title: Effect of diet-induced weight loss on lipoprotein(a) levels in obese individuals with and without type 2 diabetes.
abstract: Elevated levels of lipoprotein(a) [Lp(a)] are an independent risk factor for cardiovascular disease (CVD), particularly in individuals with type 2 diabetes. Although weight loss improves conventional risk factors for CVD in type 2 diabetes, the effects on Lp(a) are unknown and may influence the long-term outcome of CVD after diet-induced weight loss. The aim of this clinical study was to determine the effect of diet-induced weight loss on Lp(a) levels in obese individuals with type 2 diabetes.
  
  
  
  Plasma Lp(a) levels were determined by immunoturbidimetry in plasma obtained before and after 3-4 months of an energy-restricted diet in four independent study cohorts. The primary cohort consisted of 131 predominantly obese patients with type 2 diabetes (cohort 1), all participants of the Prevention Of Weight Regain in diabetes type 2 (POWER) trial. The secondary cohorts consisted of 30 obese patients with type 2 diabetes (cohort 2), 37 obese individuals without type 2 diabetes (cohort 3) and 26 obese individuals without type 2 diabetes who underwent bariatric surgery (cohort 4).
  
  
  
  In the primary cohort, the energy-restricted diet resulted in a weight loss of 9.9% (95% CI 8.9, 10.8) and improved conventional CVD risk factors such as LDL-cholesterol levels. Lp(a) levels increased by 14.8 nmol/l (95% CI 10.2, 20.6). In univariate analysis, the change in Lp(a) correlated with baseline Lp(a) levels (r = 0.38, p < 0.001) and change in LDL-cholesterol (r = 0.19, p = 0.033). In cohorts 2 and 3, the weight loss of 8.5% (95% CI 6.5, 10.6) and 6.5% (95% CI 5.7, 7.2) was accompanied by a median increase in Lp(a) of 13.5 nmol/l (95% CI 2.3, 30.0) and 11.9 nmol/l (95% CI 5.7, 19.0), respectively (all p < 0.05). When cohorts 1-3 were combined, the diet-induced increase in Lp(a) correlated with weight loss (r = 0.178, p = 0.012). In cohort 4, no significant change in Lp(a) was found (-7.0 nmol/l; 95% CI -18.8, 5.3) despite considerable weight loss (14.0%; 95% CI 12.2, 15.7).
  
  
  
  Diet-induced weight loss was accompanied by an increase in Lp(a) levels in obese individuals with and without type 2 diabetes while conventional CVD risk factors for CVD improved. This increase in Lp(a) levels may potentially antagonise the beneficial cardiometabolic effects of diet-induced weight reduction.
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Berk
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Reyhana
authors.initials: R
authors.lastname: Yahya
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Adrie J M
authors.initials: AJM
authors.lastname: Verhoeven
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Touw
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Leijten
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: van Rossum
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Wester
authors.affiliation: Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Mirjam A
authors.initials: MA
authors.lastname: Lips
authors.affiliation: Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Hanno
authors.initials: H
authors.lastname: Pijl
authors.affiliation: Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.affiliation: Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gertraud
authors.initials: G
authors.lastname: Erhart
authors.affiliation: Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Roeters van Lennep
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Eric J G
authors.initials: EJG
authors.lastname: Sijbrands
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands. m.t.mulder@erasmusmc.nl.
authors.forename: Monique T
authors.initials: MT
authors.lastname: Mulder
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000178:diet therapy* / Q000601:surgery; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000178:diet therapy* / Q000601:surgery; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology*
chemical_list: D017270:Lipoprotein(a)
keywords: Apolipoprotein(a); Bariatric surgery; Diet; Lipoprotein(a); Obesity; Type 2 diabetes; Weight loss