2005

Int J Obes Relat Metab Disord. 2005 May 10.
Impact of total and central obesity on vascular mortality in patients undergoing coronary angiography.
Hoefle G, Saely CH, Aczel S, Benzer W, Marte T, Langer P, Drexel H.
[1] 1Department of Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria [2] 2Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria.

OBJECTIVE:To prospectively investigate the impact of total and central obesity on vascular mortality in patients undergoing coronary angiography.DESIGN:Prospective cohort study; mean follow-up 2.2 y.SUBJECTS:Men (n=513) and women (n=243) undergoing coronary angiography for the evaluation of coronary artery disease.MEASUREMENTS:Body mass index (BMI) was used as a measure of total obesity; waist-to-hip ratio (WHR) and waist circumference (WCf) as measures of central obesity. The primary study end point was vascular mortality; secondary study end points were total mortality, major coronary events, and cumulative vascular events.RESULTS:For both genders, BMI, WHR, and WCf correlated significantly with fasting plasma glucose, with HOMA insulin resistance, with triglycerides, and inversely with HDL cholesterol (P<0.001 for all correlations). In Cox regression analysis adjusting for age, gender, smoking, and total cholesterol, BMI was not associated with any study end point. In contrast, WHR (standardized adjusted odds ratios (OR) 2.01, 95% CI 1.02-3.93 for men and 2.63, 95% CI 1.38-5.00 for women), and WCf (OR=2.31, 95% CI 1.16-4.60 for men and 8.71, 95% CI 1.78-42.68 for women) proved independently predictive of vascular mortality. Additional adjustment for diabetes and hypertension did not substantially alter these results. Also, the predictive value of WHR and Wcf was retained after adjustment for drug treatment and the presence of significant coronary artery disease at baseline. Further, WHR and WCf were associated with total mortality, major coronary events, and cumulative vascular end points.CONCLUSION:Both total and central obesity are associated with insulin resistance and with an atherogenic lipoprotein profile. However, only central obesity is significantly and independently predictive of the 2-y vascular mortality in coronary patients.International Journal of Obesity advance online publication, 10 May 2005; doi:10.1038/sj.ijo.0802985.

2004

Wiad Lek. 2004;57 Suppl 1:24-8.
[Selected risk factors of the coronary heart disease in the group of women aged 30-65 from Krakow].[Article in Polish]
Brzostek T, Rak A, Piorecka B, Zwirska J, Nowacka A, Zyznawska B, Schlegel-Zawadzka M.
Z Instytutu Pielegniarstwa Wydzialu Ochrony Zdrowia Collegium Medicum Uniwersytetu Jagiellonskiego w Krakowie.

Mortality rates due to cardiovascular diseases (CD) in Poland are almost twice higher than in the European Union countries. The mortality caused by CD has paid the attention on the fact that it increases relatively among women in comparison to men. Epidemiological observations conducted in female groups indicated that the ischaemic heart disease (IHD) appears more frequently after menopause. The aim of the study was to evaluate some IHD risk factors in the group of women aged 30-65 from Krakow. The study included 95 women, without IHD diagnosis, voluntarily registered to the practice of nurses group. The menopause occurrence and selected possible to modify CD risk factors as a concentration of the total cholesterol, LDL cholesterol, fasting glucose, C-reactive protein (CRP) and also blood pressure, body mass index and waist circumference were assessed. The smoking of tobacco was estimated by an objective method (the level of carbon monoxide in breath out--smoke check). The level of depression was evaluated with the use of Beck Inventory Scale. The results were calculating using Statistica Pl 6.0 programme. The investigated group, especially women after natural menopause, had higher CD risk factors such as: hypercholesterolemia, systolic hypertension, overweight, tobacco smoking, CRP and depression. The tobacco smoking appeared more often in the group after menopause because of other reasons and in the group of women with regular menstruation. The rate of depression was also higher among women after menopause because of other reasons.

2002

J Altern Complement Med 2002 Oct;8(5):643-50
Medically supervised water-only fasting in the treatment of borderline hypertension.
Goldhamer AC, Lisle DJ, Sultana P, Anderson SV, Parpia B, Hughes B, Campbell TC.
Department of Medicine, Helsinki University Hospital, Finland.

