BackgroundObesity is associated with increased risk of cardiovascular disease. Arterial stiffness assessed by carotid femoral pulse wave velocity (PWV) is an independent predictor of cardiovascular morbidity and mortality. We aimed to investigate how various measures of body composition affect arterial stiffness.MethodsThis is an analysis of cross-sectional baseline data from a controlled clinical trial addressing changes in arterial stiffness after either surgery or lifestyle intervention in a population of morbidly obese patients. High-fidelity applanation tonometry (Millar®, Sphygmocor®) was used to measure pulse wave velocity (PWV). Carotid femoral PWV is a direct measure of arterial stiffness and is considered to be the gold standard method. The Inbody 720 Body Composition Analyzer was used for bioelectrical impedance analysis (BIA). Spearman's correlation, independent samples t-test, chi-square tests, Fisher's exact test and multiple linear regression analyses were used as statistical methods.ResultsA total of 133 patients (79 women), with a mean (SD) age of 43 (11) years were included in the study. Men had a significantly higher prevalence of obesity related comorbidities and significantly higher PWV, 9.1 (2.0) m/s vs. 8.1 (1.8) m/s, p = 0.003, than women. In the female group, PWV was positively correlated with WC, WHtR, BMI and visceral fat area. In the male group, PWV was negatively correlated with BMI. Multiple linear regression analysis showed that increasing BMI, WC, WHtR, visceral fat area and fat mass were independently associated with higher PWV in women, but not in men, after adjustment for age, hypertension and type 2 diabetes.ConclusionMost measures of general and abdominal obesity were predictors of arterial stiffness in female morbidly obese patients.Trial registrationClinicalTrials.gov Identifier NCT00626964

ObjectiveArterial stiffness is an independent predictor of cardiovascular morbidity and mortality. This study aimed to compare the 7-week effect of a low-calorie diet (LCD) and an intensive lifestyle intervention program (ILI) on arterial stiffness in morbidly obese individuals.Design and MethodsNonrandomized clinical trial. The LCD provided 900 kcal/day, and participants in the LCD group were instructed to maintain their habitual physical activity level. The ILI included two 90-min supervised training sessions 3 days a week at moderate to high intensity (4-8 METs) and a caloric restriction of 1000 kcal/day.ResultsA total of 179 individuals completed the study, 88 (56 women) in the ILI group and 91 (57 women) in the LCD group. High-fidelity applanation tonometry (Millar®, Sphygmocor®) was used to measure carotid-femoral pulse wave velocity (PWV). After adjustment for relevant confounders, the ILI group had a significantly greater reduction in PWV than the LCD group; −0.4 (−0.6, −0.1) m/s, P = 0.004. When compared to the LCD group, the ILI group showed a larger reduction in systolic and diastolic blood pressure −5 (−9, −1) and −5 (−7, −2) mmHg, P = 0.038 and P ≤ 0.001 respectively, whereas no difference was observed regarding pulse pressure, P = 0.661. No significant differences between groups were found regarding the loss of fat mass, P = 0.259, but the loss of muscle mass was larger in the LCD group, 0.8 (0.5, 1.1) kg, P ≤ 0.001.ConclusionDespite the limitations of a nonrandomized design, our findings indicate that for morbidly obese individuals a moderate caloric restriction combined with aerobic physical exercise is associated with a greater decline in PWV than a LCD alone.

This study aimed to compare the effects of two aerobic exercise programs of different intensities on energy expenditure. Methods: This was a single-center randomized controlled trial of patients with severe obesity allocated to a 24-week moderate-intensity continuous training (MICT) program or a combined MICT with highintensity interval training (HIIT/MICT) program. The primary outcome was energy expenditure during exercise (EEDE). Secondary outcomes included resting metabolic rate, cardiorespiratory fitness, and body composition. Results: A total of 82 (56% females) patients were screened, and 71 (55% females) patients were allocated to HIIT/MICT (n = 37) or MICT (n = 34). Per-protocol analysis showed that EEDE increased by 10% (95% CI: 3%-17%) in the HIIT/MICT group (n = 16) and 7.5% (95% CI: 4%-10%) in the MICT group (n = 24), with no differences between groups. In the 8-to 16-week per-protocol analysis, the HIIT/MICT group had a significantly larger increase in EEDE compared with the MICT group. Resting metabolic rate remained unchanged in both groups. HIIT/MICT and MICT were associated with significant weight loss of 5 kg and 2 kg, respectively. Conclusions: Patients completing a 24-week combined HIIT/MICT program did not achieve a higher EEDE compared with those who completed a 24-week MICT program. The HIIT/MICT group experienced, on average, a 3-kg-larger weight loss than the MICT group.

Objective: To compare the long-term effects of Roux-en-Y gastric bypass (GBS) and intensive lifestyle intervention (ILI) on aortic stiffness. Methods: Nonrandomized clinical trial. Aortic stiffness was assessed by carotid-femoral pulse wave velocity ( cf PWV) using high-fidelity applanation tonometry. Results: A total of 159 treatment-seeking morbidly obese patients were included, 82 (54 females) in the GBS-group and 77 (48 females) in the ILI-group. Participants in the GBS-group were younger (42.0 6 9.9 vs. 46.4 6 10.5 years), heavier (BMI 45.7 6 5.3 vs. 42.0 6 4.9 kg/m 2 ), and had lower systolic pressure (137 6 19 vs. 145 6 18 mm Hg) and pulse pressure (57 6 16 vs. 65 6 17 mm Hg), all P 0.006. Mean (SD) cf PWV at baseline was 8.6 6 1.7 m/s in the GBS-group and 8.6 6 1.9 m/s in the ILI-group, P 5 0.959. At follow-up, mean (95% CI) weight loss was larger in the GBS-group than in the ILI-group 243.3 (246.0 to 240.7) vs. 212.1 (214.6 to 29.6) kg, P < 0.001. The mean change in cf PWV was 20.02 (20.31 to 0.27) m/s in the GBS-group and 0.03 (20.28 to 0.33) m/s in the ILI-group, both P 0.412; adjusted betweengroup difference (ANCOVA) 0.05 (20.40 to 0.49) m/s, P 5 0.836. The adjusted regression analysis showed that weight loss was associated with increased cf PWV in the GBS-group. Conclusions: GBS and ILI had no significant long-term effects on aortic stiffness in treatment-seeking morbidly obese individuals.