Effects of short-term low- and high-carbohydrate diets on postprandial metabolism in non-diabetic and diabetic subjects

Background and aimLow-fat high-carbohydrate diets raise plasma triacylglycerol (TG) concentrations. To test whether the nature of the carbohydrate affects metabolic responses, we conducted a randomized cross-over study using a short-term, intensive dietary modification.Methods and resultsEight non-diabetic subjects and four subjects with diet-controlled type 2 diabetes participated. They followed three isoenergetic diets, each for 3 days: high-fat (50% energy from fat), high-starch and high-sugar (each 70% energy from carbohydrate). Normal foods were provided. We measured plasma TG and glucose concentrations, fasting and after a standard test meal, on day 4 following each dietary period. Fasting TG concentrations were greatest following the high-sugar diet (mean ± SEM for all subjects 1900 ± 420 μmol/l) and lowest following high-fat (1010 ± 130 μmol/l) (P = 0.001); high-starch (mean 1500 ± 310) and high-fat did not differ significantly (P = 0.06). There was a greater effect in the diabetic subjects (diet × diabetes status interaction, P = 0.008). Postprandial TG concentrations were similarly affected by prior diet (P < 0.001) with each diet different from the others (P ≤ 0.01). The elevation of fasting TG on the high-sugar versus high-fat diet was strongly related to the average fasting TG concentration (P = 0.01 across both diabetic and non-diabetic subjects). Fasting glucose concentrations were not affected by prior diet but postprandial glucose concentrations were (P = 0.018), with significantly higher values after the high-fat than the high-sugar diet (P = 0.03).ConclusionsThe short-term TG-raising effect of a very low-fat diet is dependent upon the nature of the carbohydrate, with a greater effect of a sugar-rich than a complex-carbohydrate-rich diet.     

The FTO gene modifies weight, fat mass and insulin sensitivity in women with polycystic ovary syndrome, where its role may be larger than in other phenotypes

AimGenome-wide association studies have shown that variation in the FTO gene predisposes to obesity and related traits that are common features of polycystic ovary syndrome (PCOS). The aim of the present study was to assess the effect of FTO variation on obesity, insulin sensitivity, and metabolic and hormonal profiles in PCOS.MethodsWe examined 136 PCOS women (mean body mass index [BMI]: 28.28 ± 6.95 kg/m², mean age: 25.36 ± 5.48 years). Anthropometric measurement, euglycaemic–hyperinsulinaemic clamp and oral glucose tolerance tests and sex hormone assessments were performed. The study group was genotyped for the FTO rs9939609 polymorphism.ResultsBMI (29.0 ± 6.9 kg/m² vs 26.1 ± 6.8 kg/m²; P = 0.023), body weight (80.1 ± 20.7 kg vs 72.6 ± 20.2 kg; P = 0.048), fat mass (29.7 ± 1 6.6 kg vs 24.6 ± 17.7 kg; P = 0.045) and waist circumference (89.8 ± 16.7 cm vs 83.2 ± 17.1 cm; P = 0.028) were higher in carriers of at least one copy of the A allele. Differences in these parameters were more significant when comparing AA and TT homozygotes. Women with the AA genotype also had decreased insulin sensitivity (P = 0.025) and follicle-stimulating hormone (P = 0.036). In logistic-regression analyses, the association of the FTO gene polymorphism with insulin sensitivity was no longer significant when BMI was included in the model.ConclusionVariation in the FTO gene modifies weight, adiposity and other measures of obesity and insulin sensitivity in PCOS. The examined FTO gene variant appears to have a greater impact on obesity and related traits in PCOS than in other phenotypes. The effect on insulin sensitivity appears to be secondary to its influence on obesity and body fat.     

