Changes In Cardiometabolic Risk Research Articles

Change in Cardiometabolic Risk Among Blacks, Whites, and Hispanics: Findings From the Health and Retirement Study.

Blacks experience greater multisystem physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over 4 years among older whites, blacks, and Hispanics. We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk-cardiometabolic risk (CMR)-using data for each respondent from two waves of the Health and Retirement Study's biomarker assessment (n = 5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers. Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over 4 years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and high-density lipoprotein cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral, and health care-related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use. We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention.

Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study.

To compare the effect of Roux-en-Y gastric bypass (RYGB) surgery versus intensive medical diabetes and weight management (IMWM) on clinical and patient-reported outcomes in obese patients with type 2 diabetes. We prospectively randomized 38 obese patients with type 2 diabetes (15 male and 23 female, with mean ± SD weight 104 ± 16 kg, BMI 36.3 ± 3.4 kg/m2, age 52 ± 6 years, and HbA1c 8.5 ± 1.3% [69 ± 14 mmol/mol]) to laparoscopic RYGB (n = 19) or IMWM (n = 19). Changes in weight, HbA1c, cardiovascular risk factors (UKPDS risk engine), and self-reported health status (the 36-Item Short-Form [SF-36] survey, Impact of Weight on Quality of Life [IWQOL] instrument, and Problem Areas in Diabetes Survey [PAID]) were assessed. After 3 years, the RYGB group had greater weight loss (mean -24.9 kg [95% CI -29.5, -20.4] vs. -5.2 [-10.3, -0.2]; P < 0.001) and lowering of HbA1c (-1.79% [-2.38, -1.20] vs. -0.39% [-1.06, 0.28] [-19.6 mmol/mol {95% CI -26.0, -13.1} vs. -4.3 {-11.6, 3.1}]; P < 0.001) compared with the IMWM group. Changes in cardiometabolic risk for coronary heart disease and stroke were all more favorable in RYGB versus IMWM (P < 0.05 to P < 0.01). IWQOL improved more after RYGB (P < 0.001), primarily due to subscales of physical function, self-esteem, and work performance. SF-36 and PAID scores improved in both groups, with no difference between treatments. A structural equation model demonstrated that improvement in overall quality of life was more strongly associated with weight loss than with improved HbA1c and was manifest by greater improvements in IWQOL than with either SF-36 or PAID. Three years after randomization to RYGB versus IMWM, surgery produced greater weight loss, lower HbA1c, reduced cardiovascular risk, and improvements in obesity-related quality of life in obese patients with type 2 diabetes.

Cardiometabolic Impact of Changing Sitting, Standing, and Stepping in the Workplace.

According to cross-sectional and acute experimental evidence, reducing sitting time should improve cardiometabolic health risk biomarkers. Furthermore, the improvements obtained may depend on whether sitting is replaced with standing or ambulatory activities. Based on data from the Stand Up Victoria multicomponent workplace intervention, we examined this issue using compositional data analysis-a method that can examine and compare all activity changes simultaneously. Participants receiving the intervention (n = 136 ≥ 0.6 full-time equivalent desk-based workers, 65% women, mean ± SD age = 44.6 ± 9.1 yr from seven worksites) were asked to improve whole-of-day activity by standing up, sitting less, and moving more. Their changes in the composition of daily waking hours (activPAL-assessed sitting, standing, and stepping) were quantified then tested for associations with concurrent changes in cardiometabolic risk (CMR) scores and 14 biomarkers concerning body composition, glucose, insulin, and lipid metabolism. Analyses were by mixed models, accounting for clustering (3 months, n = 105-120; 12 months, n = 80-97). Sitting reduction was significantly (P < 0.05) associated only with lower systolic blood pressure at 3 months, and with CMR scores, weight, body fat, waist circumference, diastolic blood pressure, and fasting triglycerides, total/HDL cholesterol, and insulin at 12 months. Significant differences between standing and stepping were only observed for systolic blood pressure and insulin; both favored stepping. However, replacing sitting with standing was significantly associated only with improvements in CMR scores, whereas replacing sitting with stepping was significantly associated with CMR scores and six biomarkers. Improvements in several cardiometabolic health risk biomarkers were significantly associated with sitting reductions that occurred in a workplace intervention. The greatest degree and/or widest range of cardiometabolic benefits appeared to occur with long-term changes, and when increasing ambulatory activities. ACTRN1211000742976.

