R. Conde

Effects of a low-fat versus a low-carbohydrate diet on adipocytokines in obese adults.

Background and Aims: There are few studies addressing the effect of weight loss on circulating levels of adipocytokines. The aim of our study was to determine whether different diets would have different weight loss effects and to examine the changes in adipocytokine levels. Methods: A population of 90 obesity non-diabetic outpatients was analyzed in a prospective way. The patients were randomly allocated to two groups: (a) diet I (low-fat diet), and (b) diet II (low-carbohydrate diet). At baseline and after 3 months on the diet, adipocytokines were evaluated. Results: 43 patients were randomized to group I and 47 patients to diet group II. No differences were detected between weight loss in either group (3.3 ± 0.51 vs. 4.4 ± 0.6 kg; n.s.). In group I, a significant decrease in leptin levels was found. In group II, leptin and C-reactive protein (CRP) levels also decreased. The decrease in leptin levels was lower with diet I than II (16.4 vs. 22.8%; p < 0.05). Conclusion: The serum leptin concentration decreased due to the 3-month intervention with low-fat and low-carbohydrate diets, without changes in other adipocytokines. The decrease in leptin and CRP levels were higher with a low-carbohydrate diet than a low-fat diet.

Influence of ALA54THR Polymorphism of Fatty Acid Binding Protein 2 on Lifestyle Modification Response in Obese Subjects

Background/Aim: It has been found that the expression of fatty acid binding protein 2 (FABP2) mRNA is under dietary control. A G-to-A transition at codon 54 of FABP2 results in an amino acid substitution (from Ala 54 to Thr 54). This polymorphism was associated with high insulin resistance and high fasting insulin concentrations. The aim of our study was to investigate the influence of Thr54 polymorphism in the FABP2 protein on the response to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients. Methods: A population of 69 obese (body mass index >30) nondiabetic outpatients was analyzed in a prospective way. Before and after 3 months of the lifestyle modification program, indirect calorimetry, tetrapolar electrical bioimpedance measurement, blood pressure recording, serial assessment of the nutritional intake (3 days of written food records), and biochemical analysis were performed. The lifestyle modification program consisted of a hypocaloric diet (1,520 kcal; 52% carbohydrates, 25% lipids, and 23% proteins). The exercise program consisted of aerobic exercise for at least three times/week (60 min each). Statistical analysis was performed for combined Ala54/Thr54 and Thr54/Thr54 as a mutant group and wild-type Ala54/Ala54 as second group. Results: The mean age was 45.5 ± 16.7 years, the mean body mass index was 34.1 ± 5.1, and there were 14 males (20.3%) and 55 females (79.7%) with a weight loss of 3.17 ± 3.5 kg (3.5%). Thirty-seven patients (53.6%) had the genotype Ala54/Ala54 (wild-type group) and 32 (46.4%) patients either the genotype Ala54/Thr54 (26 patients, 30.2%) or the genotype Thr54/Thr54 (6 patients, 16.2%). The percentage of responders (weight loss) was similar in both groups (89.2 vs. 90.6%). In the wild-type group, body mass index, weight, fat mass, low-density lipoprotein cholesterol level, and waist circumference decreased, whereas the VO2 (oxygen consumption) increased. In the mutant group, glucose, body mass index, weight, waist circumference, and systolic blood pressure decreased, and VO2 increased. No differences were detected between basal values in both groups. Only the leptin levels showed a significant decrease in the wild-type group (23.85%; p < 0.05), with no statistically significant difference in the mutant group (2.59%; NS). Resistin, tumor necrosis factor alpha, interleukin 6, insulin, and C-reactive protein remained without changes in both groups. Conclusions: Weight loss is associated with different changes, depending on the FABP2 genotype. Carriers of the Thr54 allele have a different response than wild-type obese subjects, with a significant decrease of systolic blood pressure and glucose levels in Thr54 carriers and a significant decrease in fat mass, low-density lipoprotein cholesterol, and leptin in wild-type patients.