Nocturnal oxygen therapy prevents progress of congestive heart failure with central sleep apnea

BackgroundSleep disordered breathing has been reported to be associated with congestive heart failure (CHF). Nocturnal oxygen has been shown to abolish apnea. The aim of this study is to examine whether nocturnal oxygen reduces sympathetic nerve activity, and prevents progress of CHF.Methods93 patients with left ventricular ejection fractions< 60%, were examined with overnight saturation monitoring for an oxygen desaturation index. Subjects with oxygen desaturation of 4% ≥ 4/h were examined with polysomnography. Apnea–hypopnea index (AHI) was calculated as the total number of episodes of apnea and hypopnea per hour of sleep. We started nocturnal oxygen for the patients with AHI ≥ 20. Urinary and plasma catecholamines concentrations, serum brain natriuretic peptide, human atrial natriuretic peptide, and endothelial nitric oxide synthase levels were measured before and after starting oxygen.ResultsCompared among the three groups, CHF with central sleep apnea (CHF-CSA) group had significantly higher 24-h urinary adrenaline (CHF-CSA: 4.411 ± 2.940 μmol/day, CHF with obstructive sleep apnea (CHF-OSA): 2.686 ± 1.084 μmol/day, CHF without apnea (CHF-N): 3.178 ± 1.778 μmol/day, P < 0.05). Oxygen therapy significantly decreased AHI and 4 serum BNP levels (from 91.75 ± 80.35 pg/ml to 52.75 ± 45.70 pg/ml, mean change = 33.85 pg/ml, P = 0.0208). Serum eNOS levels were lower in CHF-CSA group and CHF-OSA group than in CHF-N group (CHF-CSA: 15.89 ± 10.75 pg/ml, CHF-OSA: 7.46 ± 3.91 pg/ml, CHF-N: 27.33 ± 14.83 pg/ml, P < 0.05).ConclusionsNocturnal oxygen may prevent progress of CHF with central sleep apnea.     

Influence of obesity indices, metabolic parameters and age on cardiac autonomic function in abdominally obese men

Heart rate variability (HRV) is affected by age, hyperglycemia and accumulation of body fat. This study compares the predictive value of four measurements of adiposity/obesity on HRV and investigates the specific role of age, metabolic contributors and degree/distribution of fat in HRV alterations. The sample consisted of 97 non-diabetic and non-medicated men with features of the metabolic syndrome (50 ± 8 years of age, body mass index [BMI] 31 ± 3 kg/m², waist circumference [WC] 107 ± 9 cm, triglycerides 2.3 ± 0.7 mmol/L, fasting glucose 6.0 ± 0.5 mmol/L, insulin 156 ± 71 pmol/L; mean ± SD). WC, BMI, percent body fat (% fat, from dual energy X-ray absorptiometry) and visceral adipose tissue volume (VAT, from computed tomography) were used as measures of adiposity/obesity. HRV measures were obtained from 24-h, day- and night-time segments of Holter recordings. BMI presented no independent association with HRV. Percentage fat was the strongest obesity index to be associated with HRV: 24-h pNN50, rMSSD, HF and daytime pNN50, rMSSD, HF and LF (?0.27 ≤ std β ≤ ?0.20, P < .05). VAT was associated with 24-h SDNN, LF (std β = ?0.25 and ?0.20, P < .05, respectively) and daytime SDNN (std β = ?0.24, P < .05) while WC was associated with nighttime SDNN and SDANN (std β = 0.22 and 0.32, P < .05). In addition, age, fasting glucose, 2-h oral glucose tolerance test and triglycerides presented independent association with HRV. Adiposity/obesity measurements seem to be differently associated with HRV. An approach considering the combination of age, obesity and glucose metabolism factors could be helpful in the global cardiovascular risk management in abdominally obese men.     

Circulating angiogenic cell populations, vascular function, and arterial stiffness

ObjectiveSeveral bone marrow-derived cell populations have been identified that may possess angiogenic activity and contribute to vascular homeostasis in experimental studies. We examined the extent to which lower quantities of these circulating angiogenic cell phenotypes may be related to impaired vascular function and greater arterial stiffness.MethodsWe studied 1948 Framingham Heart Study participants (mean age, 66 ± 9 years; 54% women) who were phenotyped for circulating angiogenic cells: CD34+, CD34+/KDR+, and early outgrowth colony forming units (CFU). Participants underwent non-invasive assessments of vascular function including peripheral arterial tone (PAT), arterial tonometry, and brachial reactivity testing.ResultsIn unadjusted analyses, higher CD34+ and CD34+/KDR+ concentrations were modestly associated with lower PAT ratio (β = ?0.052 ± 0.011, P < 0.001 and β = ?0.030 ± 0.011, P = 0.008, respectively) and with higher carotid-brachial pulse wave velocity (β = 0.144 ± 0.043, P = 0.001 and β = 0.112 ± 0.043, P = 0.009), but not with flow-mediated dilation; higher CD34+ was also associated with lower carotid-femoral pulse wave velocity (β = ?0.229 ± 0.094, P = 0.015). However, only the association of lower CD34+ concentration with higher PAT ratio persisted in multivariable analyses that adjusted for standard cardiovascular risk factors. In all analyses, CFU was not associated with measures of vascular function or arterial stiffness.ConclusionsIn our large, community-based sample of men and women, circulating angiogenic cell phenotypes largely were not associated with measures of vascular function or arterial stiffness in analyses adjusting for traditional risk factors.     