Cardiometabolic risk factors and health behaviors in family caregivers.

The purpose of this study was to compare components of cardiometabolic risk and health behaviors of 20 family caregivers of allogeneic hematopoietic stem cell transplant patients to those of age, gender, and race/ethnicity-matched controls. A prospective, repeated measures design was used to compare cardiometabolic risk and health behaviors in caregivers and controls at three time-points: pre-transplantation, discharge, and six weeks post-discharge. Measures included components of metabolic syndrome, Reynolds Risk Score, NMR serum lipoprotein particle analyses, and the Health-Promoting Lifestyle Profile II (HPLP-II). Mixed-model repeated measure analyses were used. There were no between or within group differences in LDL cholesterol, HDL cholesterol, and triglycerides. There was a significant interaction effect between time and role in large VLDL concentration (VLDL-P) (F (2, 76) = 4.36, p = .016), with the trajectory of large VLDL-P increasing over time in caregivers while remaining stable in controls. Within caregivers, VLDL particle size (VLDL-Z) was significantly larger at time-point three compared to time-points one (p = .015) and two (p = .048), and VLDL-Z was significantly larger in caregivers than in controls at time point three (p = .012). HPLP-II scores were lower in caregivers than controls at all time-points (p < .01). These findings suggest that caregiving may have a bigger impact on triglycerides than on other lipids, and it is through this pathway that caregivers may be at increased cardiometabolic risk. More sensitive measurement methods, such as NMR lipoprotein particle analyses, may be able to detect early changes in cardiometabolic risk.

Abstract MP020: Sleep as a Mediator of Racial Disparities in Cardiometabolic Disease Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Approximately half of the disparity in premature mortality between African American (AA) and European American (EA) adults is due to greater hypertension, diabetes, and stroke risk. The current study tests sleep as a mediator of racial disparities in cardiometabolic (CMB) disease risk in adulthood. Methods: A total of 618 CARDIA Study members took part in a sleep sub-study (2003-2005) and had measured CMB risk (2000-2011; mean age at baseline=40.1; 43.5% AA; 56.5% EA; 42.1% male). Sleep efficiency (% of time in bed asleep) and total sleep time were assessed via actigraphy for six total nights in years 17 and 18 of the CARDIA Study. CMB risk was assessed in years 15 and 25 from borderline high (coded as 1) and high (coded as 2) levels in seven markers using recommended cutpoints from NCEP ATP III and AHA: blood pressure, glucose, insulin resistance, waist circumference, triglycerides, HDL-C, and C-reactive protein. Scores were averaged across markers, ranging from 0 to 2 (a score of 1 indicates a borderline high average in the seven markers). Using linear path models, sleep variables were tested as mediators of racial disparities in ten-year changes in CMB risk. Results: AAs obtained less efficient sleep and less total sleep than EAs (76.5% vs 84.3%; 5.63 hrs vs. 6.43 hrs), and AAs had higher CMB risk at both periods (Mean at Y15: .75 vs. .55; Y25: .94 vs. .67) ( p ’s &lt; .001). Mediation tests are shown in the Table. Race was indirectly associated with increasing CMB risk over the ten-year period via sleep efficiency, explaining 25% of the racial disparity. Racial disparities in CMB risk were attenuated by 24.5% when adjusting for sleep time, although the mediation test was not significant. After adjusting for education and household income, 18.1% of the race disparity in diverging CMB risk was explained by sleep efficiency and 20.8% by sleep time. Conclusions: Differences in sleep likely contribute to greater CMB risk among AAs as compared to EAs in adulthood. Sleep may be an important intervention point to reduce racial health disparities.