Relation of resistin levels with cardiovascular risk factors and insulin resistance in non-diabetes obese patients

BACKGROUND The aim of the present study was to explore the relationship of resistin levels with these above mentioned factors. SUBJECTS A population of 213 obese was analyzed. A complete nutritional and biochemical evaluation was performed. RESULTS The mean age was 45.1+16.7 years, the mean BMI was 35.6+5.7. Higher weight, fat mass, fat free mass, waist to hip ratio, RMR, insulin and HOMA levels were observed in men than women. In all group, the analysis with a dependent variable (resistin) showed that fat mass remained in the model (F=2.48; p<0.05), with an increase of 0.033 ng/ml (CI 95%: 0.011-0.055) with each 1 kg of fat mass and a decrease of -0.29 ng/ml (CI 95%: -0.53, -0.01) with each mmHg of diastolic blood pressure. In a second model (only women) (resistin), fat mass remained in the model (F=6.06; p<0.05), with an increase of 0.037 ng/ml (CI 95%: 0.015, 0.06) with each kg of fat mass and a decrease of -0.032 ng/ml (CI 95%: -0.054, -0.01) with each mmHg of diastolic blood pressure. The third multivariate analysis (only men) did not show any relation among resistin levels and other parameters. CONCLUSION Resistin levels are related with different cardiovascular risk and anthropometric parameters, without relation with insulin resistance. A sex interaction has been observed.

Decreased basal levels of glucagon-like peptide-1 after weight loss in obese subjects.

Objective: Basal glucagon-like peptide-1 (GLP-1) concentrations seem to be attenuated in obese subjects, although statistical significance is unclear. Only a few studies have investigated the effect of weight reduction on GLP-1 concentrations and have found unclear results. The aim of the present study was to determine whether subjects who lose weight on a hypocaloric diet experience the same change in circulating GLP-1 levels as subjects who do not lose weight. Material and Methods: A population of 99 obese nondiabetic outpatients was analyzed in a prospective way. Weight and blood pressure were determined. Basal glucose, C-reactive protein, insulin, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and basal GLP-1 blood levels were measured before and after 3 months of hypocaloric diet. Bipolar impedance examination was performed in all patients to assess body composition. The lifestyle modification program consisted of a hypocaloric diet (1,520 kcal, 52% carbohydrates, 25% lipids and 23% proteins). The exercise program consisted of aerobic exercise for at least 3 times per week (60 min each). Results: Ninety-nine patients (20 male/79 female) gave informed consent and were enrolled in the study. Fourteen patients (2 male/12 female) did not lose weight (group I: weight increase of 2 ± 1.1 kg, NS) and 75 patients (18 male/67 female) lost weight (group II, weight loss of 4 ± 1.6 kg, p < 0.05). Weight, body mass index, fat mass, waist circumference, insulin, HOMA, LDL cholesterol, triglycerides and systolic blood pressure improved in group II, without significant statistical changes in group I. In group I, basal GLP-1 levels remained unchanged (7.4 ± 3.1 vs. 7.15 ± 3.6 ng/ml, NS). In group II, GLP-1 levels decreased significantly (8.4%, 6.88 ± 2.5 vs. 6.3 ± 2.4 ng/ml, p < 0.05). In the multivariate analysis with a dependent variable (levels of GLP-1 after hypocaloric diet adjusted by age and sex), only insulin levels remained as an independent predictor in the model (F = 5.9; p < 0.05), with an increase of 0.6 ng/ml (CI 95%: 0.1–1.1) in GLP-1 concentrations with each 1-mIU/ml increase of insulin. Conclusion: Hypocaloric diet decreased GLP-1 levels in patients with weight loss with a significant improvement in anthropometric parameters and cardiovascular risk factors. Nevertheless, patients without weight loss after dietary treatment exhibited unchanged GLP-1 levels. Basal insulin correlates with basal GLP-1.

Influence of Ala54Thr polymorphism of fatty acid-binding protein 2 on weight loss and insulin levels secondary to two hypocaloric diets: A randomized clinical trial

OBJECTIVE A transition G to A at codon 54 of FABP2 was associated with high insulin resistance and different dietary response. The aim of our study was to investigate the influence of this polymorphism on weight loss and metabolic changes secondary to two hypocaloric diets. SUBJECTS AND METHODS A sample of 204 obesity patients was analyzed. Before and after 2 months of hypocaloric diet, a nutritional evaluation was performed. Patients were randomly allocated to diet I (low-fat diet) or II (low carbohydrate diet). RESULTS With diet Type I and in the wild group (Ala54/Ala54), BMI, weight, fat mass, waist circumference, waist to hip ratio, systolic and diastolic blood pressures, total cholesterol, triglyceride and insulin levels decreased. In the mutant group (Ala54/Thr54 and Thr54/Thr54), BMI, weight, waist circumference and fat mass decreased. In the wild group with diet Type II, the same parameters that group I decreased and glucose levels, too. In the mutant group, BMI, weight, waist circumference and fat mass decreased. Only leptin levels have a significant decrease in the wild group with both diets (diet I: 30.7%; p<0.05 and diet II: 15.85%; p<0.05). CONCLUSION Similar weight loss is associated with different changes, depending on the FABP genotype with both diets. Weight loss is associated with a more deep decrease in serum leptin concentration with low-fat diet.