A protein-enriched low glycemic index diet with omega-3 polyunsaturated fatty acid supplementation exerts beneficial effects on metabolic control in type 2 diabetes

AimsThe current study aims to investigate practicability and effects of a combined dietary intervention with increased relative protein content supplemented with omega-3 polyunsaturated fatty acids (PUFA) on metabolic control and inflammatory parameters in a real life situation in type 2 diabetes patients.MethodsIn this observational study we advised thirty mostly obese patients with type 2 diabetes to follow a protein-enriched diet with carbohydrates of low glycemic index (low GI) and moderate fat reduction supplemented with omega-3 PUFA for 24 weeks. Primary efficacy parameter was the change in HbA1c; secondary parameters included changes in systemic inflammation (measured by ultrasensitive C-reactive protein, usCRP), body weight, waist circumference, fat mass. The study is registered at clinicaltrials.gov (NCT01474603).ResultsThe dietary intervention significantly reduced the primary efficacy variable HbA1c from a baseline value of 63 ± 11 mmol/mol to 59 ± 14 mmol/mol (P = 0.033) and 56 ± 12 mmol/mol (P = 0.001) after 12 and 24 weeks, respectively. In addition, usCRP decreased significantly at 24 weeks (P = 0.039). Waist circumference, an important indicator for cardiometabolic-risk and silent inflammation, decreased from baseline 116.0 ± 14.1 cm to 114.9 ± 13.5 cm (P = 0.019), 114.0 ± 14.4 cm (P = 0.001), and 112.7 ± 13.4 cm (P = 0.049), after 3, 12 and 24 weeks, respectively.ConclusionCounseling a protein enriched and low glycemic index diet supplemented with long-chain omega-3 PUFA in a real-life clinical setting improves glycemic control and also reduces waist circumference and silent inflammation in overweight or obese patients with type 2 diabetes.     

Salt and the metabolic syndrome

Background and aimsHigh blood pressure in subjects with the metabolic syndrome (MS) is largely related to dietary salt. We investigated in free-living men and women whether increase in dietary salt intake is associated with the presence and severity of the MS.Methods and resultsA total of 766 subjects (251M, 515F) of 44.9 ± 0.5 years/age and SBP/DBP of 120 ± 0.6/77 ± 0.4 mmHg were studied. Twenty-four hour urinary sodium (UNa⁺) and potassium (UK⁺) excretions were 143±2.5 mmol (median: 131.5) and 48 ± 0.9 mmol (median: 44). UNa⁺ was higher in men than in women (median: 155.5 vs. 119.8 mmol/day; P < 0.0001). UK⁺ (r = 0.34; P < 0.0001), measures of obesity (r = 0.26; P < 0.0001) and BP (r = 0.15; P < 0.0001) were significantly associated with UNa⁺. The association with BP was lost after adjusting for weight.Of the 766 subjects, 256 (33.4%) met the NCEP-ATPIII criteria for the MS. Median UNa⁺ in men and women with no traits of the MS was 140 and 116.7 mmol/day, respectively (P < 0.001), increasing to 176 in men and 135 mmol/day in women with 4–5 components of the syndrome (P < 0.001). Weight, BMI and waist increased significantly across the quartiles of UNa⁺ both in men and women; whereas, age, lipids and fasting glucose did not. SBP and DBP were associated with UNa⁺ in men but not in women. UK⁺ correlated with age in men and women (r = 023; P < 0.0001) and with obesity in women (r = 0.14; P = 0.001).ConclusionsUNa⁺ a measure of dietary sodium intake in free-living subjects was markedly increased in subjects with the MS. Higher UNa⁺ was associated with obesity and higher BP, but not with age, dyslipidemia or fasting glucose.     