Ten-year Change In Sedentary Behavior And Cardiorespiratory Fitness Are Independently Associated With Clustered Cardio-metabolic Risk

PURPOSE: We aimed to study the independent associations between change in sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA) and objectively measured cardiorespiratory fitness (CRF) over 10 years, and concurrent change in clustered cardio-metabolic risk and its individual components (waist circumference, fasting glucose, HDL-cholesterol, triglycerides and blood pressure). We also determined whether any associations were mediated by change in waist circumference or dietary intake. METHODS: A population-based sample of 425 adults (age (mean±SD) 55.83±9.40; 65%men) were followed prospectively for 9.6±0.52 years. Participants self-reported SB and MVPA and performed a maximal cycle ergometer test to estimate peak oxygen uptake at baseline (2002–2004) and follow up (2012–2014). Multiple linear regression and the product of coefficients method were used to examine independent associations and mediation effects, respectively. RESULTS: Greater increase in SB was associated with more detrimental change in clustered cardio-metabolic risk (standardized β = 0.12, p<0.01) and triglycerides (standardized β = 0.12, p<0.05), independently of baseline and change in MVPA and CRF. Greater increase in MVPA was associated with greater increase in HDL-cholesterol, independent of baseline and change in SB and CRF (standardized β = 0.15, p<0.01). Greater decrease in CRF was associated with more detrimental change in clustered cardio-metabolic risk and all other individual components, independently of baseline and change in SB (absolute standardized β ranging from 0.12 to 0.38, p<0.05). Change in waist circumference mediated the relationship between change in CRF and change in fasting glucose, HDL-cholesterol and triglycerides (a*b [95% CI]: fasting glucose: −0.11 [−0.18, −0.04]; HDL-cholesterol: 0.15 [0.08, 0.22]; triglycerides: −0.40 [−0.81, −0.01]). CONCLUSIONS: A combination of decreasing SB and increasing MVPA and CRF is most beneficial towards cardio-metabolic health. However, some associations between changes in CRF and changes in cardio-metabolic risk were mediated through changes in waist circumference. Therefore, from a public health perspective, lifestyle intervention programs need to focus on all three components, which is decreasing SB, increasing MVPA and CRF.

Weight-Loss Diets, Adiponectin, and Changes in Cardiometabolic Risk in the 2-Year POUNDS Lost Trial.

Compelling evidence suggests that the beneficial effects of weight-loss diet interventions on improvement of cardiometabolic risk factors may be partly through modulating secretion of adiponectin from adipose tissue. To investigate the effects of long-term weight-loss diets with different compositions of macronutrients on longitudinal changes in circulating adiponectin concentrations and how such changes, if they exist, affect cardiometabolic risk. In the 2-year Preventing Overweight Using Novel Dietary Strategies trial, 811 overweight or obese adults were randomly assigned to 1 of 4 diets varying in macronutrient intakes. The current analysis was restricted to participants who had baseline adiponectin measurement (n = 768). Circulating concentrations of adiponectin and cardiometabolic outcomes were repeatedly measured at baseline, 6 months, and 2 years. Circulating concentrations of adiponectin and cardiometabolic risk factors. Weight-loss diet interventions significantly increased circulating adiponectin concentrations over 2 years, similarly in 4 diet groups (P value for difference >.05). We found that the increase of adiponectin was significantly associated with reduction of waist circumference and low-density lipoprotein cholesterol, but associated with increase of high-density lipoprotein cholesterol (P < .001 for each), after adjusting for age, sex, ethnicity, follow-up time, diet group, baseline body mass index, baseline level of respective outcome trait, and concurrent weight change. Our findings indicate that long-term interventions by weight-loss diets varying in macronutrients similarly increase circulating adiponectin, which may particularly improve abdominal fat distribution and lipid metabolism independently of weight change.

Sedentary Behavior Predicts Changes in Cardiometabolic Risk in Professional Workers: A One-Year Prospective Study.

