Effect of Fat Intake on the Inflammatory Process and Cardiometabolic Risk in Obesity After Interdisciplinary Therapy

Changes in diet and eating behavior along with excessive consumption of sugar or fat and a sedentary lifestyle are related to increased obesity and its associated comorbidities. The aim of this study was to investigate the role of the type of macronutrients on specific health benefits associated with the weight loss in treating obesity. A total of 30 obese women (34.89±3.04 kg/m(2) and 43.3±5.34 years) participated in an interdisciplinary therapy approach to lifestyle change, which consisted of nutritional counseling, exercise, and psychological therapy for over a period of 26 weeks. The profile was obtained by anthropometric measurements and body composition by bioelectrical impedance analysis (BIA). Usual food intake was assessed with 3-day food record diaries and blood tests were used to determine metabolic and adipokines parameters. After therapy, there was significant reduction in all anthropometric and body composition variables. Food consumption also decreased while still providing adequate nutrient intake. There was significant improvement in LDL-cholesterol, PAI-1, leptin, CRP, ICAM-1, and VCAM-1. Lower dietary carbohydrate and fat intake led to weight loss. The effect of lower carbohydrate intake on weight loss is related to changes in body composition and leptin levels. Weight loss by reducing fat intake modified the inflammatory process and cardiovascular risk, indicating dietary fat as an independent predictor factor of cell adhesion molecules. Therefore, decreasing dietary fat consumption had greater impact on the inflammatory process on obese individuals. Our results show that the type of macronutrient influences the health benefits associated with weight loss.

Reduction in saturated fat intake improves cardiovascular risks in obese adolescents during interdisciplinary therapy

BACKGROUND/OBJECTIVES

Obesity is related to inflammation and cardiovascular disease. The increase in saturated fatty acid intake (SFA) can potentiate cardiovascular risks. The aim of this study was to assess the influence of change in SFA on carotid intima-media thickness (cIMT), metabolic profile and anti/pro-inflammatory adipokines in obese adolescents.

METHODS

Sixty obese adolescents were subjected to 1 year of interdisciplinary intervention (nutrition, psychology, physical exercise and clinical therapy). Blood glucose, insulin, lipid profile, leptin and adiponectin were analysed. Insulin resistance was estimated by HOMA-IR and HOMA-AD. cIMT was measured by ultrasonography. Dietetic intake was calculated by 3-day dietary record. Volunteers were analysed according to tertiles of change (Δ) in SFA intake: Low-SFA reduction<3.68 g; Moderate-SFA reduction 3.68-13.67 g; and High-SFA reduction>13.67 g.

RESULTS

Moderate and High-SFA tertiles presented reduction in insulin, leptin/adiponectin ratio, cIMT and increase in adiponectin and adiponectin/leptin ratio. Adiponectin/leptin ratio was predictor of cIMT. HOMA-IR, total cholesterol and LDL-cholesterol reduced only in High-SFA tertile, and was associated with SFA independent of visceral fat. Negative correlations between Δ of SFA and adiponectin and adiponectin/leptin ratio were observed.

CONCLUSION

Obese adolescents with moderate and high reduction in SFA presented improvements on pro/anti-inflammatory biomarkers and cIMT, leading to reduction in cardiovascular risks.

Hyperleptinemia: implications on the inflammatory state and vascular protection in obese adolescents submitted to an interdisciplinary therapy

The low-grade systemic inflammation seen in obesity may affect the actions of some adipose tissue-derived adipokines that are involved in the regulation of vascular function. We sought to verify whether hyperleptinemia may influence the inflammatory and atherogenic responses in obese adolescents undergoing interdisciplinary therapy. Thirty-four obese adolescents underwent interdisciplinary therapy for 1 year. Subjects were considered hyperleptinemic if they had baseline values of leptin above 20 ng/mL for boys and 24 ng/mL for girls. Both groups showed an improvement in body composition and a reduction in carotid intima-media thickness. However, only subjects in the non-hyperleptinemic group showed an increase in adiponectin concentration after therapy. Moreover, leptin concentration was positively correlated with adiponectin and inversely correlated with PAI-1 in this group. Hyperleptinemic state may impair the attenuation of inflammation in obese adolescents undergoing interdisciplinary therapy, particularly by impeding the increase in adiponectin concentration, which is directly involved in vascular protection.

