Effect of Weight Loss by Low-Calorie Diet on Cardiovascular Health in Type 2 Diabetes: An Interventional Cohort Study

Melhem, Shaden; Steven, Sarah; Taylor, Roy; Al‐Mrabeh, Ahmad

doi:10.3390/nu13051465

Cited by 11 publications

(9 citation statements)

References 48 publications

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“…Despite substantial weight loss of 7.3 kg on average and concomitant health improvements [ 32 ], 12 weeks of 25% energy reduction did not affect fasting FGF21 levels. Previous weight loss trials have reported conflicting findings, with some trials reporting a reduction in fasting FGF21 levels upon diet-induced weight loss [ 9 , 10 , 11 , 12 , 13 ], and others reporting an increase [ 40 ] or no effect on circulating FGF21 levels [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Generally, the studies that report a change in plasma fasting FGF21 were performed in individuals with more severely impaired metabolic health (e.g., T2DM, NAFLD, morbid obesity), who typically have elevated FGF21 levels and thus more room for improvement compared to individuals in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, circulating FGF21 levels have been reported to positively associate with BMI, body fat, liver fat content, blood pressure, insulin resistance (IR) and atherogenic lipid profiles [ 5 , 6 ], as well as predict incident metabolic syndrome and T2DM [ 7 , 8 ]. It is unclear whether and how weight loss and accompanying health improvements affect FGF21 levels, with some trials reporting reduced levels of circulating FGF21 upon diet-induced weight loss [ 9 , 10 , 11 , 12 , 13 ], and others reporting no effects on FGF21 [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Plasma FGF21 Levels Are Not Associated with Weight Loss or Improvements in Metabolic Health Markers upon 12 Weeks of Energy Restriction: Secondary Analysis of an RCT

et al. 2022

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Recent studies suggest that circulating fibroblast growth factor 21 (FGF21) may be a marker of metabolic health status. We performed a secondary analysis of a 12-week randomized controlled trial to investigate the effects of two energy restriction (ER) diets on fasting and postprandial plasma FGF21 levels, as well as to explore correlations of plasma FGF21 with metabolic health markers, (macro)nutrient intake and sweet-taste preference. Abdominally obese subjects aged 40–70 years (n = 110) were randomized to one of two 25% ER diets (high-nutrient-quality diet or low-nutrient-quality diet) or a control group. Plasma FGF21 was measured in the fasting state and 120 min after a mixed meal. Both ER diets did not affect fasting or postprandial plasma FGF21 levels despite weight loss and accompanying health improvements. At baseline, the postprandial FGF21 response was inversely correlated to fasting plasma glucose (ρ = −0.24, p = 0.020) and insulin (ρ = −0.32, p = 0.001), HOMA-IR (ρ = −0.34, p = 0.001), visceral adipose tissue (ρ = −0.24, p = 0.046), and the liver enzyme aspartate aminotransferase (ρ = −0.23, p = 0.021). Diet-induced changes in these markers did not correlate to changes in plasma FGF21 levels upon intervention. Baseline higher habitual polysaccharide intake, but not mono- and disaccharide intake or sweet-taste preference, was related to lower fasting plasma FGF21 (p = 0.022). In conclusion, we found no clear evidence that fasting plasma FGF21 is a marker for metabolic health status. Circulating FGF21 dynamics in response to an acute nutritional challenge may reflect metabolic health status better than fasting levels.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Plasma FGF21 Levels Are Not Associated with Weight Loss or Improvements in Metabolic Health Markers upon 12 Weeks of Energy Restriction: Secondary Analysis of an RCT

et al. 2022

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“…Weight loss brought about similar changes in intraorgan fat and VLDL1-TG production rate but not fasting plasma VLDL1-TG levels in both sexes. Estimated CVD risk was high in diabetes, with substantial improvement in both sexes after weight loss [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Sex differences in intraorgan fat levels and hepatic lipid metabolism: implications for cardiovascular health and remission of type 2 diabetes after dietary weight loss