BACKGROUND: Hypertension-related diseases are the leading causes of morbidity and mortality in industrially developed societies. Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg. Dietary and lifestyle modifications are effective in the treatment of borderline hypertension. One such lifestyle intervention is the use of medically supervised water-only fasting as a safe and effective means of normalizing BP and initiating health-promoting behavioral changes. METHODS: Sixty-eight (68) consecutive patients with borderline hypertension with systolic BP in excess of 119 mm Hg and diastolic BP less than 91 mm Hg were treated in an inpatient setting under medical supervision. The treatment program consisted of a short prefasting period (approximately 1-2 days on average) during which food consumption was limited to fruits and vegetables followed by medically supervised water-only fasting (approximately 13.6 days on average). Fasting was followed by a refeeding period (approximately 6.0 days on average). The refeeding program consisted of a low-fat, low-sodium, plant-based, vegan diet. RESULTS: Approximately 82% of the subjects achieved BP at or below 120/80 mm Hg by the end of the treatment program. The mean BP reduction was 20/7 mm Hg, with the greatest decrease being observed for subjects with the highest baseline BP. A linear regression of BP decrease against baseline BP showed that the estimated BP below which no further decrease would be expected was 96.0/67.0 mm Hg at the end of the fast and 99.2/67.3 mm Hg at the end of refeeding. These levels are in agreement with other estimates of the BP below which stroke events are eliminated, thus suggesting that these levels could be regarded as the "ideal" BP values. CONCLUSION: Medically supervised water-only fasting appears to be a safe and effective means of normalizing BP and may assist in motivating health-promoting diet and lifestyle changes.

2001

J Cardiovasc Pharmacol. 2001 Oct;38 Suppl 1:S69-74
Calorie restriction reduced blood pressure in obesity hypertensives by improvement of autonomic nerve activity and insulin sensitivity.
Nakano Y, Oshima T, Sasaki S, Higashi Y, Ozono R, Takenaka S, Miura F, Hirao H, Matsuura H, Chayama K, Kambe M.
Department of Clinical Laboratory Medicine, Hiroshima University School of Medicine, Japan.

Association between obesity and hypertension has been well recognized. A reduction in the body weight of over-weight hypertensive patients is a recommended lifestyle modification. The purpose of our study is to examine the relationship of insulin sensitivity and autonomic nervous activity with reduction of blood pressure by the calorie restriction. We evaluated the heart rate variability, nocturnal change of blood pressure and insulin resistance before and after a short-term low-calorie diet in 12 overweight essential hypertensives. After a week of standard diet (2000 kcal), 2 weeks of low-calorie diet (800 kcal) with normal sodium content induced a significant reduction in body mass index, triglyceride, fasting immunoreactive protein, homeostasis model assessment as an index of insulin resistance, and urinary excretion of sodium and potassium. Systolic blood pressure was significantly reduced both in daytime and night-time after the low-calorie diet (daytime, 134.5+/-6.0 to 122.0+/-4.1 mmHg; night-time, 126.8+/-5.2 to 113.4+/-7.2 mmHg). In daytime, diastolic blood pressure was also reduced (90.3+/-2.1 to 88.1+/-4.8 mmHg). Although heart rate was not significantly reduced, a rise of high frequency in night-time (346+/-82 to 572+/-108 ms2) and a fall of low frequency/high frequency in day-time (3.5+/-0.4 to 2.6+/-0.1) was significant after a low-calorie diet. In conclusion, weight loss by low-calorie diet with a constant intake of sodium, reduced blood pressure in obese hypertensives by improvement of vagal nervous activity and insulin resistance..

1999

Hypertension. 1999 Feb;33(2):658-62
Low calorie diet enhances renal, hemodynamic, and humoral effects of exogenous atrial natriuretic peptide in obese hypertensives.
Dessi-Fulgheri P, Sarzani R, Serenelli M, Tamburrini P, Spagnolo D, Giantomassi L, Espinosa E, Rappelli A.
Istituto di Medicina Clinica, Cattedra di Medicina Interna I, University of Ancona, Ancona, Italy.

