Abstract
ObjectiveArterial stiffness is an independent predictor of cardiovascular morbidity and mortality. This study aimed to compare the 7-week effect of a low-calorie diet (LCD) and an intensive lifestyle intervention program (ILI) on arterial stiffness in morbidly obese individuals.Design and MethodsNonrandomized clinical trial. The LCD provided 900 kcal/day, and participants in the LCD group were instructed to maintain their habitual physical activity level. The ILI included two 90-min supervised training sessions 3 days a week at moderate to high intensity (4-8 METs) and a caloric restriction of 1000 kcal/day.ResultsA total of 179 individuals completed the study, 88 (56 women) in the ILI group and 91 (57 women) in the LCD group. High-fidelity applanation tonometry (Millar®, Sphygmocor®) was used to measure carotid-femoral pulse wave velocity (PWV). After adjustment for relevant confounders, the ILI group had a significantly greater reduction in PWV than the LCD group; −0.4 (−0.6, −0.1) m/s, P = 0.004. When compared to the LCD group, the ILI group showed a larger reduction in systolic and diastolic blood pressure −5 (−9, −1) and −5 (−7, −2) mmHg, P = 0.038 and P ≤ 0.001 respectively, whereas no difference was observed regarding pulse pressure, P = 0.661. No significant differences between groups were found regarding the loss of fat mass, P = 0.259, but the loss of muscle mass was larger in the LCD group, 0.8 (0.5, 1.1) kg, P ≤ 0.001.ConclusionDespite the limitations of a nonrandomized design, our findings indicate that for morbidly obese individuals a moderate caloric restriction combined with aerobic physical exercise is associated with a greater decline in PWV than a LCD alone.
Highlights
Obesity is a world-wide health concern [1] and imparts a degree of cardiovascular risk similar to that associated with hypertension, hyperlipidemia, and smoking [2]
Several lines of evidence indicate that aerobic physical activity might decrease cardiovascular risk in obese individuals [6,7]
The groups were not significantly different in terms of pulse wave velocity (PWV), but individuals in the low-calorie diet (LCD) group were slightly younger and had higher systolic blood pressure, pulse pressure, slightly higher body weight and fat mass, and lower prevalence of ischemic heart disease compared with the intensive lifestyle intervention program (ILI) group (Table 1)
Summary
Obesity is a world-wide health concern [1] and imparts a degree of cardiovascular risk similar to that associated with hypertension, hyperlipidemia, and smoking [2]. Any intervention with the intention to cause weight loss must tip the balance between energy intake and expenditure to be successful. Official recommendations state that a reduction in energy intake of $500 kcal below energy expenditure per day will result in a weight loss of 0.5 kg per week. Dietary interventions will be more time consuming and demanding in morbidly obese individuals than in less obese individuals [5]. Several lines of evidence indicate that aerobic physical activity might decrease cardiovascular risk in obese individuals [6,7]. Whether or not this is true for morbidly obese individuals is unknown
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