et al. 2021

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Aims/hypothesis Type 2 diabetes confers a greater relative increase in CVD risk in women compared with men. We examined sex differences in intraorgan fat and hepatic VLDL1-triacylglycerol (VLDL1-TG) export before and after major dietary weight loss. Methods A group with type 2 diabetes (n = 64, 30 male/34 female) and a group of healthy individuals (n = 25, 13 male/12 female) were studied. Intraorgan and visceral fat were quantified by magnetic resonance and VLDL1-TG export by intralipid infusion techniques. Results Triacylglycerol content of the liver and pancreas was elevated in people with diabetes with no sex differences (liver 16.4% [9.3–25.0%] in women vs 11.9% [7.0–23.1%] in men, p = 0.57, and pancreas 8.3 ± 0.5% vs 8.5 ± 0.4%, p = 0.83, respectively). In the absence of diabetes, fat levels in both organs were lower in women than men (1.0% [0.9–1.7%] vs 4.5% [1.9–8.0%], p = 0.005, and 4.7 ± 0.4% vs 7.6 ± 0.5%, p< 0.0001, respectively). Women with diabetes had higher hepatic VLDL1-TG production rate and plasma VLDL1-TG than healthy women (559.3 ± 32.9 vs 403.2 ± 45.7 mg kg−1 day−1, p = 0.01, and 0.45 [0.26–0.77] vs 0.25 [0.13–0.33] mmol/l, p = 0.02), whereas there were no differences in men (548.8 ± 39.8 vs 506.7 ± 29.2 mg kg−1 day−1, p = 0.34, and 0.72 [0.53–1.15] vs 0.50 [0.32–0.68] mmol/l, p = 0.26). Weight loss decreased intraorgan fat and VLDL1-TG production rates regardless of sex, and these changes were accompanied by similar rates of diabetes remission (65.4% vs 71.0%) and CVD risk reduction (59.8% vs 41.5%) in women and men, respectively. Conclusions/interpretation In type 2 diabetes, women have liver and pancreas fat levels as high as those of men, associated with raised hepatic VLDL1-TG production rates. Dynamics of triacylglycerol turnover differ between sexes in type 2 diabetes and following weight loss. These changes may contribute to the disproportionately raised cardiovascular risk of women with diabetes. Graphical abstract

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“…Among all the factors that could affect the CRIWL-induced cFGF21 change, we found that the protein content in the diet could be a key factor with a 30% calorie from protein as a cutoff value. Most of the CRIWLdecreased cFGF21 results were obtained with relatively high dietary protein contents (≥30E% protein) (32)(33)(34)(35)(36), while controversial results were obtained with relatively low dietary protein contents (<30E% protein) (36)(37)(38)(39)(40) or with diets with unspecified protein contents (32,41,42).…”

Section: Calorie Restriction-induced Weight Loss and Cfgf21mentioning

confidence: 99%

Close association between lifestyle and circulating FGF21 levels: A systematic review and meta-analysis

Qian

Zhang

et al. 2022

Front. Endocrinol.

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BackgroundThe impact of lifestyle factors on circulating fibroblast growth factor 21 (cFGF21) remains unclear. We conducted this systematic review and meta-analysis to evaluate the association between lifestyle factors and cFGF21 levels.MethodsWe included studies that evaluated the effects of different lifestyles on cFGF21 concentration in adults, which included smoking, exercise, diets, alcohol consumption and weight loss. Random effects models or fixed effects models were used for meta-analysis to calculate the standardized mean difference (SMD) and 95% confidence interval according to the heterogeneity among studies. Study quality was assessed using the Newcastle–Ottawa Scale for cohort studies, the Joanna Briggs Institution Checklist for cross-sectional studies, and the PEDro scale for experimental studies.ResultsA total of 50 studies with 1438 individuals were included. Overall, smoking, a hypercaloric carbohydrate-rich diet, a hypercaloric fat-rich diet, amino acid or protein restriction, excessive fructose intake and alcohol consumption significantly upregulated cFGF21 levels (p<0.05), whereas fish oil intake and calorie restriction with sufficient protein intake significantly decreased cFGF21 (p<0.05). Compared to the preexercise cFGF21 level, the cFGF21 level significantly increased within 3 hours postexercise (p<0.0001), while it significantly decreased in the blood sampled >6 h postexercise (p=0.01). Moreover, higher exercise intensity resulted in higher upregulation of cFGF21 at 1-hour post exercise (p=0.0006).ConclusionFGF21 could serve as a potential biomarker for the assessment of different lifestyle interventions. When it is used for this purpose, a standard study protocol needs to be established, especially taking into consideration the intervention types and the sampling time post-intervention.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021254758, identifier CRD42021254758.

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Effect of Weight Loss by Low-Calorie Diet on Cardiovascular Health in Type 2 Diabetes: An Interventional Cohort Study

Cited by 11 publications

References 48 publications

Plasma FGF21 Levels Are Not Associated with Weight Loss or Improvements in Metabolic Health Markers upon 12 Weeks of Energy Restriction: Secondary Analysis of an RCT

Plasma FGF21 Levels Are Not Associated with Weight Loss or Improvements in Metabolic Health Markers upon 12 Weeks of Energy Restriction: Secondary Analysis of an RCT

Sex differences in intraorgan fat levels and hepatic lipid metabolism: implications for cardiovascular health and remission of type 2 diabetes after dietary weight loss

Close association between lifestyle and circulating FGF21 levels: A systematic review and meta-analysis

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