Plasminogen activator inhibitor 1 and visceral obesity during pronounced weight loss after bariatric surgery

Background and aimsElevated plasminogen activator inhibitor 1 (PAI-1) concentrations are a hallmark of obesity and are considered to contribute to the development of cardiovascular disease. As adipose tissue constitutes a major source for PAI-1 in obesity, we investigated the individual contribution of subcutaneous and intra-abdominal fat on PAI-1 concentrations during pronounced weight loss after bariatric surgery.Methods and resultsThirty-seven obese adults were examined before and 18 months after surgery. Abdominal fat distribution was determined by ultrasound, metabolic parameters and plasma PAI-1 levels by standard methods. BMI was reduced by 9.2 ± 4.9 kg/m², while total fat mass and visceral fat diameter (VFD) decreased by 20.7 ± 11.9 kg and 4.2 ± 2.3 cm, respectively. Concomitantly, PAI-1 levels diminished by 3.2 ± 5.6 ng/ml (all p ≤ 0.015). Change in PAI-1 levels was correlated with change in VFD (r = 0.441, p = 0.008), but not with subcutaneous fat diameter. In stepwise multiple regression analysis change in VFD was an independent predictor of change in PAI-1 concentrations. When adjusted for age and sex or total fat mass associations between PAI-1 and VFD remained significant.ConclusionWe demonstrate that VFD is a major determinant for PAI-1 concentrations during pronounced weight loss after bariatric surgery. Thus, significant reduction of visceral fat mass may contribute to the reduced cardiovascular morbidity and mortality after bariatric surgery by a concomitant decrease in PAI-1 concentrations.     

Gender differences in short-term effects of atorvastatin on lipid profile, fibrinolytic parameters, and endothelial function

Background and aimLittle is known about the impact of gender on short-term effects of atorvastatin. We investigated the gender differences in the short-term lipid-lowering and pleiotropic effects of atorvastatin therapy.Methods and resultsSeventy-two consecutive patients including 48 women with primary hypercholesterolemia, were assigned prospectively to treatment with atorvastatin (10 mg/day) for 3 months. We measured fasting lipid concentrations, thiobarbituric acid reactive substances (TBARS) as marker of lipid peroxide, fibrinolytic parameters, and endothelial function by flow-mediated vasodilation of the brachial artery (FMD), at baseline and after 3 months of therapy. We assessed the impact of gender on temporal differences in these parameters.In men, atorvastatin decreased total, low-density lipoprotein (LDL), and small, dense LDL-cholesterol concentrations, and increased FMD after 3 months. In women, atorvastatin decreased TBARS, triglyceride, and total, LDL, small, dense LDL, and remnant-like lipoprotein particle-cholesterol concentrations, and increased FMD after 3 months. Fibrinolytic parameters did not change significantly in either men or women. With respect to the percent change in those parameters after 3 months, TBARS (−17.6 ± 12.4 vs. −0.4 ± 18.8%, p < 0.01) and small, dense LDL-cholesterol (−96.7 ± 8.3 vs. −68.6 ± 29.7%, p < 0.01) decreased to a greater degree in women, although the relative changes in other parameters were similar between men and women.ConclusionsWe found gender differences in some of the lipid altering changes, including TBARS and small, dense LDL-cholesterol concentrations, after short-term atorvastatin therapy, which were greater in women. However, short-term atorvastatin therapy may be beneficial in improving endothelial function equally in both men and women.     

Recently postmenopausal women have the same prevalence of subclinical carotid atherosclerosis as age and traditional risk factor matched men