The purpose of the study was to examine the longitudinal influence of sedentary behavior on the development of metabolic syndrome (MS) and cardiometabolic risk in professional workers. Study participants were 203 professional workers (55.6% female; mean age = 41.9, SD = 11.2,) in low physical activity occupations. Participants' height, weight, waist circumference, fasting plasma glucose, triglycerides, high-density lipoprotein, total cholesterol, and low-density lipoprotein were measured at the baseline and follow-up over 12 months. Accelerometry was used to assess the sedentary time and moderate and vigorous physical activity. High level of sedentary behavior at baseline significantly predicted incident MS (odds ratio 4.07, 95% confidence interval 1.69 to 9.76) at follow-up. Similarly, the change in sedentary behavior significantly predicted the change in the cardiometabolic risk score (B = 0.12, SE = 0.06, P = 0.03) from baseline to the follow-up. Professional workers in low physical activity occupations were engaged in an excessive amount of sedentary behavior that predisposed them to an increased risk of developing cardiometabolic disorders.

Contributions of local-area fast-food availability and area-based weight and dietary norms to 10-year change in cardiometabolic risk

Contributions of local-area fast-food availability and area-based weight and dietary norms to 10-year change in cardiometabolic risk

Longitudinal association of anthropometric measures of adiposity with cardiometabolic risk factors in postmenopausal women

PurposeSome studies suggest that anthropometric measures of abdominal obesity may be superior to body mass index (BMI) for the prediction of cardiometabolic risk factors; however, most studies have been cross-sectional. Our aim was to prospectively examine the association of change in BMI, waist-to-hip ratio (WHR), waist circumference (WC), and waist circumference-to-height ratio (WCHtR) with change in markers of cardiometabolic risk in a population of postmenopausal women. MethodsWe used a subsample of participants in the Women's Health Initiative aged 50 to 79 years at entry with available fasting blood samples and anthropometric measurements obtained at multiple time points over 12.8 years of follow-up (n = 2672). The blood samples were used to measure blood glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides at baseline, and at years 1, 3, and 6. We conducted mixed-effects linear regression analyses to examine associations at baseline and longitudinal associations between change in anthropometric measures and change in cardiometabolic risk factors, adjusting for covariates. ResultsIn longitudinal analyses, change in BMI, WC, and WCHtR robustly predicted change in cardiometabolic risk, whereas change in WHR did not. The strongest associations were seen for change in triglycerides, glucose, and HDL-C (inverse association). ConclusionIncrease in BMI, WC, and WCHtR strongly predicted increases in serum triglycerides and glucose, and reduced HDL-C. WC and WCHtR were superior to BMI in predicting serum glucose, HDL-C, and triglycerides. WCHtR was superior to WC only in predicting serum glucose. BMI, WC, and WCHtR were all superior to WHR.

Impact of body composition on estimated glomerular filtration rate in relatively healthy adults in Taiwan.

Chronic kidney diseases are associated with changes in cardiometabolic risk (CMR) factors in which body composition parameters have been used as sensitive predictors. This study aimed to explore the associations of anthropometric indicators, body fat (BF), body mass index (BMI) and waist circumference (WC) with estimated glomerular filtration rate (eGFR) in an adult healthy Chinese population. A cross-sectional study was conducted for the subjects undergoing annual health examinations. The associations of subjects with body composition parameters were analyzed using the cutoff values of BMI, BF and WC in accordance with the criteria for Asian or Taiwanese population by gender. A total of 3473 subjects, aged 30-45 years, who received physical examinations in 2007 were analyzed. The levels of CMR factors were significantly higher in males than in females. eGFR was negatively associated with BMI but positively related to BF. The additional roles of BMI and WC were observed in the subjects who were categorized according to BF. Females with normal weight obese were associated with increased eGFR, whereas a higher eGFR was found in males with low/normal BF and BMI or normal WC. Our data provided evidence that anthropometric parameters were associated with changes of eGFR in relatively healthy adults. Higher eGFR was observed in females with normal weight obese in whom hyperfiltration may be suspected, and this finding deserves further studies.

