Abstract
Although weight loss is recommended for obese patients, it remains questionable how much weight loss is optimal. A novel index that accurately determines the risk of cardiovascular diseases (CVDs) in terms of weight loss is needed. The modified Atherogenic Index of Plasma (AIP), presented here is unique in the literature. It is calculated based on data for anti-atherogenic, high-density lipoprotein cholesterol (HDL-C) fractions, instead of the total HDL-C. This study investigates whether weight loss correlates with CVD risk, and whether the modified AIP allows more accurate diagnostics in obese/overweight people. According to the increase or decrease of AIP during weight loss, 52 Polish patients were subdivided into two groups: group I (increased AIP; n = 16) and group II (decreased AIP; n = 36). The patients’ body mass composition and fasting serum lipid parameters (total cholesterol, triglycerides, HDL-C, and LDL-C (low-density lipoprotein cholesterol)), and cholesterol in 21 lipoprotein sub-fractions were determined. Over six months, all patients reduced their body mass by about 10%. There were no significant differences in anthropometric measures between groups. Increases in large and intermediate HDL-C fractions 1 to 6 and decreases in smaller fractions 7 to 10 were observed in group II. In group I, HDL-C fractions 1 and 10 decreased, while cholesterol in other fractions increased. Increases were observed in the antiatherogenic HDL-C of 52% of group II and 4% of group I. As for atherogenic HDL-C, a decrease of 24% was observed in group II and an increase of 9% in group I. In group I, increases of very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and large LDL fractions were noticed, and the reverse in group II. The results show that the modified AIP is a more accurate indicator of CVD risk than existing indices, and that uncontrolled weight reduction does not necessarily have a beneficial influence, and may adversely affect the cardiovascular system.
Highlights
To genetic predisposition, environmental factors related to improper lifestyles are the main factors leading to disorders of lipids and carbohydrate metabolism, which induce many diseases.Morbidity is lower in people who eliminate or limit a high-calorie, poor quality diet, rich in saturated fatty acids, salt, added sugars, refined grains with a simultaneous increase in the proportion of raw vegetables, fruit, and polyunsaturated fatty acids
Using the regular Atherogenic Index of Plasma (AIP) formula, in group of patients (group I), we observed a significant increase of low-density lipoprotein (LDL) (1–2) of about 51%, and a decrease of about 6% in group II (Table 6)
The incidence of myocardial infarction correlates with the components of the metabolic syndrome, such as hypertension, high TG concentration, and low high-density lipoprotein cholesterol (HDL-C) concentration. These findings have shown that none of the parameters used in the diagnosis of obesity—body mass index (BMI), waist circumference, or WHR ratio—correlates with the prevalence of cardiovascular diseases (CVDs) if the analysis includes measurements of blood pressure, serum lipid levels, and if carbohydrate metabolism disorders were present [21]
Summary
Environmental factors related to improper lifestyles are the main factors leading to disorders of lipids and carbohydrate metabolism, which induce many diseases.Morbidity is lower in people who eliminate or limit a high-calorie, poor quality diet, rich in saturated fatty acids (especially from animal sources), salt, added sugars (sucrose, fructose, or starch), refined grains with a simultaneous increase in the proportion of raw vegetables, fruit, and polyunsaturated fatty acids. The consumption of a healthy diet alone does not guarantee good health, but must be balanced by sufficient physical activity [1,2,3]. These modifiable risk factors correlate with the frequency of the occurrence of obesity and of cardiovascular diseases (CVDs) like stroke, heart failure, peripheral arterial disease, or kidney failure [4]. CVDs due to arteriosclerosis, such as stroke and coronary heart disease, are the main causes of morbidity, hospitalization, invalidity, and premature mortality in all high-income and some middle-income countries. It is estimated that despite significant progress in diagnostics and treatment, in the majority of countries CVDs will remain the main cause of mortality until at least 2030 [11]
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