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.

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    • "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. "
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    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.
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