Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet.

Enric Sánchez,Ignacio Sajoux,Albert Lecube,Maria-Dolores Santos,Marta Bueno,Maitane Nuñez-Garcia,Andree Yeramian

doi:10.3390/nu14010033

Abstract

Weight loss after bariatric surgery decreases the earlier expansion of the adventitial vasa vasorum (VV), a biomarker of early atheromatous disease. However, no data are available regarding weight loss achieved by very low calorie ketogenic diets (VLCKD) on VV and lipid-based atherogenic indices. A randomized clinical trial was performed to examine changes in adventitial VV density in 20 patients with moderate obesity who underwent a 6-month very low calorie ketogenic diet (VLCKD, 600–800 kcal/day), and 10 participants with hypocaloric diet based on the Mediterranean Diet (MedDiet, estimated reduction of 500 kcal on the usual intake). Contrast-enhanced carotid ultrasound was used to assess the VV. Body composition analysis was also used. The atherogenic index of plasma (log (triglycerides to high-density lipoprotein cholesterol ratio)) and the triglyceride-glucose index were calculated. Serum concentrations of soluble intercellular adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. The impact of weight on quality of life-lite (IWQOL-Lite) questionnaire was administered. Participants of intervention groups displayed a similar VV values. Significant improvements of BMI (−5.3 [−6.9 to −3.6] kg/m2, p < 0.001), total body fat (−7.0 [−10.7 to −3.3] %, p = 0.003), and IWQOL-Lite score (−41.4 [−75.2 to −7.6], p = 0.027) were observed in VLCKD group in comparison with MedDiet group. Although after a 6-months follow-up period VV density (mean, right and left sides) did not change significantly in any group, participants in the VLCKD exhibited a significantly decrease both in their atherogenic index of plasma and serum concentration of sICAM-1. A 6-month intervention with VLCKD do not impact in the density of the adventitial VV in subjects with moderate obesity, but induces significant changes in markers of endothelial dysfunction and CV risk.

Highlights

The prevalence of obesity is increasing worldwide [1]
No significant differences were observed between the intervention groups (VLCKD and Mediterranean diet (MedDiet)) regarding age, sex, anthropometry, clinical and metabolic parameters, and quality of life (Table 1)
We suggest that 6 months of a very low calorie ketogenic diets (VLCKD) in subjects with moderate obesity and without previous CV disease is sufficient to ameliorate endothelial dysfunction associated with obesity

Summary

Introduction

The prevalence of obesity is increasing worldwide [1]. In the United States, 34.9% of adults have obesity [2]. In Spain, the prevalence reaches 21.6%, and it is more common in women and with increasing age [3]. Obesity is one of the world’s deadliest diseases, with more than 2.8 million deaths annually, and it has a marked impact on cardiovascular (CV) morbidity and mortality [4,5,6]. It has been reported that CV disease tends to occur at an earlier age in patients with obesity [7]. The early diagnosis of asymptomatic atherosclerosis may be key to preventing CV events and reducing mortality in persons with obesity

Methods

Discussion

Conclusion