Body Weight Reduction of 5% Improved Blood Pressure and Lipid Profiles in Obese Men and Blood Glucose in Obese Women: A Four-Year Follow-up Observational Study

The Effects of Isocaloric Intermittent Fasting vs Daily Caloric Restriction on Weight Loss and Metabolic Risk Factors for Noncommunicable Chronic Diseases: A Systematic Review of Randomized Controlled or Comparative Trials

BACKGROUND

Intermittent fasting (IF) has gained favor as an alternative regimen to daily caloric restriction (DCR). Therefore, there is a need for systematic reviews of randomized controlled/comparison trials examining the effects of isocaloric IF vs DCR on metabolic risk factors for noncommunicable chronic diseases.

OBJECTIVE

To systematically investigate the effects of isocaloric IF vs DCR on metabolic risk factors for noncommunicable chronic diseases in adults with overweight and obesity.

METHODS

Five online databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar) were searched for articles published from January 2000 through April 2022. The updated Cochrane Risk of Bias Assessment tool for randomized controlled/comparison trials was used to assess risk of bias in the included studies. This review includes randomized controlled/comparison trials with matched energy intakes (isocaloric) between IF and DCR among adults with overweight and obesity with ≥8-week durations, that assessed risk factors related to obesity and for diabetes, cardiovascular diseases, and cancers.

RESULTS

Thirteen randomized controlled/comparison trials with matched energy intakes (isocaloric) between IF and DCR were identified. The effects of IF on weight loss and metabolic risk markers of diabetes, cardiovascular diseases, and cancers were varied but generally comparable with DCR. IF (4:3 and 5:2 diets) was superior to DCR for improving insulin sensitivity in two studies. Reductions in body fat were significantly greater with IF (5:2 diet and time-restricted eating) than DCR in two studies of isocaloric diets.

CONCLUSIONS

With matched energy intakes, IF interventions produced similar beneficial effects for weight loss and chronic disease risk factors compared with DCR. Very limited evidence suggests that IF may be more effective vs DCR for fat loss and insulin sensitivity, but conclusions cannot be drawn based on the current evidence. Future clinical studies with larger populations and longer durations are needed for further elucidation of any potential effects of IF regimens for prevention of noncommunicable chronic diseases.

Group Medical Visits for Addressing Weight and Blood Pressure in an Underserved Population

The effect of group medical visits (GMV) compared to individual medical visits (IMV), on weight and blood pressure in a large primary care practice serving a predominantly underserved population, was assessed. The records of 304 patients attending a weight-loss program were analyzed using mixed-effects regression models. Patients in GMV lost an average of 11.63 lbs, whereas patients in IMV lost an average of 3.99 lbs (p < 0.001). A total of 55% of patients lost ≥7% in GMV compared to 11% of patients in IMV (p ≤ 0.001). Individuals who lost >5% of their baseline weight had a higher reduction in overall blood pressure. For systolic and diastolic blood pressure, the differences between baseline and three months for GMV and IMV were −7.4 vs. 4.1 mm of Hg (p = 0.002) and −4.6 vs. 4.2 mm of Hg (p = 0.003), respectively. Results from this study demonstrate that GMV may be a potentially useful modality for addressing weight and blood pressure in an underserved population.

Association Between Weight Change and Increased Likelihood of Abdominal Aortic Calcification Among Men

OBJECTIVE

We aimed to explore the effect of weight change on abdominal aortic calcification (AAC) among men.

METHODS

Data were obtained from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). Self-reported cardiovascular disease patients were excluded. Lateral spine images were used to quantify AAC score and severe AAC was defined as a AAC score greater than 6. Weight change over a 10-year period was defined as long-term weight change, and weight change over a 1-year period was defined as short-term weight change. The relationship between long-term and short-term weight change with AAC grade was estimated by using multivariable regression analysis and subgroup analysis.

RESULTS

After adjusting for covariates, weight gain, especially severe weight gain (> 10 kg), was associated with increased likelihood of AAC and severe AAC both in the short term (1 year) and long term (10 years) among men when compared to stable weight change, while long-term weight loss could also lead to an increased likelihood of AAC and severe AAC.

CONCLUSION

Stable body weight might be a predictor of a lower risk of AAC and severe AAC among men in the long term and short term.

Association between changes in body weight and cardiovascular disease risk factors among obese Japanese patients with type 2 diabetes

Aims/Introduction

We aimed to assess the association between bodyweight reduction and cardiovascular disease risk factors, and to identify the minimum bodyweight reduction associated with significant improvement in cardiovascular disease risk factors among obese Japanese patients with type 2 diabetes.

