CORRESPONDENCE: LETTER TO THE EDITOR
Cardiac Steatosis and Myocardial Dysfunction
Abhijeet Dhoble, MD, MPH* and
Mehul B. Patel, MD
* Department of Internal Medicine, Michigan State University, B 308 Clinical Center, East Lansing, Michigan 48824 (Email: abhijeet.dhoble{at}ht.msu.edu).
Hammer et al. (1) showed that prolonged caloric restriction in obese patients with type 2 diabetes mellitus decreases body mass index and improves glucose regulation associated with decreased myocardial triglyceride (TG) content and improved diastolic heart function. We have 3 questions regarding this study and its outcome measures. The authors mentioned that one of the exclusion criteria for the study was the use of medications that influence lipolysis and glucose metabolism. Nicotinic acid and fish oil can alter serum and tissue TG levels through different mechanisms without affecting lipolysis (2,3). We would like to know if any of the patients in the study were taking these supplements or any other alternative medicines. Second, we would like to know the reason why 1 patient was excluded from the analysis of an already very small sample size. Third, and most importantly, we would like to know if there was any significant reduction in waist circumference in the study population. Central obesity, not body mass index, has been shown to be a very powerful indicator of cardiovascular morbidity and mortality compared with peripheral and/or overall adiposity (4,5). Knowing any changes in waist circumference and triceps skin thickness would be helpful in interpreting the factors that can affect diastolic function. The authors did not provide any information on these issues that can potentially cause bias while interpreting the results.
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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. Miller ON, Hamilton JG, Goldsmith GA. On the mechanism of action of nicotinic acid in lowering serum lipids Am J Clin Nutr 1962;10:285-296.[Abstract] 3. Qi K, Fan C, Jiang J, et al. Omega-3 fatty acid containing diets decrease plasma triglyceride concentrations in mice by reducing endogenous triglyceride synthesis and enhancing the blood clearance of triglyceride-rich particles Clin Nutr 2008;27:424-430.[CrossRef][Web of Science][Medline] 4. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk Am J Clin Nutr 2004;79:379-384.[Abstract/Free Full Text] 5. Simpson JA, MacInnis RJ, Peeters A, Hopper JL, Giles GG, English DR. A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study Obesity (Silver Spring) 2007;15:994-1003.[CrossRef][Medline]
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