Abstract P090: Change in Visceral Adipose Tissue and Change in Cardiometabolic Risk in a Minority Cohort: The IRAS Family Study

Visceral adipose tissue (VAT), the more metabolically harmful fat depot, has been associated with a higher prevalence of diabetes, insulin resistance, and impaired glucose homeostasis. Higher levels of VAT are associated cross-sectionally with cardiovascular (CV) risk factors, specifically hypertension and unfavorable lipid profiles. Research on the effects of change in VAT on CV risk factors is extremely limited and no studies have explored these questions in minority cohorts. The Insulin Resistance Atherosclerosis Family (IRAS Family) Study offered the opportunity to explore whether changes in VAT were associated with changes in CV risk, independent of changes in BMI, in a minority cohort. Abdominal computed tomography (CT) scans were obtained at two time points spanning a five year interval among African-American (N=295) and Hispanic-American participants (N=719), aged 18-65 years. The CV risk factors included 5-year change in insulin resistance (HOMA), high density lipoprotein (HDL) cholesterol and systolic blood pressure (SBP). To account for family structure, we used mixed models stratified by gender to estimate change in CV risk factors as a function of change in VAT, adjusted for change in BMI, age category, race, physical activity level, smoking status, statin use (for HDL) and antihypertensive use (for SBP). The cohort was 62% female, with an overall mean age of 40 years at baseline. The mean (SD) changes in BMI and VAT over 5-years were 1.1 (2.6) kg/m 2 and 4.2 (31.0) cm 2 , respectively; the mean (SD) changes in HOMA, HDL, and SBP over 5 years were 1.3 units (2.8), 4.8 (9.3) mg/dL and 2.4 (12.7) mm Hg, respectively. On average, a one standard deviation increase in VAT (31 cm 2 ) was significantly associated with a 0.58 unit increase in HOMA in men (p&lt;0.0001) and 0.42 unit increase in women (p=0.0048) in the adjusted model. A 31 cm 2 increase in VAT was significantly associated with a 1.8 mg/dL decrease in HDL in women (p=0.0007), but not in men (0.07 mg/dL increase, p=0.87). VAT change was not significantly associated with change in SBP in men or women. In this study of change in CT measured abdominal fat area in a large minority cohort, modest increases in VAT were significantly related to changes in HOMA and HDL, independent of changes in BMI. Further research is needed to determine whether preventing VAT accumulation may lead to improvements in glucose homeostasis and lipid profile.

Stability of relative weight category and cardiometabolic risk factors among moderately and severely obese middle school youth

ObjectiveTo examine the stability of severe pediatric obesity relative to moderate obesity and associated changes in cardiometabolic risk from the beginning of 6th to the end of 8th grade.Design and MethodsParticipants in HEALTHY, a multi-site, cluster randomized school-based study designed to mitigate risk for type 2 diabetes, completed standardized assessments of height, weight, glucose, insulin, lipids and blood pressure at the beginning of 6th grade and the end of 8th grade. Youth were classified as moderately obese (100–119% of the 95th percentile of BMI for age and gender) or severely obese (≥120% of the 95th percentile of BMI for age and gender). Generalized linear mixed models (GLMM) that controlled for relevant covariables were used to examine the relation between baseline demographic and cardiometabolic risk factors and BMI status, as well as changes in relative weight category and risk factors during middle school.ResultsSevere obesity was more likely to endure over the course of middle school than was moderate obesity, and was associated with significantly higher levels of cardiometabolic risk.ConclusionsResearch with a specific focus on understanding, preventing, and treating severe obesity in children is warranted.

