Effect of Weight Loss by Low-Calorie Diet on Cardiovascular Health in Type 2 Diabetes: An Interventional Cohort Study.

Shaden Melhem,Roy Taylor,Ahmad Al-Mrabeh,Sarah Steven

doi:10.3390/nu13051465

Shaden Melhem, Roy Taylor + Show 2 more

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https://doi.org/10.3390/nu13051465

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Abstract

Cardiovascular disease (CVD) remains a major problem for people with type 2 diabetes (T2DM), and the leading cause of death worldwide. We aimed to determine cardiovascular benefits of weight loss with or without remission of diabetes, and to assess utility of plasma biomarkers. 29 people with T2DM were studied at baseline and after dietary weight loss. Change in plasma adipokines and lipid related markers was examined in relation to weight loss, diabetes remission, 10-year cardiovascular risk (QRISK), and duration of diabetes. QRISK decreased markedly after weight loss (18.9 ± 2.2 to 11.2 ± 1.6%, p < 0.0001) in both responders and non-responders, but non-responders remained at higher risk (15.0 ± 2.0 vs. 5.8 ± 1.6%, p < 0.0001). At baseline, plasma GDF-15 was higher in longer diabetes duration (1.19 ± 0.14 vs. 0.82 ± 0.09 ng/mL, p = 0.034), as was the QRISK (22.8 ± 2.6 vs. 15.3 ± 3.4%, p = 0.031). Leptin, GDF-15 and FGF-21 decreased whereases adiponectin increased after weight loss in responders and non-responders. However, the level of FGF-21 remained higher in non-responders (0.58 [0.28–0.71] vs. 0.25 [0.15–0.42] ng/mL, p = 0.007). QRISK change correlated with change in plasma VLDL1-TG (r = 0.489, p = 0.007). There was a positive correlation between rise in HDL cholesterol and the decrease in leptin (r = 0.57, p = 0.001), or rise in adiponectin (r = 0.58, p = 0.001) levels. In conclusion, weight loss markedly decreases cardiometabolic risk particularly when remission of diabetes is achieved. Leptin, adiponectin, GDF-15 and FGF-21 changes were related to weight loss not remission of diabetes. Normalization of 10-year cardiovascular risk and heart age is possible after substantial dietary weight loss and remission of T2DM.

Highlights

Cardiovascular disease (CVD) remains a major problem for people with type 2 diabetes mellitus (T2DM), and the leading cause of death worldwide [1,2,3]
This paper reports change in CVD risk after weight loss in relation to change of major lipid-related plasma biomarkers
There were no significant differences in intraorgan fat, total cholesterol, leptin, adiponectin, and fibroblast growth factor 21 (FGF-21) between both groups

Summary

Introduction

Cardiovascular disease (CVD) remains a major problem for people with type 2 diabetes mellitus (T2DM), and the leading cause of death worldwide [1,2,3]. T2DM [4,5,6,7] raises the possibility that clinically useful decrease in cardiovascular risk may follow This is required to be defined, and the relationship of change in CVD risk to change in plasma biomarkers is of importance. Non-alcoholic fatty liver disease (NAFLD) increases hepatic triglyceride export via very low-density lipoprotein (VLDL), and this is related to the pathogenesis of T2DM [6,8,9]. These abnormalities in lipid metabolism markedly increase CVD risks [3,10,11]. Remission of T2DM by weight loss is associated with normalization of liver fat and hepatic VLDL1-TG export [4,5,6], and the changes in plasma biomarkers on CVD risk requires to be established after remission

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