Saturated fatty acid intake can influence increase in plasminogen activator inhibitor-1 in obese adolescents

The aim of this study was to verify if saturated fatty acid intake adjusted by tertiles can influence metabolic, inflammation, and plasminogen activator inhibitor-1 (PAI-1) in obese adolescents. Body mass, height, body mass index, waist circumference, blood pressure, and body composition of 108 obese adolescents were obtained. Fasting glucose, insulin, PAI-1, and CRP were determined. Insulin resistance was assessed by Homeostasis Model Assessment (HOMA-IR) and insulin sensitivity by Quantitative Insulin Sensitivity Check Index (QUICKI). Dietetic intake was estimated by a 3-day dietary record, and volunteers were divided according to consumption of saturated fatty acids: tertile 1 [Low Saturated Fatty Acid Intake (Low-SFA): ≤12.14 g], tertile 2 [Moderate Saturated Fatty Intake (Moderate SFA intake): 12.15-20.48 g], and tertile 3 [High Saturated Fatty Acid Intake (High-SFA Intake); >20.48 g]. Statistical analysis was performed using STATISTICA 7.0 software and the significance level was set at p<0.05. The most important finding in the present study is that Moderate and High-SFA intakes presented significantly higher values of PAI-1 than Low-SFA Intake. PAI-1 was positively associated with saturated fatty intake, waist circumference, mean blood pressure, and HOMA-IR. SFA intake was predictor of PAI-1 independent of body fat, HOMA-IR and total-cholesterol. In addition, PAI-1 was an independent predictor of blood pressure. HOMA-IR and QUICKI presented significantly higher and lower, respectively, in High-SFA compared to Moderate-SFA intake. High-SFA influenced cardiovascular disease risks, since it increased PAI-1 and insulin resistance, and decreased insulin sensibility, leading to vicious cycle among food ingestion, pro-thrombotic state, and cardiovascular risks in obese adolescents.

The role of leptinemia state as a mediator of inflammation in obese adults

Hyperleptinemia has emerged as a marker of proinflammatory status, while the adiponectin/leptin ratio has been used to identify anti-inflammatory state. In this context, the aims of the present study were to investigate the role of leptinemia, adjusted by tertiles, on inflammatory state in obese adults according to obesity degree. This is a cross-sectional study comprised of 43 obese adults. The anthropometric variables and body composition were analyzed, as well as markers of inflammation such as leptin, adiponectin, and plasminogen activator inhibitor. Subjects were grouped using adjusted tertiles of the leptin levels. The major finding was the negative correlation between leptin concentration with adiponectin/leptin ratio (r=-0.622, p=0.000) and the positive correlation with leptin/adiponectin ratio (r=0.622, p=0.000). Indeed, both ratios were decreased and increased, respectively, according to the obesity degree. Furthermore, in the stepwise multiple linear regression analysis, the high degree of obesity was an independent predictor of leptinemia when adjusted for age and BMI (β=0.588, p=0.000 and β=0.778, p=0.005). Finally, the strong negatively correlation between the leptinemia with adiponectin/leptin ratio and the positive correlation with leptin/adiponectin ratio reinforce the role of this adipokine as a biomarker of inflammation in obese adults, according to obesity degree. Our findings can elucidate that hyperleptinemic status was a major factor in the proinflammatory status related to higher obesity degree. All together, these data reinforce the role of leptinemia state as a mediator of inflammation in obese adults.

The effect of weight loss magnitude on pro-/anti-inflammatory adipokines and carotid intima-media thickness in obese adolescents engaged in interdisciplinary weight loss therapy

BACKGROUND

Obesity is a chronic disease defined by an excess amount of adipose tissue and presents a low-grade inflammatory state, increasing cardiovascular risk.

OBJECTIVE

To assess the effect of weight loss magnitude on the inflammatory profile and carotid intima-media thickness (cIMT) in obese adolescents engaged in interdisciplinary therapy.

DESIGN AND PATIENTS

Seventy-seven postpubertal obese adolescents with a BMI greater than the 95th percentile (37·18 ± 5·14), of both genders and between the ages of 14 and 19 years (16·74 ± 1·59) were subjected to a 1-year period of interdisciplinary intervention (nutrition, psychology, physical exercise and clinical support).