Relation of Trp64Arg polymorphism of beta 3-adrenergic receptor gene to adipocytokines and fat distribution in obese patients.

Background/Aim: Obesity has multiple causes and is determined by the interaction between genetic and environmental factors. A genetic factor is a (Trp64Arg) missense mutation in the beta 3-adrenergic receptor. The aim of our study was to investigate the influence of Trp64Arg polymorphism in the beta 3-adrenergic receptor gene on weight, adipocytokines, insulin resistance, and fat distribution in obese patients. Methods: A population of 217 nondiabetic obese Caucasian outpatients was analyzed. Indirect calorimetry and tetrapolar bioimpedance results, blood pressure, nutritional intake with 3-day food records, and biochemical parameters were evaluated. The genotype of beta 3-adrenergic receptor gene polymorphism (Trp64Arg) was studied. Results: The mean age of the patients was 44.3 ± 16.4 years, and the mean body mass index was 35.2 ± 5.2. One hundred and eighty-six patients (52 males and 134 females; 85.8%) had the genotype Trp64/Trp64 (wild-type group), and 31 patients (11 males and 20 females; 14.2%) had the genotype Trp64/Arg64 (mutant group). In the mutant group, body mass index, weight, fat mass, waist-to-hip ratio, waist circumference, and C-reactive protein levels were higher than in the wild-type group. The adipocytokine levels were similar in both groups. Conclusion: The patients of the mutant group (Trp64/Arg64) had higher body mass index, weight, waist circumference, fat mass, waist-to-hip ratio, and C-reactive protein values than those of the wild-type group.

Circulating visfatin in obese non-diabetic patients in relation to cardiovascular risk factors, insulin resistance, and adipocytokines: a contradictory piece of the puzzle.

OBJECTIVE Obesity and insulin resistance are associated with cardiovascular risk factors. The aim of the present study was to explore the relation of circulating visfatin to insulin resistance, cardiovascular risk factors, anthropometry, and adipocytokines in obese patients without diabetes mellitus. METHODS A population of 228 obese non-diabetic outpatients was analyzed in a prospective way. All patients with a 2-wk weight-stabilization period before recruitment were enrolled. Biochemical analysis and nutritional evaluation were performed. RESULTS Subjects were 62 men (27.2%) and 166 women (62.8%) with a mean age of 41.1 ± 16.4 y and a mean body mass index of 35.8 ± 3.6 kg/m(2). Patients were divided in two groups by median visfatin value (22.8 ng/mL), i.e., those with low values (group I) and those with high values (group II). Patients in group I had greater weight, body mass index, fat mass, fat-free mass, insulin, homeostasis model of assessment, triacylglycerol, leptin, and adiponectin than patients in group II. Patients in group II had higher total cholesterol, low-density lipoprotein cholesterol, resistin, and tumor necrosis factor-α levels than patients in group I. In a multivariate analysis with age- and sex-adjusted basal visfatin concentration as a dependent variable, only weight and leptin remained as an independent predictor in the model (F = 6.5, P < 0.05), with an inverse correlation. CONCLUSION Total cholesterol, low-density lipoprotein cholesterol, tumor necrosis factor-α, and resistin levels are elevated in patients with visfatin levels above the median value. Homeostasis model of assessment, insulin, weight, fat mass, fat-free mass, triacylglycerols, leptin, and adiponectin are decreased in these patients.

