Effect of Weight Loss on Cardiac Synchronization and Proinflammatory Cytokines in Premenopausal Obese Women
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OBJECTIVE—Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss. RESEARCH DESIGN AND METHODS—Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women. RESULTS—Compared with nonobese women, obese women had increased concentrations of CRP (P < 0.01), TNF-α (P < 0.01), IL-6 (P < 0.01), and IL-18 (P < 0.01). Moreover, obese women had a higher myocardial performance index (P < 0.02) and lower transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02), and ejection fraction (P < 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-α, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P < 0.01) and CRP (P < 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity. CONCLUSIONS—In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women.
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Even modest weight loss (5% to 10% of body weight) and modest physical activity (30 minutes daily) can have a positive impact on diabetes risk and management.
“Even modest weight loss (5% to 10% of body weight) and modest physical activity (30 minutes daily) can have a positive impact on diabetes risk and management.”
There are now 6 large studies, including 4 randomized control trials, that have tested whether progression from prediabetes to diabetes could be delayed or prevented by intensive lifestyle modification or glucose-lowering drugs such as metformin or acarbose.
“There are now 6 large studies, including 4 randomized control trials, that have tested whether the progression from prediabetes to diabetes could be delayed or prevented by intensive lifestyle modification (nutritional and exercise interventions) or by the use of commercially available glucose-lowering drugs such as metformin or acarbose.79,81,[133][134][135][136]”
All of these interventions were effective to variable degrees.
“All of these interventions were effective to variable degrees.”
In the lifestyle-modification studies, the results were obtained by a modest reduction in body weight and moderate exercise (eg, walking).
“Of note, in the lifestylemodification studies, the results were obtained by a modest reduction in body weight and moderate exercise (eg, walking).”
Most of the diabetes-prevention trials required that subjects have IGT as the main enrollment criterion.
“Most of the diabetes-prevention trials required that subjects have IGT as the main enrollment criterion.”
In the Finnish, DPP, and STOP-NIDDM trials, screening data suggested that individuals >45 years of age who are overweight (BMI ≥25 kg/m2) were most likely to have IGT (or IFG).
“In the Finnish, DPP, and STOP-NIDDM trials, screening data suggested that individuals Ͼ45 years of age who are overweight (ie, BMI Ն25 kg/m 2 ) were most likely to have IGT (or IFG).81,133,134”
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- Authors
- Marfella, R., Esposito, K., Siniscalchi, M., Cacciapuoti, F., Giugliano, F., Labriola, D., Ciotola, M., Di Palo, C., Misso, L., & Giugliano, D.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2004-01-01
- Volume
- 27
- Issue
- 1
- Pages
- 47-52
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2139321163
- Cited by
- 170
- References
- 35
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 11 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 4 · 2013: 7 · 2012: 4
- FWCI
- 11.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- obesity, weight loss, ventricular dyssynchrony, cardiac synchronization, inflammatory cytokines, TNF-α, interleukin-6, IL-18, C-reactive protein, premenopausal women, heart failure risk, myocardial performance index, pulmonary venous flow, ejection fraction, visceral fat, cardiac function
- MeSH terms
- Adult, Anthropometry, Female, Humans, Inflammation, Mitral Valve, Obesity, Reference Values, Weight Loss, Interleukin-6, Cytokines, Interleukin-8, Ventricular Function, Premenopause
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