Weight Loss Improves Blood Lipids and Other CAD Risk Factors

Weight loss is generally associated with a modest reduction in LDL[1] A study of overweight men with moderately high TC levels found that the loss of just 13.4 lbs resulted in a marked reduction in cholesterol synthesis.[2] Some of this reduction may be due to a reduction in dietary factors that raise LDL. Also, HDL often drops during active weight loss, but usually recovers to higher than pre-diet levels, if a lower body weight is maintained.[3]

Weight loss reduces other ischemic heart disease risk factors like hypertension and high triglyceride (TG)levels. Since weight loss reduces insulin resistance, it will also improve a number of other metabolic abnormalities associated with a faster progression of atherosclerosis and risk of coronary artery disease. These include higher levels of apo B, an increased preponderance of small dense LDL particles (a.k.a. pattern B or phenotype B), higher levels of fibrinogen and plasma activator inhibitor-I (PAI-I), and a more exaggerated postprandial lipemia.[4] Weight loss has been shown to slow the progression of atherosclerosis to that of lean controls in a 4-year study. In this study, the obese control subjects experienced a nearly 3-fold faster progression than the obese subjects who lost weight as measured by changes in the intima-media thickness.[5]

While this review is focusing primarily on how dietary factors impact blood lipids and the risk of CVD, it should be noted that successful long-term weight control is best achieved by a healthier diet coupled with increased activity. Regular exercise should help raise HDL, lower TG and reduce IR. A goal of burning at least 300-400 kcal daily or 2000 kcal per week will not only promote weight loss but may improve many other CVD risk factors associated with the insulin resistance syndrome or Syndrome X.[6]

There is some evidence that weight loss may come disproportionately from the hips and thighs rather than the abdominal area in women with Type-2 DM eating a high-CHO diet compared to a high-MUFA diet.[7],[8] If these results are confirmed, it may help to explain why some researchers have found adverse metabolic effects on isocaloric high-CHO diets compared to high-MUFA diets, particularly in postmenopausal women with Type-2 DM. Little is currently known about how the ratio of dietary fat to CHO and/or the type of dietary fat and CHO might impact the distribution of body fat.

[1]. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids: a meta-analysis. Am J Clin Nutr 1992;56:320-8.
[2]. DiBuono M, Hannah JS, Katzel LI, Jones PJH. Weight loss due to energy restriction suppresses cholesterol biosynthesis in overweight, mildly hypercholesterolemic men. J Nutr 1999;129:1545-8.
[3]. Eckel RH, Yost TJ. HDL subfractions and adipose tissue metabolism in the reduced-obese state. Am J Physiol 1989;256:E740-6.
[4]. Griffin BA, Zampelas A. Nutr Res Rev 1995;8:1-26. and Reaven GM. Syndrome X: 6 years later. J Int Med 1994;236 (suppl):S13-22.
[5]. Karason K, Wikstrand J, Sjostrom L, Wendelhag I. Weight loss and the progression of early atherosclerosis in the carotid artery: a four-year controlled study of obese subjects. Int J Obes 1999;23:948-56.
[6]. Hardman AE. Physical activity, obesity and blood lipids. In t J Obes 1999;23(suppl 3):S64-71.
[7]. Walker KZ, O'Dea K, Johnson L, et al. Body fat distribution and no-insulin-dependent diabetes: comparison of a fibre-rich, high-carbohydrate, low-fat (23%) diet and a 35% fat diet high in monounsaturated fat. Am J Clin Nutr 1996;63:254-60.
[8]. Walker KZ, O'Dea K, Nicholson GC. Dietary composition affects regional body fat distribution and levels of dehydroepiandrosterone sulfate (DHEAS) in postmenopausal women with Type-2 diabetes. Eur J Clin Nutr 1999;53:700-5.

This article is excerpted from Diet and Cardiovascular Disease: An Overview from Dr. James J. Kenney, PhD, RD, FACN from 21st Century Heart - A Master Kit for You and Your Patients. For more information, click here

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