Double blind randomized clinical trial controlled by placebo with an alpha linoleic acid and prebiotic enriched cookie on risk cardiovascular factor in obese patients

INTRODUCTION Inulin and FOS are prebiotics with potential benefit in cardiovascular risk factors. Alpha linolenic acid (ALA) is the metabolic precursor of the long chain n-3 fatty acid eicosapentaenoic acid (20: 5n-3), this fatty acid has anti-inflammatory properties. The aim of our study was to evaluate the response of the cardiovascular risk profile in obese patients after inclusion in the diet of an ALA, FOS and inulin enriched-cookie. MATERIAL AND METHODS 36 patients were randomized in both branches: group I (inulin, FOS and ALA enriched cookie) Gullon SL(®) and group II (control cookie). Previous and after 1 month of the treatment, a nutritional and biochemical study was realized. RESULTS 15 patients finished the procotol in each group. In group I, a significantly increase in soluble fiber (2.3 ± 0.8 g/day vs 7.7 ± 0.8 g/day: p < 0.05) and ALA (0.6 ± 0.5 g/day vs 3.8 ± 0.5 g/day; p < 0.05) intakes was detected. In this group a significant decrease of total cholesterol (238.1 ± 45.3 mg/dl vs 210.5 ± 38.1 mg/dl: p < 0.05), LDL cholesterol (153.6 ± 23.2 mg/dl vs 127.1 ± 27.9 mg/dl: p < 0.05) and C reactive protein (6.6 ± 1.4 mg/dl vs 4.4+7-1.8 mg/dl: p < 0.05) was reached in males. Anthropometric parameters did not change in both groups. The increase in soluble fiber and ALA dietary intakes did not produce any gastrointestinal adverse effect. CONCLUSION The increase of 2 grams per day of inulin, 3.1 grams per day of FOS and 3.2 grams per day of alpha linolenic (ALA) dietary intakes from an enriched-cookie, improved total cholesterol, LDL cholesterol and C reactive protein levels in obese males. As far as we know, this is the first study that has evaluated the effect on risk factors of an ALA enriched cookies.

Influence of Ala54Thr polymorphism of fatty acid–binding protein-2 on clinical results of biliopancreatic diversion

OBJECTIVE Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate the fatty acid-binding protein-2 Ala54Thr polymorphism outcomes 1 y after biliopancreatic diversion in morbidly obese patients. METHODS A sample of 41 morbidly obese patients (body mass index >40 kg/m(2)) were operated upon from December 2004 to December 2006. Weight, fat mass, blood pressure, basal glucose, triacylglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at the basal visit and at each visit. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS Twenty-three patients (56.1%) had genotype Ala54/Ala54 (wild group) and 18 patients had genotype Ala54/Thr54 (15 patients, 36.5%) or Thr54/Thr54 (3 patients, 7.4%; mutant group). In the wild group, body mass index, weight, fat mass, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol, and triacylglycerol concentrations decreased. Diastolic blood pressure remained unchanged. In the mutant group, the same parameters improved, without statistical differences from the wild group. Initial excess weight percent loss at 1 y of follow-up was similar in both genotype groups (61.8% versus 61.9%, NS). CONCLUSION Polymorphism Ala54Thr of fatty acid-binding protein did not have an effect on weight loss or clinical outcomes after bariatric surgery.

Influence of Lys656Asn polymorphism of leptin receptor gene on leptin response secondary to two hypocaloric diets: a randomized clinical trial.

Background: Human obesity is characterized by high levels of leptin, and it has been suggested that obese patients may be leptin-resistant. Objective: The aim of our study was to investigate the influence of Lys656Asn polymorphism in the LEPR gene on leptin response secondary to a low fat versus a low carbohydrate diet in obese patients. Design: A population of 78 obesity patients was enrolled. Before and after 2 months of two diets, a nutritional evaluation was performed. Results: 52 patients had genotype Lys656/Lys656 (wild group) and 26 patients Lys656/Asn656 or Asn656/Asn656 (mutant group). In the low fat and wild groups, BMI, weight, fat mass, glucose, total cholesterol, triglyceride, insulin, and blood pressure decreased. In mutant type (MT), BMI, weight and fat mass decreased. In wild type (WT) with low carbohydrate diet, BMI, weight, fat mass, waist circumference, waist-to-hip ratio, total cholesterol, and blood pressures decreased. In MT, BMI, weight and fat mass decreased. Only leptin concentrations have a significant decrease in WT with both diets (diet I: 30.3%; p < 0.05) and (diet II: 15.5%; p < 0.05). Conclusion: In WT patients, the changes in serum leptin concentration due to 2 months’ intervention with low fat are higher than with a low carbohydrate diet.