Effect of Weight Loss and Lifestyle Changes on Vascular Inflammatory Markers in Obese Women: A Randomized Trial

JAMA. 2003 Apr 9;289(14):1799-804. doi: 10.1001/jama.289.14.1799.

Abstract

Context: Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue.

Objective: To determine the effect of a program of changes in lifestyle designed to obtain a sustained reduction of body weight on markers of systemic vascular inflammation and insulin resistance.

Design and setting: Randomized single-blind trial conducted from February 1999 to February 2002 at a university hospital in Italy.

Patients: One hundred twenty premenopausal obese women (body mass index > or =30) aged 20 to 46 years without diabetes, hypertension, or hyperlipidemia.

Interventions: The 60 women randomly assigned to the intervention group received detailed advice about how to achieve a reduction of weight of 10% or more through a low-energy Mediterranean-style diet and increased physical activity. The control group (n = 60) was given general information about healthy food choices and exercise.

Main outcome measures: Lipid and glucose intake; blood pressure; homeostatic model assessment of insulin sensitivity; and circulating levels of interleukin 6 (IL-6), interleukin 18 (IL-18), C-reactive protein (CRP), and adiponectin.

Results: After 2 years, women in the intervention group consumed more foods rich in complex carbohydrates (9% corrected difference; P<.001), monounsaturated fat (2%; P =.009), and fiber (7 g/d; P<.001); had a lower ratio of omega-6 to omega-3 fatty acids (-5; P<.001); and had lower energy (-310 kcal/d; P<.001), saturated fat (-3.5%; P =.007), and cholesterol intake (-92 mg/d; P<.001) than controls. Body mass index decreased more in the intervention group than in controls (-4.2; P<.001), as did serum concentrations of IL-6 (-1.1 pg/mL; P =.009), IL-18 (-57 pg/mL; P =.02), and CRP (-1.6 mg/L; P =.008), while adiponectin levels increased significantly (2.2 microg/mL; P =.01). In multivariate analyses, changes in free fatty acids (P =.008), IL-6 (P =.02), and adiponectin (P =.007) levels were independently associated with changes in insulin sensitivity.

Conclusion: In this study, a multidisciplinary program aimed to reduce body weight in obese women through lifestyle changes was associated with a reduction in markers of vascular inflammation and insulin resistance.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adiponectin
  • Adult
  • Biomarkers / blood
  • Body Mass Index
  • C-Reactive Protein / metabolism*
  • Cardiovascular Diseases
  • Diet, Reducing
  • Exercise
  • Female
  • Humans
  • Insulin Resistance
  • Intercellular Signaling Peptides and Proteins*
  • Interleukin-18 / blood*
  • Interleukin-6 / blood*
  • Life Style*
  • Obesity / blood*
  • Obesity / therapy*
  • Premenopause
  • Proteins / metabolism*
  • Risk Factors
  • Risk Reduction Behavior*
  • Single-Blind Method
  • Weight Loss / physiology*

Substances

  • Adiponectin
  • Biomarkers
  • Intercellular Signaling Peptides and Proteins
  • Interleukin-18
  • Interleukin-6
  • Proteins
  • C-Reactive Protein