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
* Department of Endocrinology & Metabolism and Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, Zuid-Holland 2333 ZA, the Netherlands (Email: s.hammer{at}lumc.nl).
We appreciate the interest of Drs. Dhoble and Patel in our recent publication in the Journal (1). In our model of prolonged caloric restriction in obese patients with type 2 diabetes mellitus, we showed dramatic changes in body mass index associated with a decrease in myocardial triglyceride content and improvements in left ventricular diastolic function.
During the study period, none of the patients used any medications or dietary additives that may affect lipid or glucose metabolism. This includes nicotinic acid analogs, statins (patients using statins were instructed to stop 3 weeks before the first magnetic resonance study), and fish oil supplements. We therefore believe the favorable effects we observed can be attributed to the prolonged caloric restriction and associated weight loss. This is in line with other studies showing improvements in myocardial function after bariatric surgery (2).
As correctly stated, the sample size of the study was relatively small. One patient was excluded from analysis, solely for spectroscopic measurements of the heart, because of insufficient quality of the obtained spectra. For all other measurements, this patient was included in the analyses. The fact that we had to exclude this patient highlights the difficulty of obtaining measurements on myocardial triglyceride content, especially in obese patients. Future work should be undertaken to make the technique suitable for general application in clinical practice.
We agree with Drs. Dhoble and Patel that central obesity is a more powerful indicator of cardiovascular morbidity and mortality than body mass index. However, the changes illustrate the magnitude of the observed effect of prolonged caloric restriction. Measurements of central obesity were also performed (but initially not presented) and showed a decrease in waist circumference from 115 ± 2 cm to 94 ± 3 cm (p < 0.001).
These results show the potential of prolonged caloric restriction as a therapeutic option for obese patients with type 2 diabetes mellitus. Furthermore, it underlines the potential of metabolic cardiovascular imaging in detecting early unfavorable changes in myocardial metabolism and function in this common disease.
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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. Ikonomidis I, Mazarakis A, Papadopoulos C, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study J Hypertens 2007;25:439-447.[Web of Science][Medline]
Related Article
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Cardiac Steatosis and Myocardial Dysfunction
- Abhijeet Dhoble and Mehul B. Patel
J. Am. Coll. Cardiol. 2009 53: 636.
[Full Text]
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