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Clinical Care/Education/Nutrition

Long-Term Effects of Low-Calorie Diet on the Metabolic Syndrome in Obese Nondiabetic Patients

  1. Fulvio Muzio, MD1,
  2. Luca Mondazzi, MD1,
  3. Domenico Sommariva, MD1 and
  4. Adriana Branchi, MD2
  1. 1Department of Internal Medicine 1, G. Salvini Hospital, Milan, Italy
  2. 2Department of Internal Medicine, University of Milan, Maggiore Hospital IRCCS, Milan, Italy
  1. Address correspondence and reprint requests to Dr. Fulvio Muzio, Unità Operativa di Medicina I, Ospedale G. Salvini, Viale Forlanini 121, 20020 Garbagnate Milanese (MI), Italy. E-mail: fulviomuzio{at}tin.it
Diabetes Care 2005 Jun; 28(6): 1485-1486. https://doi.org/10.2337/diacare.28.6.1485
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  • ATPIII, Adult Treatment Panel III
  • NCEP, National Cholesterol Education Program

The prevalence of obesity is increasing among western populations, bringing about a parallel rise in the prevalence of the metabolic syndrome (1), which is strictly related to overweight (2). There is full agreement that lifestyle changes primarily focused on weight reduction are the first-line approach to patients with the metabolic syndrome (3). In short-term trials, even a modest weight reduction has been shown to favorably affect the components of the metabolic syndrome such as hypertension, lipid abnormalities, and glycemic control (4–8). The long-term effects of weight loss on the cluster of factors that comprise the metabolic syndrome have been studied in both overweight (9) and mildly obese (10) patients. We report here the extent to which a 2-year treatment program with a low-calorie, low-fat diet altered components of the metabolic syndrome in obese, nondiabetic patients presenting with the syndrome.

RESEARCH DESIGN AND METHODS

The local ethics committee reviewed and approved the study, and each eligible participant gave written informed consent. We enrolled 41 patients (30 women and 11 men, age 58.7 ± 11.27 years [means ± SD]) with the metabolic syndrome as diagnosed according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) (2). The inclusion criteria were age >18 years, BMI ≥30 kg/m2, and a willingness to adhere to the prescribed diet. The exclusion criteria were a history of thyroid disease or diabetes, current pregnancy, an unstable medical condition, and the current use of medications known to affect weight, appetite, and/or blood lipids. Patients on antihypertensive therapy maintained a stable medical regimen throughout the study. All patients were prescribed a low-calorie diet tailored to provide an ∼500-calorie/day deficit based on their estimated daily energy expenditure (11). The diet was modeled after the NCEP ATPIII diet (2) and provided 30% of energy from fat (<7% from saturated fat), 55% from carbohydrates, and 15% from protein, with <200 mg cholesterol/day. The fiber content ranged from 20 to 30 g. The patients were also encouraged to increase their physical activity, preferably by aerobic activities (12). After the initial visit, the patients met in monthly group sessions for 4 months and were then seen in three to four follow-up visits per year for the next 20 months. Laboratory values were measured in the hospital laboratory by standard methods. For each variable, differences between basal conditions and follow-up were assessed using Student’s t test for paired data. χ2 Test was used to compare discrete variables.

RESULTS

At the beginning of the study, all 41 patients had abdominal obesity, 39 (95%) were hypertensive, 26 (63%) had low HDL cholesterol, 22 (54%) had high triglycerides, and 17 (41%) had high blood glucose. The most common triad of metabolic syndrome components was abdominal obesity, hypertension, and low HDL cholesterol (59%). Body weight decreased by 8.5% after 6 months and was 9.9% lower than baseline (range +6 to −39%) at the end of the study. After 2 years, all of the components of the metabolic syndrome underwent a highly significant improvement (Table 1 ). HDL cholesterol normalized in 8 of 26 patients, serum triglycerides fell below 150 mg/dl in 5 of 22 patients, blood pressure ceased to be elevated in 7 of 39 patients, waist girth decreased to below metabolic syndrome cut points in 5 of 41 patients, and blood glucose normalized in 4 of 17 patients. Twenty-six (63%) patients had impaired fasting glucose at baseline, according to the new criteria of the American Diabetes Association (13), and 9 of them (35%) reached a fasting level of blood glucose <100 mg/dl at the end of the study.

Because of the improvement of one component (6 patients) or more (9 patients) of the metabolic syndrome at the end of the study, 15 patients (37%) no longer fulfilled the criteria for the metabolic syndrome. Patients who lost >10% of initial body weight (n = 15, mean −18.1 ± 8.55%) experienced greater reduction in the number of components of the metabolic syndrome than patients who lost <10% (n = 26, mean −3.9 ± 3.61%). At the end of the 2nd year, 10 patients in the first group (66%) and 5 in the second group (19%) ceased to fulfill the criteria for the metabolic syndrome (χ2 11.384, P < 0.001).

CONCLUSIONS

In this study, the metabolic syndrome was effectively treated by long-term diet and lifestyle therapy alone in 37% of obese, nondiabetic patients. Our diet was low in fat, relatively rich in carbohydrates and fiber, and closely resembled the NCEP ATPIII–recommended diet. Resolution of the metabolic syndrome was achieved in two-thirds of patients, who achieved a weight loss of at least 10% over 2 years, whereas in patients who lost <10%, the prevalence of the metabolic syndrome remained high (81%). However, all of the patients in whom the metabolic syndrome resolved remained obese (BMI >30 kg/m2) at the end of the study. Our results therefore confirm, in a typical clinical setting, the usefulness of weight loss in obese patients for resolving the metabolic syndrome, and they support the view that obese patients need not achieve ideal body weight to improve their metabolic profile (3).