Materials and Methods

The cohort comprised 1,753 patients with type 2 diabetes and body mass index ≥25 kg/m², who visited our clinic between 2013 and 2016. Multivariable linear regression analysis was carried out to assess the relationship between bodyweight changes and glycated hemoglobin A1c, serum lipids and blood pressure. Analyses of covariance were carried out to compare mean changes in cardiovascular disease risk factors across six groups of bodyweight change, <−5%, −5% to <−3%, −3% to <−1%, −1% to <1% (reference), 1% to <3% and ≥3%.

Results

Log‐transformed bodyweight change had a significantly positive relationship with log‐transformed glycated hemoglobin A1c, triglycerides, low‐density lipoprotein cholesterol and systolic blood pressure changes, and a negative relationship with high‐density lipoprotein cholesterol, after adjusting for sex, age, duration of diabetes, body mass index, use of glucose‐lowering, lipid‐lowering and antihypertensive agents, and changes in the use of these medications. A mean change in glycated hemoglobin A1c was significantly improved only in the <−5% group compared with the reference. Mean changes in triglycerides were improved in all groups, and significantly in the <−5% group.

Conclusions

Bodyweight change was significantly associated with cardiovascular disease risk factor changes, and >5% bodyweight reduction was associated with improved glycated hemoglobin A1c.

Effects of Body Mass Index, Waist Circumference, Waist-to-Height Ratio and Their Changes on Risks of Dyslipidemia among Chinese Adults: The Guizhou Population Health Cohort Study

This study aimed to assess the effects of different anthropometric indices and their changes on the risk of incident dyslipidemia among the Chinese population. From the Guizhou population health cohort study, 2989 Chinese adults without dyslipidemia at baseline were followed up. Anthropometric parameters including waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), and their changes in the latter two indices, and serum lipids were tested after at least 8 h fasting. Hazard ratio (HR), adjusted hazard ratio (aHR), and 95% confidential interval (CI) were calculated to estimate the association between anthropometric parameters and dyslipidemia risk using multivariate Cox regression. A total of 2089 (69.98%) new dyslipidemia cases were identified over an average follow-up of 7.0 years. Baseline BMI (aHR = 1.12, 95%CI 1.01, 1.23) and WHtR (aHR = 1.06, 95%CI 1.00, 1.13) were positively associated with higher risks of incident dyslipidemia but not WC. Each 5.0 kg/m² increment of BMI or 0.05-unit increment of WHtR was significantly associated with 43% or 25% increased risk of incident dyslipidemia, respectively. The aHRs (95%CI) of incident dyslipidemia for subjects maintaining or developing general obesity were 2.19 (1.53, 3.12) or 1.46 (1.22, 1.75), and 1.54 (1.23, 1.82) or 1.30 (1.06, 1.60) for subjects maintaining or developing abdominal obesity, respectively. Linear trends for aHRs of BMI, WHtR change, and BMI change were observed (p for trend: 0.021, <0.001, <0.001, respectively). BMI, WHtR, and their changes were closely associated with the incidence of dyslipidemia for Chinese adults. Loss in BMI and WHtR had protective effects on incident dyslipidemia, whereas gain of BMI or WHtR increased the dyslipidemia risk. Interventions to control or reduce BMI and WHtR to the normal range are important for the early prevention of dyslipidemia, especially for participants aged 40 years or above, male participants, and urban residents with poor control of obesity.

Predictors of the Prevalence of Dyslipidemia and Influencing Factors for Young Health Examination Cohort: A Cross-Sectional Survey

Objectives: The objective of this study was to estimate the prevalence of dyslipidemia and associated influencing factors in young adults in the southeastern coastal area of China. Methods: This study adopted a cross-sectional survey and included 7,859 young people who underwent examinations at three hospitals in Wenzhou, Zhejiang Province, China. All subjects completed a questionnaire in the form of face-to-face interviews and underwent anthropometric measurements and biochemical tests. The continuous data are presented as the means ± standard deviations and were compared using Student's t-tests. The categorical variables are presented as proportions. The influencing factors associated with dyslipidemia were evaluated through a multivariate logistic regression. Results: The prevalence of dyslipidemia among young adults aged 18-45 years in the southeastern coast of China was high with 7.1, 15.0, 22.9, and 4.0% for high-total cholesterol (TC), high-triglyceride (TG), low-high-density lipoprotein cholesterol (HDL-C), and high-low-density lipoprotein cholesterol (LDL-C). Among those with dyslipidemia, a statistically significant difference in sex was observed, and all types of dyslipidemia were associated with smoking and alcohol consumption. However, those with high-TG, high-LDL, and low-HDL levels did not significantly differ in education level or occupation. The presence of dyslipidemia was significantly associated with increased age, the male sex (OR: 1.85, 95% CI: 1.39-2.21), smoking (OR: 2.02, 95% CI: 1.98-2.13), alcohol consumption (OR: 1.33, 95% CI: 1.16-1.63), overweight or obesity (OR: 2.01, 95% CI: 1.79-2.41), and intellectual work (OR: 1.36, 95% CI: 1.11-1.72). Conclusion: The prevalence of dyslipidemia among young adults aged 18-45 years in the southeastern coast of China was high. To prevent dyslipidemia at an early age, it is essential to conduct effective intervention programs targeting risk factors and to implement routine screening programs.

