Dietary intervention in patients with metabolic syndrome: short- and long-term effects on abdominal obesity

Objective. To assess prospectively the short- and long-term effects of the calorie-reduced diet on anthropometric
parameters, such as body-mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and compliance to the diet
in men and women with metabolic syndrome (MS). Design and methods. 60 MS patients were enrolled according to IDF
criteria (36 men) (average age 48  13 years). BMI at baseline was 33,4  4,9 kg/m2 in both sexes; WCmen = 113,9  10,9 cm,
WCwomen = 108,8  10,1 cm; WHRmen = 1,01  0,05, WHRwomen = 0,99  0,07. All MS patients were insulin resistant
(mean HOMA-IR = 5,8  3,6). Hypertension was diagnosed in 88,3 % (n = 53) MS patients according to the current
guidelines. Mean blood pressure (BP) in men was 151,6  19,6/94,7  10,7 mmHg, BP in women was 161,4  22,4/96,0  10,3
mmHg. We compared anthropometric changes in two diet programs: short-term low-caloric diet in reduction of 500 kcal
per day during 3 weeks supervised by hospital physicians; after that diet was home-based and completed by the participants
on their own during 6 months period. Results. At 3 weeks, in supervised group there were signifi cant reductions in all
anthropometric parameters in both sexes (p < 0,0003); however, men have achieved larger reduction in WC and WHR
than women (baseline-3-weeks ƒWCmen = 4,38  1,7 cm vs ƒWCwomen = 3,7  2,0 cm; ƒWHRmen = 0,03  0,01 vs
ƒWHRwomen = 0,027  0,01). At 6 month unsupervised patients had less WC and WHR reductions as compared to 3-week
data (WCmen 112,1  10,7 cm vs 110,6  10,4 cm; WCwomen 103,0  6,9 cm vs 104,7  9,3 cm; WHRmen = 1,0  0,05
vs 0,99  0,05; WHRwomen = 0,96  0,05 vs 0,98  0,06). Compliance to the home-based diet was related to sex (women
better than men) and was associated with greater reduction in WC and WHR in women. At 6 months home-based diet men
had a signifi cant increase in abdominal obesity comparing to 3-week diet (difference 3-weeks-6-months WC = -1,44  2,9
cm in men, p = 0,02; difference WHR = -0,014  0,02, p = 0,003). Conclusion. In this prospective study supervised shortterm
low-caloric program is more effective than home-based 6-months diet. We demonstrated the predictive value of gender
in outcomes: men had greater reductions in WC and WHR in short-term supervised program, but due to the less compliance
to the long-term home-based diet in males, women had greater reduction in WC and WHR after 6-months period.

metabolic syndrome, abdominal obesity, dietary intervention, insulin resistance, hypertension

1. Агеев Ф.Т., Е.М. Середенина Е.М. Клинический случай успешного применения розувастатина у пациента с высоким риском развития фатальных сердечно-сосудистых осложнений // Consilium Medicum. - 2005. - Т.7. - № 11.- С.32-35.

2.

3. Драпкина О.М., Ашихмин Я.И., Ивашкин В.Т. Питание и сердечно-сосудистые заболевания // Трудный пациент. - 2006. - Т. 4. - № 8. - С.43-48.

4.

5. Драпкина О.М., Корнеева О.Н., Ивашкин В.Т. Ожирение в практике врача-кардиолога // ВРАЧ. - 2005. - №1. - С. 45-48.

6.

7. Корнеева О.Н. Клинические варианты метаболического синдрома // Дис….канд. мед. наук. - Москва, 2007. - 161 с.

8.

9. Chipkin S., Black S., Braun B. The balance between exercise and diet: impact on insulin sensitivity // Current Opinion in Endocrinology and Diabetes. - 2005. -Vol. 12. - Р. 152-156.

10.

11. Klein S, Fontana L, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease // N Engl J Med. - 2004. - Vol. 350. - P. 2549-2557.

12.

13. Ryan D. Risk and benefits of weight loss: challenges to obesity research // European Heart Jornal Supplements ( Supplement L). - 2005. - Vol. 7. - P.27-31.

14.

15. Wing R, Blair E et al. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients // Diabetes Care. - 1994. - Vol. 17. - P. 30-36.

16.

17. World Health Organisation. Diet, nutrition and the prevention chronic disease // Report of a Joint/FAO Expart Consultation. Geneva. WHO. - 2003.

18.