The macronutrient composition of diet, not just the caloric deficit, may be important in the management of the metabolic syndrome. For example, diets high in carbohydrates may have detrimental effects on blood glucose, triglyceride, and HDL cholesterol (14,15). However, in our study, which utilized a relatively high-carbohydrate diet, we observed no cases of worsening blood glucose, triglycerides, or HDL cholesterol. On the contrary, these all improved significantly after 2 years of diet. In particular, blood glucose fell by 6% on average and normalized in 35% of patients with impaired fasting blood glucose (13) at baseline, suggesting that a relatively high-carbohydrate diet is safe in patients at risk of developing diabetes, at least when associated with body weight loss. In conclusion, a diet consistent with NCEP ATPIII recommendations with only a modest reduction in calories is effective in the long-term management of the metabolic syndrome in obese nondiabetic patients, particularly in those who achieve a body weight reduction >10%. However, whether their risk for developing coronary heart disease and/or diabetes has been lowered simply because they no longer meet the criteria for the metabolic syndrome remains to be documented.

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Table 1—

Mean component values of the metabolic syndrome at baseline and after 2 years of low-calorie diet

Acknowledgments

We express our sincere thanks and gratitude to Professor William S. Harris of St. Luke’s Hospital, Kansas City, Missouri, and Dr. John M. Miles of Mayo Clinic, Rochester, Minnesota, for their review and suggestions.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted March 10, 2005.
    • Received March 4, 2005.
  • DIABETES CARE

References

  1. ↵
    Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 287:356–359, 2002
    OpenUrlCrossRefPubMedWeb of Science
  2. ↵
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497, 2001
    OpenUrlCrossRefPubMedWeb of Science
  3. ↵
    Grundy SM, Hansen B, Smith SC, Cleeman JI, Kahn RA, the Conference Participants: Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association Conference on scientific issues related to management. Circulation 109:551–556, 2004
    OpenUrlFREE Full Text
  4. ↵
    Wood PD, Stefanick ML, Dreon DM, Frey-Hewitt B, Garay SC, Williams PT, Superko HR, Fortmann SP, Albers JJ, Vranizan KM, Ellsworth NM, Terry RB, Haskell WL: Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med319:1173–1179, 1988
    OpenUrl
  5. Brook RD, Bard RL, Glazewski L, Kehrer C, Bodary PF, Eitzman DL, Rajagopalan S: Effect of short-term weight loss on the metabolic syndrome and conduit vascular endothelial functions in overweight adults. Am J Cardiol 93:1012–1016, 2004
    OpenUrlCrossRefPubMedWeb of Science
  6. Watkins LL, Sherwood A, Feinglos M, Hinderliter A, Babyak M, Gullette E, Waugh R, Blumenthal JA: Effects of exercise and weight loss on cardiac risk factors associated with syndrome X. Arch Intern Med 163:1889–1895, 2003
    OpenUrlCrossRefPubMedWeb of Science
  7. Poppitt SD, Keogh GF, Prentice AM, Williams DEM, Sonnemans HMW, Valk EEJ, Robinson E, Wareham NJ: Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome. Am J Clin Nutr 75:11–20, 2002
    OpenUrlAbstract/FREE Full Text
  8. ↵
    Case CC, Jones PH, Nelson K, O’Brian Smith E, Ballantyne CM: Impact of weight loss on the metabolic syndrome. Diabetes Obes Metab 4:407–414, 2002
    OpenUrlCrossRefPubMedWeb of Science
  9. ↵
    Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D: Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 292:1440–1446, 2004
    OpenUrlCrossRefPubMedWeb of Science
  10. ↵
    Christ M, Iannello C, Iannello PG, Grimm W: Effects of a weight reduction program with and without aerobic exercise in the metabolic syndrome. Int J Cardiol 97:115–122, 2004
    OpenUrlCrossRefPubMedWeb of Science
  11. ↵
    National Institutes of Health: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report (Review). Obes Res 2:51S–209S, 1998
    OpenUrl
  12. ↵
    Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK: Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the American Heart Association Council on Clinical Cardiology (subcommitee on Exercise, Rehabilitation, and prevention) and the Council on Nutrition, Physical Activity, and Metabolism (subcommittee on Physical Activity). Circulation 107:3109–3116, 2003
    OpenUrlFREE Full Text
  13. ↵
    American Diabetes Association: Diagnosis and classification of diabetes mellitus (Position Statement). Diabetes Care 28(Suppl. 1):S37–S42, 2005
    OpenUrlPubMed
  14. ↵
    Reaven GM: Do high-carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against. Curr Opin Lipidol 8:23–27, 1997
    OpenUrlPubMedWeb of Science
  15. ↵
    Aude YW, Mego P, Metha JL: Metabolic syndrome: dietary interventions. Curr Opin Cardiol 19:473–479, 2004
    OpenUrlCrossRefPubMedWeb of Science
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Long-Term Effects of Low-Calorie Diet on the Metabolic Syndrome in Obese Nondiabetic Patients
Fulvio Muzio, Luca Mondazzi, Domenico Sommariva, Adriana Branchi
Diabetes Care Jun 2005, 28 (6) 1485-1486; DOI: 10.2337/diacare.28.6.1485

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Long-Term Effects of Low-Calorie Diet on the Metabolic Syndrome in Obese Nondiabetic Patients
Fulvio Muzio, Luca Mondazzi, Domenico Sommariva, Adriana Branchi
Diabetes Care Jun 2005, 28 (6) 1485-1486; DOI: 10.2337/diacare.28.6.1485
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