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J Am Coll Cardiol, 2008; 52:1006-1012, doi:10.1016/j.jacc.2008.04.068
© 2008 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: MYOCARDIAL METABOLISM

Prolonged Caloric Restriction in Obese Patients With Type 2 Diabetes Mellitus Decreases Myocardial Triglyceride Content and Improves Myocardial Function

Sebastiaan Hammer, MSc*,{dagger},*, Marieke Snel, MD{ddagger}, Hildo J. Lamb, MD, PhD{dagger}, Ingrid M. Jazet, MD, PhD{ddagger}, Rutger W. van der Meer, MD{dagger}, Hanno Pijl, MD, PhD*, Edo A. Meinders, MD, PhD{ddagger}, Johannes A. Romijn, MD, PhD*, Albert de Roos, MD, PhD{dagger} and Johannes W.A. Smit, MD, PhD*

* Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
{dagger} Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
{ddagger} Department of General Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands

Manuscript received February 6, 2008; revised manuscript received April 4, 2008, accepted April 16, 2008.

* Reprint requests and correspondence: Dr. Sebastiaan Hammer, Department of Endocrinology and Metabolism (C4-R), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands (Email: S.Hammer{at}LUMC.nl).

Objectives: This study sought to assess the effects of prolonged caloric restriction in obese patients with type 2 diabetes mellitus (T2DM) on myocardial triglyceride (TG) content and myocardial function.

Background: Myocardial TG content is increased in patients with T2DM and may reflect altered myocardial function. It is unknown whether myocardial TG content is influenced during a therapeutic intervention.

Methods: Myocardial TG content (magnetic resonance [MR] spectroscopy), myocardial function (MR imaging), plasma hemoglobin A1c, and body mass index (BMI) were measured in 12 obese, insulin-treated T2DM patients before and after a 16-week very-low-calorie diet (VLCD) (450 kcal/day) to achieve substantial weight loss. Insulin was stopped during the VLCD.

Results: The BMI decreased from 35.6 ± 1.2 kg/m2 (baseline, mean ± SEM) to 27.5 ± 1.3 kg/m2 (after the VLCD, p < 0.001) and was associated with an improvement in hemoglobin A1c from 7.9 ± 0.4% (baseline) to 6.3 ± 0.3% (after the VLCD, p = 0.006). Myocardial TG content decreased from 0.88 ± 0.12% to 0.64 ± 0.14%, respectively (p = 0.019), and was associated with improved diastolic function (reflected by the ratio between the early and atrial filling phase) from 1.02 ± 0.08 to 1.18 ± 0.06, respectively (p = 0.019).

Conclusions: Prolonged caloric restriction in obese T2DM patients decreases BMI and improves glucoregulation associated with decreased myocardial TG content and improved diastolic heart function. Therefore, myocardial TG stores in obese patients with T2DM are flexible and amendable to therapeutic intervention by caloric restriction.

Key Words: cardiovascular imaging • type 2 diabetes mellitus • weight loss • triglycerides

Abbreviations and Acronyms
  1HMRS = proton magnetic resonance spectroscopy
  BMI = body mass index
  ECG = electrocardiogram
  FA = fatty acid
  LV = left ventricular
  MR = magnetic resonance
  NEFA = nonesterified fatty acids
  T2DM = type 2 diabetes mellitus
  TG = triglyceride
  VLCD = very-low-calorie diet


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