CORRESPONDENCE: LETTER TO THE EDITOR
Reply
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
* Departments of Endocrinology and Metabolism and Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, Zuid-Holland 2333 ZA, the Netherlands (Email: S.Hammer{at}LUMC.nl).
We thank Dr. Opie for his comment on our recent publication (1). Caloric restriction is a powerful tool to reverse at least some of the negative effects induced by obesity in diabetic patients.
The hypothesis that the effects of the metabolic syndrome arise from high levels of circulating fatty acids and cytokines derived from (visceral) adipose tissue (2) is indeed supported by our data, although one has to use caution in considering this a causal relationship, solely based on the present results.
On the other hand, it was recently shown, in another group of patients with type 2 diabetes, that plasma free fatty acids are, at least to some extent, involved in the effects of short-term caloric restriction on the heart (3). We showed that short-term caloric restriction induced increased levels of free fatty acids and consequently, myocardial triglycerides accumulated. This was associated with a change in diastolic function. Interestingly, when this caloric restriction was combined with administration of the antilipolytic drug acipimox, these changes were not observed. These results provide circumstantial evidence for the relevance of fatty acids in myocardial triglyceride accumulation and changes in diastolic function in this particular group of patients, perfectly in line with the hypothesis stating the relevance of fatty acids and cytokines released by adipose tissue.
We therefore generally agree with Dr. Opie that our results are exciting, and they underline the high potential of treatments aiming to decrease adipose tissue compartments to reverse the effects of metabolic disease on the heart, whether associated with fatty acids released from adipose tissue or not.
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1. Hammer S, Snel M, Lamb HJ, et al. Prolonged caloric restriction in obese patients with type 2 diabetes mellitus decreases myocardial triglyceride content and improves myocardial function J Am Coll Cardiol 2008;52:1006-1012.[Abstract/Free Full Text]2. Opie LH. Metabolic syndrome Circulation 2007;115:e32-e35.[Free Full Text] 3. Hammer S, van der Meer RW, Lamb HJ, et al. Short-term flexibility of myocardial triglycerides and diastolic function in patients with type 2 diabetes mellitus Am J Physiol Endocrinol Metab 2008;295:E714-E718.[Abstract/Free Full Text]
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Caloric Restriction Models Reverse Metabolic Syndrome
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