title: Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial.
abstract: BACKGROUND
  Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue.
  
  
  OBJECTIVE
  To determine the effect of a program of changes in lifestyle designed to obtain a sustained reduction of body weight on markers of systemic vascular inflammation and insulin resistance.
  
  
  METHODS
  Randomized single-blind trial conducted from February 1999 to February 2002 at a university hospital in Italy.
  
  
  METHODS
  One hundred twenty premenopausal obese women (body mass index > or =30) aged 20 to 46 years without diabetes, hypertension, or hyperlipidemia.
  
  
  METHODS
  The 60 women randomly assigned to the intervention group received detailed advice about how to achieve a reduction of weight of 10% or more through a low-energy Mediterranean-style diet and increased physical activity. The control group (n = 60) was given general information about healthy food choices and exercise.
  
  
  METHODS
  Lipid and glucose intake; blood pressure; homeostatic model assessment of insulin sensitivity; and circulating levels of interleukin 6 (IL-6), interleukin 18 (IL-18), C-reactive protein (CRP), and adiponectin.
  
  
  RESULTS
  After 2 years, women in the intervention group consumed more foods rich in complex carbohydrates (9% corrected difference; P<.001), monounsaturated fat (2%; P =.009), and fiber (7 g/d; P<.001); had a lower ratio of omega-6 to omega-3 fatty acids (-5; P<.001); and had lower energy (-310 kcal/d; P<.001), saturated fat (-3.5%; P =.007), and cholesterol intake (-92 mg/d; P<.001) than controls. Body mass index decreased more in the intervention group than in controls (-4.2; P<.001), as did serum concentrations of IL-6 (-1.1 pg/mL; P =.009), IL-18 (-57 pg/mL; P =.02), and CRP (-1.6 mg/L; P =.008), while adiponectin levels increased significantly (2.2 microg/mL; P =.01). In multivariate analyses, changes in free fatty acids (P =.008), IL-6 (P =.02), and adiponectin (P =.007) levels were independently associated with changes in insulin sensitivity.
  
  
  CONCLUSIONS
  In this study, a multidisciplinary program aimed to reduce body weight in obese women through lifestyle changes was associated with a reduction in markers of vascular inflammation and insulin resistance.
authors.affiliation: Center for Obesity Management, Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy. katherine.esposito@unina2.it
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pontillo
authors.forename: Carmen
authors.initials: C
authors.lastname: Di Palo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Giugliano
authors.forename: Mariangela
authors.initials: M
authors.lastname: Masella
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marfella
authors.forename: Dario
authors.initials: D
authors.lastname: Giugliano
mesh_terms: D052242:Adiponectin; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D036341:Intercellular Signaling Peptides and Proteins; D020382:Interleukin-18 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008019:Life Style; D009765:Obesity / Q000097:blood* / Q000628:therapy*; D017697:Premenopause; D011506:Proteins / Q000378:metabolism*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016037:Single-Blind Method; D015431:Weight Loss / Q000502:physiology*
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D036341:Intercellular Signaling Peptides and Proteins; D020382:Interleukin-18; D015850:Interleukin-6; D011506:Proteins; D002097:C-Reactive Protein