ObjectiveTo compare the prevalence of subclinical atherosclerosis between postmenopausal women and men of similar age early after the onset of menopause.MethodsIn the first part of this cross-sectional study 186 non-diabetic young postmenopausal women (n = 101, menopausal age ≤10 years) and men (n = 85) aged 40–60 years without overt CVD were consecutively recruited from the outpatients clinics of an academic hospital. Subclinical carotid atherosclerosis was assessed by high-resolution ultrasonography. The presence of carotid atherosclerosis was defined as either increased carotid intima-media thickness (IMT > 0.9 mm) and/or the presence of plaques. In the second part, 1:1 matching for age and traditional risk factors (hyperlipidemia, smoking, hypertension and BMI) was performed between men and women of this cohort resulting in a matched sub-sample of 76 subjects.ResultsBy multivariate analysis, gender was not an independent determinant of any measure of carotid atherosclerosis. In the matched sub-sample, carotid IMT and the number of segments with atherosclerosis did not significantly differ between women and men (0.734 ± 0.119 mm and 1.47 ± 1.6 versus 0.717 ± 0.138 mm and 1.47 ± 1.5, p = 0.575 and p = 0.999, respectively). Also, the prevalence of increased IMT (60.5% in both genders), carotid plaques and subclinical atherosclerosis (31.6% and 63.2% versus 28.9% and 65.8%, p = 0.803 and p = 0.811, respectively) was similar between men and women.ConclusionsThe prevalence and severity of carotid atherosclerosis was similar between men and young postmenopausal women matched for traditional risk factors. Whether these women may be better risk stratified irrespective of gender should be further assessed in prospective studies.     

Circulating homocysteine levels in patients with type 2 diabetes mellitus

Background and aimPrevious studies have shown conflicting results regarding circulating homocysteine levels in patients with type 2 diabetes.Methods and resultsThis observational study included 2121 patients with angiographically proven coronary artery disease (507 patients with type 2 diabetes and 1614 patients without diabetes). Circulating homocysteine levels, methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, renal function, presence of coronary artery disease (CAD) diagnosed by coronary angiography, and circulating folate and vitamin B₁₂ status were assessed. Plasma homocysteine levels [median (25th; 75th percentile)] were significantly higher in patients with diabetes than in those without [12.4 μmol/L (9.9 μmol/L; 15.9 μmol/L) versus 11.7 μmol/L (9.6 μmol/L; 14.5 μmol/L), P = 0.011]. Diabetes affected homocysteine levels only in patients with a glomerular filtration rate <90 mL/min [13.0 μmol/L (10.5 μmol/L; 16.7 μmol/L) in patients with diabetes versus 12.2 μmol/L (10.1 μmol/L; 15.2 μmol/L) in patients without diabetes, P = 0.006] but not in those with a glomerular filtration rate ≥90 mL/min [10.1 μmol/L (8.1 μmol/L; 12.4 μmol/L) versus 10.2 μmol/L (8.8 μmol/L; 12.3 μmol/L), P = 0.267]. Multivariable analysis did not show an independent association between diabetes and homocysteine level (P = 0.342).ConclusionCirculating homocysteine levels are increased in patients with type 2 diabetes compared with non-diabetic patients due to a more diabetes-associated adverse risk profile rather than to diabetes itself.     

Waist circumference cut-off values to predict the incidence of hypertension: an estimation from a Brazilian population-based cohort

Background and aimsCentral obesity is a key component in the definition of the metabolic syndrome, but the cut-off values proposed to define abnormal values vary among different guidelines and are mostly based on cross-sectional studies. In this study, we identify the best cut-off values for waist circumference (WC) associated with the incidence of hypertension.Methods and resultsParticipants for this prospectively planned cohort study were 589 individuals who were free of hypertension and selected at random from the community of Porto Alegre, Brazil. Hypertension was defined by a blood pressure measurement ≥ 140/90 mmHg or the use of blood pressure lowering drugs. A logistic regression model established the association between WC and the incidence of hypertension. A receiver operating characteristics (ROC) curve analysis was used to select the best WC cut-off point to predict the incidence of hypertension. During a mean follow-up of 5.5 ± 0.9 years, 127 subjects developed hypertension. The hazard ratios for the development of hypertension, adjusted for age, baseline systolic blood pressure, alcohol consumption, gender and scholarship were 1.02 (95% CI; 1.00–1.04; P = 0.02) for WC. The best cut-off WC values to predict hypertension were 87 cm in men and 80 cm in women, with an area under the curve of 0.56 (95% CI; 0.47–0.64; P = 0.17) and 0.70 (95% CI; 0.63–0.77; P < 0.001), respectively.ConclusionExcess visceral adiposity is a major risk factor for hypertension in individuals living in communities in Brazil, and this risk begins at lower values of WC that those recommended by some guidelines.     

