TY - JOUR
T1 - Dynamics of intrapericardial and extrapericardial fat tissues during long-term, dietary-induced, moderate weight loss
AU - Tsaban, Gal
AU - Wolak, Arik
AU - Avni-Hassid, Hila
AU - Gepner, Yftach
AU - Shelef, Ilan
AU - Henkin, Yaakov
AU - Schwarzfuchs, Dan
AU - Cohen, Noa
AU - Bril, Nitzan
AU - Rein, Michal
AU - Serfaty, Dana
AU - Kenigsbuch, Shira
AU - Tene, Lilac
AU - Zelicha, Hila
AU - Yaskolka-Meir, Anat
AU - Komy, Oded
AU - Bilitzky, Avital
AU - Chassidim, Yoash
AU - Ceglarek, Uta
AU - Stumvoll, Michael
AU - Blüher, Matthias
AU - Thiery, Joachim
AU - Dicker, Dror
AU - Rudich, Assaf
AU - Stampfer, Meir J.
AU - Shai, Iris
N1 - Publisher Copyright: © 2017 American Society for Nutrition.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background: In view of evidence linking pericardial fat accumulation with increased cardiovascular disease risk, strategies to reduce its burden are needed. Data comparing the effects of specific long-term dietary interventions on pericardial fat tissue mobilization are sparse. Objective: We sought to evaluate intrapericardial-fat (IPF) and extrapericardial-fat (EPF) changes during weight-loss interventions by different dietary regimens. Design: During 18 mo of a randomized controlled trial, we compared a Mediterranean/low-carbohydrate (MED/LC) diet plus 28 g walnuts/d with a calorically equal low-fat (LF) diet among randomly assigned participants with moderate abdominal obesity. We performed whole-body MRI and volumetrically quantified IPF and EPF among 80 participants to follow the 18-mo changes. Results: The participants [mean age: 48.6 y; mean body mass index (BMI; in kg/m2); 31.7; 90% men] had baseline IPF and EPF (mean 6 SD) volumes of 172.4 6 53.3 mL and 194.9 6 71.5 mL, respectively. The 18-mo moderate weight loss of 3.7 kg was similar in both groups, but the reduction in waist circumference was higher in the MED/LC group (26.9 6 6.6 cm) than in the LF diet group (22.3 6 6.5 cm; P = 0.01). After 18 mo, the IPF volume had reduced twice as much in the MED/LC group compared with the LF group [237 6 26.2 mL (222% 6 15%) compared with 215.5 6 26.2 mL (28% 6 15%), respectively; P, 0.05, after adjustment for changes in weight or visceral adipose tissue]. The EPF volume had reduced similarly in both groups [241.6 6 30.2 mL (223% 6 16%) in the MED/LC group compared with 237.9 6 28.3 mL (219% 6 14%) in the LF group; P . 0.1]. After controlling for weight loss, IPF and EPF volume reduction paralleled changes in lipid profile but not with improved glycemic profile variables: the IPF relative reduction was associated with a decrease in triglycerides (TGs) (b = 0.090; 95% CI: 0.026, 0.154; P = 0.007) and the ratio of TGs to high-density lipoprotein (HDL) cholesterol (b = 2.689; 95% CI: 0.373, 5.003; P = 0.024), and the EPF relative reduction was associated with an increase in HDL cholesterol (b = 20.452; 95% CI: 20.880, 20.023; P = 0.039) and a decrease in total cholesterol and HDL cholesterol (b = 3.766; 95% CI: 1.092, 6.440; P = 0.007). Conclusions: Moderate but persistent dietary-induced weight loss substantially decreased both IPF and EPF volumes. Reduction of pericardial adipose tissues is independently associated with an improved lipid profile. The Mediterranean diet, rich in unsaturated fats and restricted carbohydrates, is superior to an LF diet in terms of the IPF burden reduction. This trial was registered at clinicaltrials.gov as NCT01530724.
AB - Background: In view of evidence linking pericardial fat accumulation with increased cardiovascular disease risk, strategies to reduce its burden are needed. Data comparing the effects of specific long-term dietary interventions on pericardial fat tissue mobilization are sparse. Objective: We sought to evaluate intrapericardial-fat (IPF) and extrapericardial-fat (EPF) changes during weight-loss interventions by different dietary regimens. Design: During 18 mo of a randomized controlled trial, we compared a Mediterranean/low-carbohydrate (MED/LC) diet plus 28 g walnuts/d with a calorically equal low-fat (LF) diet among randomly assigned participants with moderate abdominal obesity. We performed whole-body MRI and volumetrically quantified IPF and EPF among 80 participants to follow the 18-mo changes. Results: The participants [mean age: 48.6 y; mean body mass index (BMI; in kg/m2); 31.7; 90% men] had baseline IPF and EPF (mean 6 SD) volumes of 172.4 6 53.3 mL and 194.9 6 71.5 mL, respectively. The 18-mo moderate weight loss of 3.7 kg was similar in both groups, but the reduction in waist circumference was higher in the MED/LC group (26.9 6 6.6 cm) than in the LF diet group (22.3 6 6.5 cm; P = 0.01). After 18 mo, the IPF volume had reduced twice as much in the MED/LC group compared with the LF group [237 6 26.2 mL (222% 6 15%) compared with 215.5 6 26.2 mL (28% 6 15%), respectively; P, 0.05, after adjustment for changes in weight or visceral adipose tissue]. The EPF volume had reduced similarly in both groups [241.6 6 30.2 mL (223% 6 16%) in the MED/LC group compared with 237.9 6 28.3 mL (219% 6 14%) in the LF group; P . 0.1]. After controlling for weight loss, IPF and EPF volume reduction paralleled changes in lipid profile but not with improved glycemic profile variables: the IPF relative reduction was associated with a decrease in triglycerides (TGs) (b = 0.090; 95% CI: 0.026, 0.154; P = 0.007) and the ratio of TGs to high-density lipoprotein (HDL) cholesterol (b = 2.689; 95% CI: 0.373, 5.003; P = 0.024), and the EPF relative reduction was associated with an increase in HDL cholesterol (b = 20.452; 95% CI: 20.880, 20.023; P = 0.039) and a decrease in total cholesterol and HDL cholesterol (b = 3.766; 95% CI: 1.092, 6.440; P = 0.007). Conclusions: Moderate but persistent dietary-induced weight loss substantially decreased both IPF and EPF volumes. Reduction of pericardial adipose tissues is independently associated with an improved lipid profile. The Mediterranean diet, rich in unsaturated fats and restricted carbohydrates, is superior to an LF diet in terms of the IPF burden reduction. This trial was registered at clinicaltrials.gov as NCT01530724.
KW - Cardiac magnetic resonance imaging
KW - Extrapericardial fat
KW - Intrapericardial fat
KW - Low-fat diet
KW - Mediterranean diet
UR - http://www.scopus.com/inward/record.url?scp=85031702211&partnerID=8YFLogxK
U2 - https://doi.org/10.3945/ajcn.117.157115
DO - https://doi.org/10.3945/ajcn.117.157115
M3 - Article
C2 - 28814394
SN - 0002-9165
VL - 106
SP - 984
EP - 995
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 4
ER -