Sedentary Behaviour, Visceral Fat Accumulation and Cardiometabolic Risk in Adults: A 6-Year Longitudinal Study from the Quebec Family Study

BackgroundSedentary behaviour has recently emerged as a unique risk factor for chronic disease morbidity and mortality. One factor that may explain this relationship is visceral adiposity, which is prospectively associated with increased cardiometabolic risk and mortality. The objective of the present study was to determine whether sedentary behaviour was associated with increased accumulation of visceral fat or other deleterious changes in cardiometabolic risk over a 6-year follow-up period among adult participants in the Quebec Family Study.MethodsThe current study included 123 men and 153 women between the ages of 18 and 65. Total sedentary time and physical activity were assessed by self-report questionnaire. Cross-sectional areas of visceral and subcutaneous abdominal adipose tissue were assessed using computed tomography. Cardiometabolic biomarkers including fasting insulin, glucose, blood lipids, HOMA-Insulin Resistance, and oral glucose tolerance were also measured. All variables of interest were collected at both baseline and follow-up.ResultsAfter adjustment for age, sex, baseline BMI, physical activity, energy intake, smoking, education, income and menopausal status, baseline sedentary behaviour was not associated with changes in visceral adiposity or any other marker of cardiometabolic risk. In the longitudinal model which adjusted for all studied covariates, every 15-minute increase in sedentary behaviour from baseline to follow-up was associated with a 0.13 cm increase in waist circumference (95% CI = 0.02, 0.25). However, there was no association between changes in sedentary behaviour and changes in visceral adiposity or other markers of cardiometabolic risk.ConclusionThese results suggest that neither baseline sedentary behaviour nor changes in sedentary behaviour are associated with longitudinal changes in visceral adiposity in adult men and women. With the exception of waist circumference, the present study did not find evidence of a relationship between sedentary behaviour and any marker of cardiometabolic risk in this population.

Lifestyle and dietary factors associated with the evolution of cardiometabolic risk over four years in West-African adults: the Benin study.

Aim. To assess in adults from Benin changes in cardiometabolic risk (CMR) using both the Framingham risk score (FRS) and metabolic syndrome (MetS) and to examine the effects of diet, and lifestyles, controlling for location and socioeconomic status. Methods. Apparently healthy subjects (n = 541) aged 25–60 years and randomly selected in the largest city, a small town, and rural areas were included in the four-year longitudinal study. Along with CMR factors, socioeconomic, diet and lifestyle data were collected in individual interviews. A food score based on consumption frequency of four “sentinel” food groups (meat and poultry, dairy, eggs, and vegetables) was developed. Lifestyle included physical activity, alcohol and tobacco use. Education and income (proxy) were the socioeconomic variables. Results. Among the subjects with four-year follow-up data (n = 416), 13.5% were at risk at baseline, showing MetS or FRS ≥ 10%. The incidence of MetS and FRS ≥ 10% during follow-up was 8.2% and 5%, respectively. CMR deteriorated in 21% of subjects. Diet and lifestyle mediated location and income effects on CMR evolution. Low food scores and inactivity increased the likelihood of CMR deterioration. Conclusion. Combining MetS and FRS might be appropriate for surveillance purposes in order to better capture CMR and inform preventive measures.

Are the 2005 Dietary Guidelines for Americans Associated With reduced risk of type 2 diabetes and cardiometabolic risk factors? Twenty-year findings from the CARDIA study.

OBJECTIVETo examine the prospective association between accordance with the 2005 Dietary Guidelines for Americans (DGA) and subsequent diabetes incidence and changes in cardiometabolic risk factors.RESEARCH DESIGN AND METHODSThe sample consisted of 4,381 black and white young adults examined repeatedly from 1985 to 2005. We used the 2005 Diet Quality Index (DQI) to rate participants’ diets based on meeting key dietary recommendations conveyed by the 2005 DGA.RESULTSOverall, we found no association between DQI score and diabetes risk using Cox models adjusted for potential confounders. Higher DQI scores were associated with favorable changes in HDL cholesterol and blood pressure overall (P for trend <0.05), but with increased insulin resistance among blacks (P for trend <0.01).CONCLUSIONSOur findings highlight the need for evaluation of the DGA’s effectiveness, particularly among ethnic minority populations. Clinicians should be aware that following the DGA might not lower diabetes risk.