MEASUREMENTS

Blood samples were collected to analyse glucose, lipid and adipokine concentrations. Body composition, anthropometric profiles and cIMT were measured. The results are presented according to quartiles of weight loss: 1st (≤5·80 kg) = low; 2nd (5·80-10·90 kg) = low to moderate; 3rd (10·90-15·90 kg) = moderate; and 4th (>15·90 kg) = massive.

RESULTS

Leptin, the leptin/adiponectin ratio and plasminogen activator inhibitor 1 (PAI-1) were decreased significantly in the low-to-moderate weight loss. The cIMT was reduced in the moderate weight loss. Moreover, adiponectin was increased only in the massive weight loss. Additionally, weight loss was an independent predictor of changes in leptin level, the adiponectin/leptin ratio (A/L ratio) and PAI-1 when the data were adjusted for age and gender. BMI changes were predictors of changes in leptin and PAI-1 levels. A/L ratio was associated with lean body mass (%), independent of gender and age. In addition, changes in A/L ratio were independent predictors of cIMT alterations.

CONCLUSIONS

Interdisciplinary therapy may reduce cardiovascular risk factors among adolescents depending on their degree of weight loss (moderate to massive) and when correlated with their inflammatory profile, metabolic state and cIMT.

Is the neck circumference an emergent predictor for inflammatory status in obese adults?

BACKGROUND

Plasminogen Activator Inhibitor 1 (PAI-1) is a prothrombotic adipokine involved in the coagulation cascade and fibrinolysis that associated with proinflammatory adipokines may increase the risk related to obesity. Anthropometric measures are commonly used in clinical practice and, currently, neck circumference (NC) has been used as a marker of cardiovascular risk that can favour inflammatory factors.

OBJECTIVE

To verify the possible correlations between prothrombotic and pro/anti-inflammatory markers with anthropometric measurements in obese.

SUBJECTS AND METHODS

  A total of 43 obese adults were enrolled. The variables include body mass, stature, body mass index (BMI), NC, chest circumference (CC), abdominal circumference (AC), hip circumference (HC), blood pressure and blood collection used to assess the level of adipokines.

RESULTS

The sample was stratified by BMI. PAI-1 levels were positively correlated with body mass (r=0.31, p=0.04), NC (r=0.43, p=0.004), CC (r=0.40, p=0.004), AC (r=0.37, p=0.01), diastolic blood pressure (r=0.35, p=0.03), leptin/adiponectin ratio (r=0.36, p=0.01) and negatively correlated with adiponectin (r=-0.34, p=0.02). In stepwise multiple linear regression analysis, NC showed to be an independent predictor to PAI-1 when adjusted for gender and BMI, according to the age (β=0.47, p=0.02 and β=0.42, p=0.02 respectively).

CONCLUSION

In conclusion, NC could be suggested as an independent predictor higher PAI-1. This association can be a new screening of persons at an enhanced cardiovascular risk and inflammation in this obese population, so useful in clinical practice.

Interaction of bone mineral density, adipokines and hormones in obese adolescents girls submitted in an interdisciplinary therapy

Obesity is a chronic inflammatory condition with numerous metabolic consequences to the organism, highlighting its influence on bone mass. Therefore, the aim of this study was to verify the role of visceral fat, leptin, adiponectin and ghrelin on bone mineral density in obese post-puberty adolescents girls, submitted to an interdisciplinary therapy. The study involved 20 post-puberty obese adolescent girls: 16±1.5 years of age, 98.9±15.8 kg (weight), 1.60±0.72 m (height) and 37.2±4.8 kg/m2 [body mass index (BMI)]. Anthropometric measurements, body composition, visceral fat, subcutaneous fat, bone mineral density and content were determined. Ghrelin, leptin and adiponectin were analyzed and the leptin/adiponectin ratio was calculated. Our findings showed a significant increase in adiponectin concentration and a reduction in body weight, BMI, total fat mass, visceral and subcutaneous fat. In addition, ghrelin (r2=-0.53; p=0.02) visceral fat (r2=-0.46, p=0.04) (r2 -0.66, p=0.001) and leptin/adiponectin ratio (r2 -0.56, p=0.01) were negative predictors for bone mineral density and content in obese adolescent girls, respectively. It provides a novel physiologically concept that may shed light on the etiology of osteoporosis and help to identify new therapeutic targets. However this should be confirmed in a large cohort study.