Association between leptin and its soluble receptor with cardiometabolic risk factors in a Brazilian population

BackgroundMost studies evaluating the conjoint effects of leptin and human soluble leptin receptor (hs-LR) on cardiometabolic risk factors have been conducted in well-characterized ethnic groups. We aimed to assess the associations of leptin and hs-LR with the cardiometabolic risk factors that reflect the components of metabolic syndrome (MetS) in a Brazilian population with varying degrees of adiposity.MethodsThis is a cross-sectional analysis of adult subjects (n = 173, age 45 ± 12 years, 124 women; body mass index [BMI] 35.6 ± 9.5 kg/m²) for association of leptin and its soluble receptor with cardiometabolic risk factors (glucose, BMI, waist circumference, hip circumference, blood pressure, insulin, cholesterol and triglycerides). Plasma hs-LR was measured by ELISA; insulin and leptin were determined by RIA. Metabolic syndrome was defined by NCEP/ATP III.ResultsLeptin was positively associated with blood pressure, BMI, waist circumference, hip circumference, triglycerides, glucose, insulin and HOMA and inversely correlated with HDL-cholesterol. The hs-LR exhibited inverse relationship with cardiometabolic risk factors (P ≤ 0.006), except for glucose and lipid parameters. Leptin increased, whereas hs-LR decreased, with increasing number of MetS components (P for trend < 0.001). In multivariable models, sex, BMI and insulin were independently associated with leptin, whereas age, sex, BMI and systolic blood pressure were the independent correlates of hs-LR.ConclusionIn a Brazilian population with complex interethnic admixture, levels of hs-LR and leptin were independently associated with systolic blood pressure and insulin, respectively. Leptin increased with increasing number of MetS components. In turn, hs-LR decreased as the number of MetS components increased.     

Early impairment of beta-cell function and insulin sensitivity characterizes normotolerant Caucasian women with previous gestational diabetes

Background and aimsWomen with previous gestational diabetes (pGDM) are at high risk of developing type 2 diabetes mellitus. The aim of this study was to evaluate insulin action and insulin secretion in women with pGDM.Methods and resultsOne hundred and fifty-three pGDM women and 45 with normal glucose tolerance during pregnancy (controls) were studied 1–3 years after delivery. Insulin sensitivity (ISI) and β-cell secretory capacity (β-index) were derived from 75-g OGTT. Disposition Index was calculated as the product of β-index and ISI. One hundred and twenty-two pGDM were normotolerant (NGT) and 31 had impaired glucose regulation (IGR) i.e. impaired glucose tolerance and/or impaired fasting glucose. NGT-pGDM, as compared to controls, had significant impairment in insulin action (ISI: 5.46 ± 2.81 vs. 7.38 ± 3.68, P < 0.01) and insulin secretion (β-index: 4.68 ± 1.01 vs. 5.24 ± 0.82 pmol/min/m²; P < 0.01). A further impairment was apparent in IGR-pGDM for β-index (4.16 ± 1.09; P < 0.05). The disposition index was reduced in NGT-pGDM as compared to controls (33.9%) and further reduced in IGR-pGDM (28.6%, vs. NGT-pGDM; ANOVA P < 0.001). In women of normal weight, ISI and β-index were significantly (P < 0.01) impaired in NGT-pGDM compared to controls and further reduced in IGR-pGDM, although a more pronounced defect in insulin secretion was apparent in these women (β-index: 4.02 ± 0.9; P < 0.05).ConclusionsNormotolerant women with pGDM show both impairment in insulin secretion and action irrespective of body weight. A more pronounced defect in insulin secretion seems to characterize normal weight women while a more prominent defect in insulin action is found in overweight women.     