A four-year naturalistic prospective study of cardiometabolic disease in antipsychotic-treated patients

The relationship between antipsychotic use and cardiovascular morbidity and mortality is controversial. There is a lack of long-term prospective studies investigating changes in cardiometabolic risk in patients treated with antipsychotic drugs. We report data from a 4-year prospective study. Patients (89) underwent detailed metabolic and cardiovascular risk assessment at 4-years which included anthropometric assessment, blood pressure, lipid profile, and an oral glucose tolerance test. We used the homeostatic model assessment to determine insulin resistance, and calculated 10-year cardiovascular risk scores . Mean age of subjects was 44.7 (±11.5) years, and 52% were male. The prevalence of type 2 diabetes was 8%, and 38.4% fulfilled diagnostic criteria for the metabolic syndrome. With the exception of increased central adiposity over the 4-year follow-up period ( p < 0.001), other cardiometabolic parameters were generally unchanged. There was a high prevalence of dyslipidaemia, but only 16.9% were prescribed lipid-lowering treatment. Commencing lipid-lowering therapy was associated with a reduction in cardiovascular risk score (OR 7.9, 95% CI = 1.3 to 48.7; p = 0.02). Patients established on longer-term antipsychotic treatment show less dramatic metabolic changes than those occurring in the early stages of treatment, but have a high burden of cardiovascular risk. Lipid-lowering therapy is associated with a significant reduction in cardiovascular risk.

Effects of Diet and Physical Activity Interventions on Weight Loss and Cardiometabolic Risk Factors in Severely Obese Adults

The prevalence of severe obesity is increasing markedly, as is prevalence of comorbid conditions such as hypertension and type 2 diabetes mellitus; however, apart from bariatric surgery and pharmacotherapy, few clinical trials have evaluated the treatment of severe obesity. To determine the efficacy of a weight loss and physical activity intervention on the adverse health risks of severe obesity. Single-blind randomized trial conducted from February 2007 through April 2010 at the University of Pittsburgh. Participants were 130 (37% African American) severely obese (class II or III) adult participants without diabetes recruited from the community. One-year intensive lifestyle intervention consisting of diet and physical activity. One group (initial physical activity) was randomized to diet and physical activity for the entire 12 months; the other group (delayed physical activity) had the identical dietary intervention but with physical activity delayed for 6 months. Changes in weight. Secondary outcomes were additional components comprising cardiometabolic risk, including waist circumference, abdominal adipose tissue, and hepatic fat content. Of 130 participants randomized, 101 (78%) completed the 12-month follow-up assessments. Although both intervention groups lost a significant amount of weight at 6 months, the initial-activity group lost significantly more weight in the first 6 months compared with the delayed-activity group (10.9 kg [95% confidence interval {CI}, 9.1-12.7] vs 8.2 kg [95% CI, 6.4-9.9], P = .02 for group × time interaction). Weight loss at 12 months, however, was similar in the 2 groups (12.1 kg [95% CI, 10.0-14.2] vs 9.9 kg [95% CI, 8.0-11.7], P = .25 for group × time interaction). Waist circumference, visceral abdominal fat, hepatic fat content, blood pressure, and insulin resistance were all reduced in both groups. The addition of physical activity promoted greater reductions in waist circumference and hepatic fat content. Among patients with severe obesity, a lifestyle intervention involving diet combined with initial or delayed initiation of physical activity resulted in clinically significant weight loss and favorable changes in cardiometabolic risk factors. clinicaltrials.gov Identifier: NCT00712127.

Rethinking dietary saturated fats

AbstractA re‐evaluation of the diet/heart disease hypothesis is occurring, and the link between dietary fat and heart disease is not as conclusive as once was thought. A re‐evaluation of assessment of cardiometabolic risk is also occurring – from serum low density lipoprotein to serum triacylglycerol and high density lipoprotein. As the focus of cardiometabolic risk changes, the emphasis will change from dietary fat restriction (which lowers low density lipoprotein) to dietary carbohydrate restriction (which lowers triacylglycerol and raises high density lipoprotein). If these re‐evaluations continue to de‐emphasize dietary fat restriction, then products to support low‐carbohydrate, high‐fat lifestyles could rise in importance.