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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CARDIOVASCULAR RISK AND DIET AND SMOKING

Effect of Moderate Diet-Induced Weight Loss and Weight Regain on Cardiovascular Structure and Function

Lisa de las Fuentes, MD^_*, Alan D. Waggoner, MHS^_*, B. Selma Mohammed, MD, PhD, Richard I. Stein, PhD, Bernard V. Miller, III, MD, Gary D. Foster, PhD, Holly R. Wyatt, MD, Samuel Klein, MD and Victor G. Davila-Roman, MD^_*,_*

^_* Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Center for Obesity Research and Education, Departments of Medicine and Public Health, Temple University School of Medicine, Philadelphia, Pennsylvania
Center for Human Nutrition, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado

Manuscript received April 2, 2009; revised manuscript received July 8, 2009, accepted July 12, 2009.

^_* Reprint requests and correspondence: Dr. Victor G. Davila-Roman, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110 (Email: vdavila{at}wustl.edu).

Objectives: The objective of this prospective, single-site, 2-year dietary intervention study was to evaluate the effects of moderate weight reduction and subsequent partial weight regain on cardiovascular structure and function.

Background: Obesity is associated with adverse cardiac and vascular structural and functional alterations.

Methods: Sixty obese subjects (age 46 ± 10 years, body mass index 37 ± 3 kg/m²) were evaluated during their participation in a weight loss study. Cardiac and vascular ultrasound studies were performed at baseline and at 3, 6, 12, and 24 months after start of intervention.

Results: Forty-seven subjects (78%) completed the entire 2-year follow-up. Average weight loss was 7.3 ± 4.0%, 9.2 ± 5.6%, 7.8 ± 6.6%, and 3.8 ± 7.9% at 3, 6, 12, and 24 months, respectively. Age- and sex-adjusted mixed linear models revealed that the follow-up time was significantly associated with decreases in weight (p < 0.0001), left ventricular (LV) mass (p = 0.001), and carotid intima-media thickness (p < 0.0001); there was also significant improvement in LV diastolic (p 0.0001) and systolic (p = 0.001) function. Partial weight regain diminished the maximal observed beneficial effects of weight loss, however cardiovascular parameters measured at 2 years still showed a net benefit compared with baseline.

Conclusions: Diet-induced moderate weight loss in obese subjects is associated with beneficial changes in cardiovascular structure and function. Subsequent weight regain is associated with partial loss of these beneficial effects. (The Safety and Effectiveness of Low and High Carbohydrate Diets; NCT00079547)

Key Words: carotid arteries • diastolic function • echocardiography • hypertrophy • obesity

Abbreviations and Acronyms   BMI = body mass index   CIMT = carotid intima-media thickness   E' = early diastolic myocardial velocity   LV = left ventricular   LVH = left ventricular hypertrophy   LVM/Ht2.7 = left ventricular mass indexed to height2.7   S' = systolic myocardial velocity   SBP = systolic blood pressure   TDI = tissue Doppler imaging

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