A Two-Year Follow-Up Cohort Study-Improved Clinical Control over CVD Risk Factors through Weight Loss in Middle-Aged and Older Adults

Modest weight loss enhances clinical control over cardiovascular disease (CVD) risk factors in overweight and obese individuals. This study aimed to assess the associations between individual weight loss and predefined criteria for clinical improvement in blood pressure, lipid levels, and glycemia. A two-year follow-up study involved 3388 (37.9% men) aged 45−64 years, BMI ≥ 25 kg/m². Changes in body weight were calculated as a percentage of baseline weight; outcome variables: systolic (SBP), diastolic (DBP) blood pressure, high-density (HDL-C) and low-density (LDL-C) lipoproteins, fasting blood glucose (FBG), and triglycerides (TG) were construed as the differences between baseline and outcome values. Clinically significant improvement was defined as SBP/DBP reduction by 5 mm/Hg, FBG−20 mg/dL, LDL-C-10 mg/dL, TG−40 mg/dL, and HDL-C increase by 5 mg/dL. Apart from LDL-C, a modest 5%–10% weight loss was associated with clinically significantly improved outcomes. The incident rate ratios and 95% confidence intervals for clinical improvement of SBP were: 1.27 (1.14–1.40), DBP/1.30 (1.12–1.50), HDL/1.54 (1.18–2.02), and TG/1.69 (1.32–2.17). In the higher category of weight loss, associations were still manifest, although the results proved diagnostically challenging (low number of cases). Even though modest weight loss does enhance clinical control over CVD risk factors, offering regular medical guidance to patients is postulated to further boos the anticipated outcomes.

Adipose afferent reflex is enhanced by TNFα in paraventricular nucleus through NADPH oxidase-dependent ROS generation in obesity-related hypertensive rats

BACKGROUND

The adipose afferent reflex (AAR), a sympatho-excitatory reflex, can promote the elevation of sympathetic nerve activity (SNA) and blood pressure (BP). Inflammation in the paraventricular nucleus (PVN) involves sympathetic abnormality in some cardiovascular diseases such as hypertension. This study was designed to explore the effects of tumor necrosis factor alpha (TNFα) in the PVN on the AAR and SNA in rats with obesity-related hypertension (OH) induced by a high-fat diet for 12 weeks.

METHODS

Renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were continuously recorded in anesthetized rats, and their responses to capsaicin (CAP) stimulation of the right inguinal white adipose tissue were used to evaluate the AAR.

RESULTS

Compared to the control rats, the systolic blood pressure (SBP), plasma norepinephrine (NE, indicating SNA) and TNFα levels, TNFα mRNA and protein levels, reactive oxygen species (ROS) content and NADPH oxidase activity in the PVN were significantly elevated in rats with OH. TNFα in the PVN markedly enhanced sympathoexcitation and AAR. Moreover, the enhancement of AAR caused by TNFα can be significantly strengthened by the pretreatment of diethyldithiocarbamate (DETC), a superoxide dismutase inhibitor, but attenuated by TNF-α receptor antagonist R-7050, superoxide scavenger PEG-SOD and NADPH oxidase inhibitor apocynin (Apo) in rats with OH. Acute microinjection of TNF-α into the PVN significantly increased the activity of NADPH oxidase and ROS levels in rats with OH, which were effectively blocked by R-7050. Furthermore, our results also showed that the increased levels of ROS, TNFα and NADPH oxidase subunits mRNA and protein in the PVN of rats with OH were significantly reversed by pentoxifylline (PTX, 30 mg/kg daily ip; in 10% ethanol) application, a cytokine blocker, for a period of 5 weeks. PTX administration also significantly decreased SBP, AAR and plasma NE levels in rats with OH.

CONCLUSIONS

TNFα in the PVN modulates AAR and contributes to sympathoexcitation in OH possibly through NADPH oxidase-dependent ROS generation. TNFα blockade attenuates AAR and sympathoexcitation that unveils TNFα in the PVN may be a possible therapeutic target for the intervention of OH.