OBJECTIVE The risk of cardiovascular disease in type 2 diabetes is greater than is accounted for by conventional risk factors. We investigated whether energy restriction or modest fat loss improved the lipid profile in obese subjects with and without type 2 diabetes. The relationship of site of adipose tissue loss to lipid changes was also examined.

RESEARCH DESIGN AND METHODS Lipid levels were measured in 18 subjects with normal glucose tolerance (NGT) (n = 9, BM1 = 31.5 ± 0.8 [SEM] kg/m²) or type 2 diabetes (n = 9, BMI = 31.8 ± 0.7) before and on the 4th (d4) and 28th (d28) days of a hypocaloric formula diet. Body composition was assessed with dual energy X-ray absorptiometry on dO and d28.

RESULTSL:— Mean daily energy intake during the diet was 1,100 ± 60 kcal (33% protein, 38% carbohydrate, and 29% fat). Mean weight loss was 6.2 ± 0.4 kg. Initial lipid profiles were similar in subjects with or without diabetes, and diabetes did not affect the responses. Dietary intervention resulted in early (d4) and late (d28) changes. Energy restriction(d4) reduced VLDL cholesterol and total triglyceride (TG) concentrations andincreased LDL particle size. With fat loss (d28), there were falls in total LDL cholesterol (free and esterified components), LDL TG, and LDL apolipoprotein B (apoB) concentrations. Reduction in central abdominal fat (but not other body fat) was correlated with a less atherogenic lipid profile: Δ abdominal fat versus Δ LDL free cholesterol, r = 0.65, P = 0.006 and versus Δ apoB, r = 0.64, P = 0.008.

CONCLUSIONS Even in obese subjects with an average lipid profile, modest weight loss reduces atherogenicity, independently of type 2 diabetes, and abdominal fat loss is specifically related to such improvements.