Epicardial fat thickness: relationship with plasma visfatin and plasminogen activator inhibitor-1 levels in visceral obesity

Background and aimEpicardial fat (EF), a true visceral adipose tissue (VAT) deposited around the heart, is considered as possible cardiovascular risk indicator, in view of its ability to produce and release several inflammatory adipo-cytokines. It is still not known whether increased cardiac adiposity is related to increased inflammatory adipo-cytokines in obesity. The aim of this study was to evaluate whether echocardiographic EF thickness, an indicator of cardiac adiposity, is related to circulating levels of inflammatory adipo-cytokines such as visfatin and plasminogen activator inhibitor-1 (PAI-1) in visceral obesity.Methods and resultsEF thickness (measured by echocardiography), visfatin, PAI-1 antigen and some inflammatory markers were studied in 42 women, 27 of them severely obese (OB) (BMI 43.5 ± 4.8 kg/m²) but with no apparent complications, and 15 normal-weight controls. Abdominal VAT in the OB was assessed by computed tomography. OB had thicker EF and higher visfatin and PAI-1 antigen concentrations than controls (P < 0.0001). EF thickness, log-visfatin and log-PAI-1 antigen concentrations directly correlated with VAT (P < 0.0001). Log-visfatin and log-PAI-1 antigen were correlated with EF thickness even after adjusting for indices of fat distribution (P < 0.01 and P < 0.001 respectively). Moreover, when dividing OB on the basis of median EF thickness, women with greater EF thickness had more VAT and higher adipo-cytokine concentrations and inflammatory markers.ConclusionsThis study suggests that EF thickness, an indicator of cardiac adiposity, may be significantly related to inflammatory adipo-cytokines in visceral-obese patients. This suggests EF might be used as an easy and reliable marker of visceral adiposity and inflammation and as a cardiovascular risk indicator.     

High protein diets decrease total and abdominal fat and improve CVD risk profile in overweight and obese men and women with elevated triacylglycerol

Background and aimsIt is unclear whether high protein weight loss diets have beneficial effects on weight loss, abdominal fat mass, lipids, glucose and insulin compared to conventional low fat diets in subjects at increased risk of cardiovascular disease (CVD) because of elevated glucose and triglyceride concentrations. Our objective was to determine the effects of high protein (HP) compared to standard protein (SP) diets on CVD risk in obese adults.Methods and resultsData from three, 12 week, randomized parallel trials with subjects assigned to either HP or SP diet (5500–6500 kJ/day) were pooled. Weight, body composition (dual energy X-ray absorptiometry), lipids, insulin and glucose were measured before and after weight loss. Data from 215 subjects (49.9 ± 9.8 years, BMI 33.5 ± 3.7 kg/m²), 108 HP, 107 SP were analyzed. Weight loss (HP diet 7.82 ± 0.37 kg; SP diet 7.65 ± 0.39 kg, NS) and total fat loss were not different (HP 6.8 ± 4.3 kg; LP 6.4 ± 4.7 kg, NS on intention to treat analysis). The reduction in triacylglycerol (TAG) was greater on HP than SP 0.48 ± 0.07 mmol/L vs 0.27 ± 0.06 mmol/L, (P < 0.001). Subjects with TAG greater than the median (>1.54 mmol/L at baseline) lost more weight (HP 8.5 ± 0.6; SP 6.9 ± 0.6 kg, P = 0.01, diet by TG group), total (HP 6.17 ± 0.50 kg; SP 4.52 ± 0.52 kg, P = 0.007) and abdominal fat (HP 1.92 ± 0.17 kg; SP 1.23 ± 0.19 kg, P = 0.005) on HP. Total cholesterol (12 vs 6%, HP vs SP) and TAG (39 vs 20%, HP vs SP) decreased to a greater extent in these subjects (both P ≤ 0.05) on HP.ConclusionShort-term high protein weight loss diets had beneficial effects on total cholesterol and triacylglycerol in overweight and obese subjects and achieved greater weight loss and better lipid results in subjects at increased risk of CVD. These observations provide further information regarding the utility of this dietary approach in effectively managing body weight and composition and reducing CVD risk in overweight and obese individuals.     

