title: Relation of B-type natriuretic peptide levels to body mass index after comprehensive lifestyle changes.
abstract: Cross-sectional studies have reported inverse associations of B-type natriuretic peptide (BNP) with the body mass index (BMI). We evaluated whether changes in the BMI are associated with changes in BNP. A nested prospective cohort study of a lifestyle intervention (low-fat, whole-foods diet, exercise, stress management, and social support) was conducted. BNP, BMI, and other biomarkers were measured at baseline and 3 months. A total of 131 subjects, 56 with coronary heart disease (CHD) and 75 at high risk, with > or =3 CHD risk factors and/or diabetes mellitus, were enrolled. At 3 months, the mean BMI had decreased (34.4 to 31.7 kg/m(2), p <0.001), BNP had increased (median 18 to 28 pg/ml, p <0.001), and low-density lipoprotein, C-reactive protein, apolipoprotein B (all p <0.002), and angina frequency (p = 0.017) and severity (p = 0.052) had decreased. The subjects' physical limitations had decreased and their physical functioning had improved (all p <0.001). The percentage of change in BNP was inversely associated with the percentage of change in insulin (r = -0.339, p = 0.005, n = 63 nondiabetics). It was also inversely associated with the percentage of change in BMI (r = -0.28, p = 0.002, n = 116), and this association remained significant (p = 0.029) in multiple regression analyses controlling for age, gender, CHD, diabetes mellitus, percentage of change in lifestyle index, and beta-blocker use. The metabolic changes related to adipose tissue lipolysis could explain these findings. In conclusion, BNP increased in subjects experiencing weight loss while following a lifestyle intervention, and angina pectoris, physical limitations, and other CHD risk factors decreased. Therefore, in this context, increasing BNP might not indicate worsening disease or a worsening prognosis. Thus, the proposed use of BNP in monitoring disease progression should take into account changes in the BMI during the same period.
authors.affiliation: Preventive Medicine Research Institute, Sausalito, California; University of California, San Francisco, California, USA. nita.wu@ucsf.edu
authors.forename: Nita
authors.initials: N
authors.lastname: Chainani-Wu
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Purnell
authors.forename: Steven
authors.initials: S
authors.lastname: Frenda
authors.forename: Terri
authors.initials: T
authors.lastname: Merritt-Worden
authors.forename: Colleen
authors.initials: C
authors.lastname: Kemp
authors.forename: Edward
authors.initials: E
authors.lastname: Kersh
authors.forename: Dean
authors.initials: D
authors.lastname: Ornish
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002140:California; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis; D048909:Diabetes Complications / Q000097:blood; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010414:Pennsylvania; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D014903:West Virginia
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain