Clinical Implications of Obesity With Specific Focus on Cardiovascular Disease

Klein, Samuel; Burke, Lora E.; Bray, George A.; Blair, Steven N.; Allison, David B.; Pi‐Sunyer, Xavier; Hong, Yuling; Eckel, Robert H.

doi:10.1161/01.cir.0000145546.97738.1e

Cited by 786 publications

(316 citation statements)

References 207 publications

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“…These recommendations may require modification, however, as new information is generated from additional diet intervention studies [80]. " Rather than additional studies, however, we provide new information from an evaluation of papers already in the literature that may provide a basis for modification.…”

Section: Discussionmentioning

confidence: 99%

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

2005

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Metabolic Syndrome (MetS) represents a constellation of markers that indicates a predisposition to diabetes, cardiovascular disease and other pathologic states. The definition and treatment are a matter of current debate and there is not general agreement on a precise definition or, to some extent, whether the designation provides more information than the individual components. We consider here five indicators that are central to most definitions and we provide evidence from the literature that these are precisely the symptoms that respond to reduction in dietary carbohydrate (CHO). Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure. In addition, low fat, high CHO diets have long been known to raise TAG, lower HDL and, in the absence of weight loss, may worsen glycemic control. Thus, whereas there are numerous strategies for weight loss, a patient with high BMI and high TAG is likely to benefit most from a regimen that reduces CHO intake. Reviewing the literature, benefits of CHO restriction are seen in normal or overweight individuals, in normal patients who meet the criteria for MetS or in patients with frank diabetes. Moreover, in low fat studies that ameliorate LDL and total cholesterol, controls may do better on the symptoms of MetS. On this basis, we feel that MetS is a meaningful, useful phenomenon and may, in fact, be operationally defined as the set of markers that responds to CHO restriction. Insofar as this is an accurate characterization it is likely the result of the effect of dietary CHO on insulin metabolism. Glucose is the major insulin secretagogue and insulin resistance has been tied to the hyperinsulinemic state or the effect of such a state on lipid metabolism. The conclusion is probably not surprising but has not been explicitly stated before. The known effects of CHO-induced hypertriglyceridemia, the HDL-lowering effect of low fat, high CHO interventions and the obvious improvement in glucose and insulin from CHO restriction should have made this evident. In addition, recent studies suggest that a subset of MetS, the ratio of TAG/HDL, is a good marker for insulin resistance and risk of CVD, and this indicator is reliably reduced by CHO restriction and exacerbated by high CHO intake. Inability to make this connection in the past has probably been due to the fact that individual responses have been studied in isolation as well as to the emphasis of traditional therapeutic approaches on low fat rather than low CHO.We emphasize that MetS is not a disease but a collection of markers. Individual physicians must decide whether high LDL, or other risk factors are more important than the features of MetS in any individual case but if MetS is to be considered it should be recognized that reducing CHO will bring improvement. Response of symptoms to CHO ...

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Section: Discussionmentioning

confidence: 99%

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

2005

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“…22 Increases in BMI and waist circumference are associated with increased prevalence and incidence of hypertension and CVD. [22][23][24] Our study found both central obesity and higher BMI (at 24 kg m À2 or higher) were significantly associated with the prevalence of hypertension, especially in the Minnan group. In addition to hypertension, the highest prevalence of central obesity, elevated BMI, dyslipidaemia, hyperuricaemia (or gout) and diabetes mellitus in the Aborigines revealed poor general cardiovascular profiles in the Aborigines.…”

Section: Discussionmentioning

confidence: 50%

Ethnic variation in hypertension prevalence of women in Taiwan

Hwang

You

et al. 2008

J Hum Hypertens

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The prevalence and risk factors of hypertension vary in ethnic groups. This study aimed to estimate the hypertension prevalence and to compare risk factors associated with hypertension in women of four ethnic groups in Taiwan. The study subjects were participants in the Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia (TwSHHH) enrolled in 2002. In this analysis, only 2810 women who were at age of 20-80 years old and whose father and mother had same ethnic background (Minnan, Hakka, Aborigines or Mainland Chinese) were included. Results showed that there were significant ethnic differences in the prevalence of hypertension, obesity indices, fasting glucose, dyslipidaemia, hyperuricaemia, history of alcohol drinking and tobacco smoking and socioeconomic status. Aborigines had the highest prevalence of hypertension (28.6%) and diabetes mellitus (8.9%), whereas the Minnan group had the second highest prevalence of hypertension (19.2%) and diabetes mellitus (7.9%). Both age and central obesity were associated with an increased prevalence of hypertension except central obesity in Mainland Chinese in all four ethnic groups. Compared with the Mainland Chinese as the referent, the multivariateadjusted odds ratio (OR) (95% CI) was 1.19 (0.63-2.26), 1.92 (1.15-3.21) and 2.03 (1.00-4.12) for Hakka, Minnan and Aborigines, respectively. Elevated body mass index (X27.0 vs o24.0 kg m À2 ) and central obesity were significantly associated with hypertension showing multivariate-adjusted OR (95% CI) of 1.68 (1.18-2.38) and 1.95 (1.48-2.57), respectively. In addition, dyslipidaemia, hyperuricaemia and diabetes associated with higher OR for hypertension in Minnan women. In conclusion, there were ethnic variations in hypertension prevalence and determinants in Taiwanese women.

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“…21 However, some prospective population-based studies failed to confirm the independent influence of obesity on fatal outcomes. [22][23][24][25][26][27] Among others, undefined confounding risk factors associated with obesity and CHD risk might account for these inconsistencies.…”

Section: Discussionmentioning

confidence: 99%

Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA–KORA Augsburg Cohort Study 1984–1998

et al. 2006

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Objective: To examine the contribution of depressed mood in obese subjects on the prediction of a future coronary heart disease event (CHD). Design: A prospective population-based cohort study of three independent cross-sectional surveys with 6239 subjects, 45-74 years of age and free of diagnosed CHD, stroke and cancer. During a mean follow-up of 7 years, 179 CHD events occurred among men and 50 events among women. Subjects: A total of 737 (23%) male and 773 (26%) female subjects suffering from obesity (BMI X30 kg/m 2 ). Measurements: Body weight determined by trained medical staff following a standardized protocol; standardized questionnaires to assess subsyndromal depressive mood and other psychosocial features. Results: The main effect of obesity to predict a future CHD (hazard ratio, HR ¼ 1.38, 95% CI 1.03-1.84; P ¼ 0.031) and the interaction term of obesity by depression (HR ¼ 1.73, 95% CI 0.98-3.05; P ¼ 0.060) were borderline significant, both covariate adjusted for multiple risk factors. Relative to the male subgroup with normal body weight and no depression, the male obese group with no depression was not at significantly increased risk for CHD events (HR ¼ 1.17, 95% CI 0.76-1.80; P ¼ 0.473) whereas CHD risk in males with both obesity and depressed mood was substantially increased (HR ¼ 2.32, 95% CI 1.45-3.72, P40.0001). The findings for women were similar, however, not significant probably owing to lack of power associated with low event rates. Combining obesity and depressed mood resulted in a relative risk to suffer from a future CHD event of HR 1.84 (95% CI 0.79-4.26; P ¼ 0.158). Conclusions: Depressed mood substantially amplifies the CHD risk of middle-aged obese, but otherwise apparently healthy men. The impact of depression on the obesity risk in women is less pronounced.

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Clinical Implications of Obesity With Specific Focus on Cardiovascular Disease

Cited by 786 publications

References 207 publications

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

Ethnic variation in hypertension prevalence of women in Taiwan

Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA–KORA Augsburg Cohort Study 1984–1998

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