Adipocytokine profiles in a putative novel postmenopausal polycystic ovary syndrome (PCOS) phenotype parallel those in premenopausal PCOS: the Rancho Bernardo Study

The objective was to investigate whether the associations between leptin, adiponectin, andadiposity reported in classic polycystic ovary syndrome (PCOS) are also observed in elderly women with a novel putative postmenopausal PCOS phenotype. We studied 713 postmenopausal community-dwelling women. Diagnosis of the novel phenotype required the presence of ≥ 3 diagnostic features including: 1) a personal history of oligomenorrhea; 2) history of infertility or miscarriage; 3) current or past clinical or hormonal evidence of hyperandrogenism; 4) central obesity; 5) biochemical evidence of insulin resistance. Women in the control group had ≤ 2 of these components. Mean age (± SD) was 74 ± 8 years for the study cohort. Sixty-six women (9.3%) had the putative PCOS phenotype. Serum leptin was higher (mean 25.70 ± 15.67 vs 14.94 + 9.89 ng/mL, P < .01) and adiponectin lower (mean 11.72 ± 4.80 vs 17.31 ± 7.45 μg/mL, P < .01) in cases vs controls. Leptin was positively, and adiponectin inversely, associated with an increasing number of phenotype features (P < .01 for linearity). In age-adjusted regression analysis, adjustment for waist circumference eliminated the association between leptin and the PCOS phenotype, but not the association between adiponectin and the PCOS phenotype. In this novel postmenopausal PCOS phenotype, adipocytokine profiles and their associations with adiposity parallel those reported in younger women with classic PCOS. These results support our hypothesis that a putative phenotype analogous to PCOS can be identified in postmenopausal women using clinical and biochemical criteria. Use of this novel phenotype could provide a basis for studies of the delayed consequences of PCOS in older women.     

Vitamin C consumption is associated with less progression in carotid intima media thickness in elderly men: A 3-year intervention study

Background and aimPlant foods may lower the risk of cardiovascular disease.Methods and resultsWe assessed changes in the intima media thickness (IMT) of the carotid artery and diet in elderly men. Men (n = 563) aged 70 ± 5 years were randomly assigned to 1 of 4 groups (dietary intervention, omega-3 supplementation, both or neither) using a 2 × 2 factorial design. B-mode ultrasound of the carotid arteries and calculation of dietary intake were performed at baseline and after 3 years. We previously showed that omega-3 supplementation did not influence the IMT, thus the dietary intervention (n = 233) and no dietary intervention (n = 231) groups were pooled.The dietary intervention group had less progression in the carotid IMT compared with the controls (0.044 ± 0.091 mm versus 0.062 ± 0.105 mm; P = 0.047). This group increased their daily vitamin C intake (P = 0.005) and intake of fruit, berries and vegetables (P ≤ 0.001). Increased intake of vitamin C and of fruit and berries was inversely associated with IMT progression (r = −0.181; P = 0.006 and r = −0.125; P = 0.056, respectively). Multivariate linear regression analysis showed that increased intakes of vitamin C and of fruit and berries were associated with less IMT progression in the intervention group and in the total study population, after adjustment for consumption of dietary cholesterol, cheese, saturated fat and group assignment.ConclusionVitamin C containing foods may protect against the progression of carotid atherosclerosis in elderly men.     

Structured medium and long chain triglycerides show short-term increases in fat oxidation, but no changes in adiposity in men

BackgroundMedium chain triglycerides (MCT) have been suggested as modulators of human energy expenditure (EE) and thus may influence total and regional body fat distribution.ObjectiveTo investigate in overweight men the effects of structured medium and long chain triglycerides on EE, substrate oxidation and body adiposity, compared to extra virgin olive oil (OO).MethodsIn a 6 week single-blind crossover study, 23 overweight men were randomly assigned to consume a standard high-fat diet of which 75% total fat was provided as either structured medium and long chain triglycerides referred to as structured oil (StO), or OO. EE and body composition were measured using indirect calorimetry and magnetic resonance imaging, respectively, at weeks 1 and 6 of each phase.ResultsBody weight decreased (p < 0.01) from baseline to end-point during consumption of both the StO (−1.46 ± 0.4 kg) and OO (−1.17 ± 0.4 kg); however, no significant treatment differences were observed. There were no changes in body composition among treatment groups. No differences between diets for EE measurements were reported. Fat oxidation rates did not differ between oils, but were reduced (p < 0.05) in the StO group between baseline (0.0020 ± 0.0003 g/kg fat free mass per min) in comparison to after week 6 (0.0013 ± 0.0001 g/kg fat free mass per min). No differences in carbohydrate oxidation rate were noted across diets or time.ConclusionThe present structured medium and long chain triglyceride oil increases short-term fat oxidation but fails to modulate body weight or adiposity through a change in EE.