The _expression of the natriuretic peptide clearance receptor is abundant in human and rat adipose tissue, where it is specifically inhibited by fasting. In obese hypertensives, plasma atrial natriuretic peptide (ANP) levels were found to be lower than in obese normotensives. Therefore, the increased adipose mass might influence ANP levels and/or its biological activity. The aim of the present study was to evaluate whether the humoral, hemodynamic, and renal effects of exogenous ANP in obese hypertensives might be enhanced by a very low calorie diet. Eight obese hypertensives received a bolus injection of ANP (0.6 mg/kg) after 2 weeks of a normal calorie/normal sodium diet, and blood pressure (BP), heart rate, ANP, cGMP, plasma renin activity, and aldosterone were evaluated for 2 hours before and after the injection. Diuresis and natriuresis were measured every 30 minutes. The patients then started a low calorie/normal sodium diet (510 kcal/150 mmol/d) for 4 days, and then the ANP injection protocol was repeated. The low calorie diet induced a slight weight loss (from 90.6+/-1.1 to 87. 7+/-1.2 kg; P<0.01), which was accompanied by increase of cGMP excretion (from 146.0+/-10.1 to 154.5+/-9.5 nmol/24 h; P<0.05) together with a reduction of BP (P<0.01 versus basal levels). ANP injection after diet was followed by an increase of ANP levels similar to that observed before diet, but plasma cGMP, diuresis, and natriuresis increased significantly only after diet. Similarly, the decrease of BP after ANP administration was significantly higher after diet (change in mean arterial pressure, -6.4+/-0.7 versus -4. 0+/-0.6 mm Hg; P<0.05) as well as that of aldosterone (P<0.01). These data show that a low calorie diet enhances the humoral, renal, and hemodynamic effects of ANP in obese hypertensives and confirm the importance of caloric intake in modulating the biological activity of ANP, suggesting that the natriuretic peptide system can play a role in the acute changes of natriuresis and diuresis associated with caloric restriction.

1998

Int J Obes Relat Metab Disord 1998 Jul;22(7):661-6
Weight loss with very-low-calorie diet and cardiovascular risk factors in moderately obese women: one-year follow-up study including ambulatory blood pressure monitoring.
Pekkarinen T; Takala I; Mustajoki P.
Department of Medicine, Helsinki University Hospital, Finland.

The beneficial effects of weight loss with a very-low-calorie diet (VLCD) on cardiovascular risk factors have been reported at the end of energy restriction. As the effects, especially on blood pressure, may not remain constant during weight maintenance, we studied the longer-term effects of weight loss on 24h ambulatory blood pressure (ABP), lipids, glucose and insulin. DESIGN: Prospective study of a 17-week weight loss programme containing an eight-week VLCD period and follow-up visit at one-year. SUBJECTS: Twenty-nine moderately obese, normotensive or mildly hypertensive women. The mean +/- s.d. body mass index (BMI) was 36.0 +/- 2.6 kg/m2 and mean age 40.3 +/- 8.3 y. RESULTS: In the last week of the VLCD, the mean (s.d.) weight loss was 12.4 +/- 3.3 kg (P < 0.001), at the end of the programme 15.1 +/- 4.4 kg (P < 0.001 vs baseline), and at one-year follow-up 10.7 +/- 7.6 kg (P < 0.001 vs baseline). Mean 24 h ABP decreased 8.0/4.6 mmHg (P < 0.001 for both) on the last week of the VLCD, at the end of the programme, the systolic ABP decrease was 4.7 mmHg (P < 0.01 vs baseline) and diastolic 2.1 mmHg (not statistically significant (NS) vs baseline). At one-year follow-up, the mean systolic ABP decrease was 4.1 mmHg (P < 0.01 vs baseline) and mean diastolic 3.0 mmHg (P < 0.05 vs baseline). Sodium excretion decreased 55 mmol/24 h in the last VLCD week (P < 0.01) and returned to baseline after that. At the one-year follow-up, beneficial changes, compared with baseline, were observed in mean serum glucose (-0.28 mmol/l, P < 0.05), triglyceride (-0.35 mmol/l, P < 0.01) and HDL cholesterol (+0.16 mmol/l, P < 0.001). CONCLUSIONS: This weight loss programme with a VLCD enabled obese subjects to lose weight and decrease cardiovascular risks. Despite some regain in weight during follow-up, the beneficial effects were overall maintained over the year. Sodium intake tended to increase during follow-up. Information on sodium restriction should be included in weight loss programmes.

1976

Proc Soc Exp Biol Med 1976 Feb;151(2):368-71
Effect of low calorie diet on the hyperlipidemia, hypertension, and life span of genetically obese rats.
Koletsky S, Puterman DI.

A new strain of genetically obese rat recently obtained in our laboratory exhibits endogenous hyperlipidemia (marked hypertriglyceridemia and moderate hypercholesterolemia) and spontaneous hypertension. The animals die prematurely from kidney failure or from the complications of atherosclerosis. A low calorie diet proved to be highly beneficial to these rats. Body weight declined, obesity diminished, the hypertriglyceridemia was almost eliminated, and the hypercholesterolemia was reduced. However, the hypertensive state was not alleviated. Since the life span of the rats was greatly prolonged by a low calorie diet, the latter undoubtedly served to prevent or arrest the development of renal and vascular disease in these obese animals.