The role of pro/anti-inflammatory adipokines on bone metabolism in NAFLD obese adolescents: effects of long-term interdisciplinary therapy

To investigate the role of pro- and anti-inflammatory adipokines in the bone metabolism of non-alcoholic fatty liver disease (NAFLD) obese adolescents as well as the effects of long-term interdisciplinary therapy on metabolic-related risk factors. Forty post-puberty obese adolescents were randomly assigned into two groups: (1) NAFLD group and (2) non-NAFLD group (diagnosis by ultrasonography) and submitted to a weight loss therapy. Body composition was analyzed by air displacement plethysmography, bone mineral density (BMD) and content by dual-energy X-ray absorptiometry, blood samples were collected to measure lipid profile, hepatic enzymes, and adipokines. Leptin and adiponectin concentrations were measured by ELISA. A decrease in total body mass, BMI, body fat, visceral and subcutaneous fat, insulin concentration, HOMA-IR, total cholesterol and an increase in lean body mass were observed in both groups after therapy. It was found positive correlation between the Δ BMD and the Δ fat mass (%) (r = 0.31, P = 0.01) and negative correlations between Δ BMC with Δ HOMA-IR (r = -0.34, P = 0.02) and Δ HOMA-IR with Δ leptin (r = -0.34, P = 0.02). In addition, increased levels of adiponectin and reduction in leptin concentrations were observed in NAFLD group. In the simple regression analysis, the HOMA-IR was an independent predictor changes in BMC in total obese adolescents and in the non-NAFLD group. One year of interdisciplinary weight loss therapy for obese adolescents with or without NAFLD, could regulate bone mineral metabolism as result of an increased BMC and improved inflammatory state.

Influence of visceral and subcutaneous fat in bone mineral density of obese adolescents

OBJECTIVE

To verify the influence of visceral and subcutaneous fat, as well adipokines in bone mineral density (BMD) in obese adolescents.

SUBJECTS AND METHODS

The study involved 125 postpubertal obese adolescents (45 boys and 80 girls). Anthropometric measurements, body composition, visceral and subcutaneous fat, and BMD were determined. Leptin, adiponectin, and insulin levels also analyzed.

RESULTS

Data demonstrated a negative relationship between BMD with insulin resistance, visceral fat and leptin concentration; and bone mineral content with visceral/subcutaneous ratio. Positive association between BMD and subcutaneous fat was observed.

CONCLUSIONS

Visceral fat and insulin resistance, as well as visceral/subcutaneous ratio and leptin concentration, were negative predictors of BMD in boys and girls, respectively. However, subcutaneous fat had a protective influence in BMD only in boys.

The role of pro/anti-inflammatory adipokines on bone metabolism in NAFLD obese adolescents: effects of long-term interdisciplinary therapy

To investigate the role of pro- and anti-inflammatory adipokines in the bone metabolism of non-alcoholic fatty liver disease (NAFLD) obese adolescents as well as the effects of long-term interdisciplinary therapy on metabolic-related risk factors. Forty post-puberty obese adolescents were randomly assigned into two groups: (1) NAFLD group and (2) non-NAFLD group (diagnosis by ultrasonography) and submitted to a weight loss therapy. Body composition was analyzed by air displacement plethysmography, bone mineral density (BMD) and content by dual-energy X-ray absorptiometry, blood samples were collected to measure lipid profile, hepatic enzymes, and adipokines. Leptin and adiponectin concentrations were measured by ELISA. A decrease in total body mass, BMI, body fat, visceral and subcutaneous fat, insulin concentration, HOMA-IR, total cholesterol and an increase in lean body mass were observed in both groups after therapy. It was found positive correlation between the Δ BMD and the Δ fat mass (%) (r = 0.31, P = 0.01) and negative correlations between Δ BMC with Δ HOMA-IR (r = -0.34, P = 0.02) and Δ HOMA-IR with Δ leptin (r = -0.34, P = 0.02). In addition, increased levels of adiponectin and reduction in leptin concentrations were observed in NAFLD group. In the simple regression analysis, the HOMA-IR was an independent predictor changes in BMC in total obese adolescents and in the non-NAFLD group. One year of interdisciplinary weight loss therapy for obese adolescents with or without NAFLD, could regulate bone mineral metabolism as result of an increased BMC and improved inflammatory state.