Prolonged Caloric Restriction in Obese Patients With Type 2 Diabetes Mellitus Decreases Myocardial Triglyceride Content and Improves Myocardial Function
Sebastiaan Hammer, MSc*, ,*,
Marieke Snel, MD ,
Hildo J. Lamb, MD, PhD,
Ingrid M. Jazet, MD, PhD,
Rutger W. van der Meer, MD,
Hanno Pijl, MD, PhD*,
Edo A. Meinders, MD, PhD,
Johannes A. Romijn, MD, PhD*,
Albert de Roos, MD, PhD and
Johannes W.A. Smit, MD, PhD*
* Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Department of General Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Figure 1 Fat Stores and Body Mass Index
Example of a transverse slice at the level of the 5th lumbar vertebrae showing visceral and subcutaneous fat depots, illustrating the effects of 16 weeks of caloric restriction in the same patient (A and B). Body mass index (BMI) is decreased after prolonged caloric restriction (C). *p < 0.001. VLCD = very-low-calorie diet.
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Figure 2 Metabolic Changes at Baseline and After 16 Weeks of VLCD
Changes in plasma NEFA (A), plasma TG levels (B), and myocardial (C), and hepatic (D) TG content on prolonged caloric restriction. *p < 0.001; p < 0.05. Data are mean ± SEM. NEFA = nonesterified fatty acids; TG = triglyceride; VLCD = very-low-calorie diet.
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Figure 3 Myocardial Proton Spectra
Typical unsuppressed proton spectra of the same patient at baseline and after 16 weeks of caloric restriction (A). The starred boxes indicate the part of spectrum where the myocardial lipids resonate, of which the suppressed spectra are shown in (B). ppm= parts per million; other abbreviations as in Figure 2.
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Figure 4 Changes in Myocardial Function
Intraindividual changes in left ventricular (LV) mass (A) and the ratio between the early filling phase and the atrial filling phase (E/A ratio) on progressive caloric restriction (B). *p < 0.001; p < 0.05. VLCD = very-low-calorie diet.
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