Effects of visceral adipose tissue reduction on CVD risk factors independent of weight loss: The Look AHEAD study

<b>Objectives:</b> To determine if the reduction of visceral adipose tissue (VAT) volume by lifestyle intervention improved risk factors for cardiovascular disease (CVD) independent of weight loss amount. <b>Design:</b> Ancillary study of randomized-controlled trial. Setting: Data analysis using multivariable regression models. <b>Participants:</b> Participants of the Look AHEAD (Action for HEAlth in Diabetes) Fatty Liver Ancillary Study. <b>Main outcome measures:</b> Correlations between changes in VAT and in CVD risk factors, while adjusting for weight loss and treatment (intensive lifestyle intervention [ILI] vs. diabetes support and education [DSE]). <b>Results:</b> Of 100 participants analyzed, 52% were women, and 36% were black, with a mean age of 61.1 years. In the DSE group, mean weight and VAT changed by 0.1 % (<i>p</i>=0.90) and 4.3% (<i>p</i>=0.39), respectively. In the ILI group, mean weight and VAT decreased by 8.0% (<i>p</i>&lt;0.001) and 7.7% (<i>p</i>=0.01), respectively. Across both groups, mean weight decreased by 3.6% (<i>p</i>&lt;0.001), and mean VAT decreased by 1.2% (<i>p</i>=0.22); the decrease in VAT was correlated with the increase in HDL-cholesterol (HDL-C; R=−0.37; <i>p</i>=0.03). There were no correlations between changes in VAT and blood pressure, triglycerides, LDL-C, glucose, or HbA1c. After adjusting for age, race, gender, baseline metabolic values, fitness, and treatment group, changes in HDL-C were not associated with changes in VAT, while weight changes were independently associated with decrease in glucose, HbA1c, and increase in HDL-C. <b>Conclusions:</b> VAT reduction was not correlated with improvements of CVD risk factors in a sample of overweight and obese adults with type 2 diabetes after adjusting for weight loss.

<b>研究目标：</b>旨在明确生活方式干预所致内脏脂肪组织（visceral adipose tissue, VAT）体积减少，是否在不考虑减重幅度的前提下，改善心血管疾病（cardiovascular disease, CVD）的相关危险因素。<b>研究设计：</b>为随机对照试验的附属子研究。<b>分析场景：</b>采用多变量回归模型开展数据分析。<b>研究对象：</b>为《行动改善糖尿病患者健康（Look AHEAD）》脂肪肝附属研究的受试者。<b>主要结局指标：</b>在校正减重情况与干预分组（强化生活方式干预[intensive lifestyle intervention, ILI] vs. 糖尿病支持与教育[diabetes support and education, DSE]）的前提下，分析内脏脂肪组织变化与心血管疾病危险因素变化之间的相关性。<b>研究结果：</b>本研究共纳入100名受试者进行分析，其中女性占比52%，黑人占比36%，平均年龄为61.1岁。在糖尿病支持与教育（DSE）组中，受试者平均体重与内脏脂肪组织体积分别变化0.1%（p=0.90）与4.3%（p=0.39）。在强化生活方式干预（ILI）组中，受试者平均体重与内脏脂肪组织体积分别下降8.0%（p<0.001）与7.7%（p=0.01）。综合两组数据，受试者平均体重下降3.6%（p<0.001），平均内脏脂肪组织体积下降1.2%（p=0.22）；内脏脂肪组织体积的下降与高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）升高呈显著相关（R=-0.37；p=0.03）。未观察到内脏脂肪组织体积变化与血压、甘油三酯、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）、血糖或糖化血红蛋白（glycated hemoglobin A1c, HbA1c）之间存在相关性。在校正年龄、种族、性别、基线代谢指标、体能状态与干预分组后，高密度脂蛋白胆固醇的变化与内脏脂肪组织体积变化无显著关联，而体重变化则与血糖、糖化血红蛋白水平下降及高密度脂蛋白胆固醇水平升高独立相关。<b>研究结论：</b>在校正减重幅度后，在合并2型糖尿病的超重与肥胖成人队列中，内脏脂肪组织体积减少与心血管疾病危险因素改善并无相关性。