but might also be involved in the processes that restore the damaged vascular wall.
Show more