Department of Epidemiology and Health Systems Evaluation, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
Circulation. 2010 Mar 16;121(10):1200-8. doi: 10.1161/CIRCULATIONAHA.109.879254. Epub 2010 Mar 1.
It is currently unknown whether dietary weight loss interventions can induce regression of carotid atherosclerosis.
In a 2-year Dietary Intervention Randomized Controlled Trial-Carotid (DIRECT-Carotid) study, participants were randomized to low-fat, Mediterranean, or low-carbohydrate diets and were followed for changes in carotid artery intima-media thickness, measured with standard B-mode ultrasound, and carotid vessel wall volume (VWV), measured with carotid 3D ultrasound. Of 140 complete images of participants (aged 51 years; body mass index, 30 kg/m(2); 88% men), higher baseline carotid VWV was associated with increased intima-media thickness, age, male sex, baseline weight, blood pressure, and insulin levels (P<0.05 for all). After 2 years of dietary intervention, we observed a significant 5% regression in mean carotid VWV (-58.1 mm(3;) 95% confidence interval, -81.0 to -35.1 mm(3); P<0.001), with no differences in the low-fat, Mediterranean, or low-carbohydrate groups (-60.69 mm(3), -37.69 mm(3), -84.33 mm(3), respectively; P=0.28). Mean change in intima-media thickness was -1.1% (P=0.18). A reduction in the ratio of apolipoprotein B(100) to apolipoprotein A1 was observed in the low-carbohydrate compared with the low-fat group (P=0.001). Participants who exhibited carotid VWV regression (mean decrease, -128.0 mm(3); 95% confidence interval, -148.1 to -107.9 mm(3)) compared with participants who exhibited progression (mean increase, +89.6 mm(3); 95% confidence interval, +66.6 to +112.6 mm(3)) had achieved greater weight loss (-5.3 versus -3.2 kg; P=0.03), greater decreases in systolic blood pressure (-6.8 versus -1.1 mm Hg; P=0.009) and total homocysteine (-0.06 versus +1.44 mumol/L; P=0.04), and a higher increase of apolipoprotein A1 (+0.05 versus -0.00 g/L; P=0.06). In multivariate regression models, only the decrease in systolic blood pressure remained a significant independent modifiable predictor of subsequent greater regression in both carotid VWV (beta=0.23; P=0.01) and intima-media thickness (beta=0.28; P=0.008) levels.
Two-year weight loss diets can induce a significant regression of measurable carotid VWV. The effect is similar in low-fat, Mediterranean, or low-carbohydrate strategies and appears to be mediated mainly by the weight loss-induced decline in blood pressure. Clinical Trial Registration- http://www.clinicaltrials.gov. Unique Identifier: NCT00160108.
目前尚不清楚饮食减肥干预是否能使颈动脉粥样硬化消退。
在为期 2 年的饮食干预随机对照试验-颈动脉（DIRECT-Carotid）研究中，参与者被随机分配到低脂、地中海或低碳水化合物饮食组，并随访颈动脉内中膜厚度的变化，通过标准 B 型超声测量，以及颈动脉血管壁体积（VWV），通过颈动脉 3D 超声测量。在 140 名完成图像的参与者（年龄 51 岁；体重指数 30kg/m2；88%为男性）中，较高的基线颈动脉 VWV 与内膜-中膜厚度增加、年龄、男性、基线体重、血压和胰岛素水平相关（所有 P<0.05）。经过 2 年的饮食干预，我们观察到平均颈动脉 VWV 显著下降了 5%（-58.1mm3；95%置信区间，-81.0 至-35.1mm3；P<0.001），低脂、地中海或低碳水化合物组之间没有差异（分别为-60.69mm3、-37.69mm3、-84.33mm3；P=0.28）。内膜-中膜厚度的平均变化为-1.1%（P=0.18）。与低脂组相比，低碳水化合物组的载脂蛋白 B(100)与载脂蛋白 A1 的比值降低（P=0.001）。与颈动脉 VWV 进展的参与者（平均增加，+89.6mm3；95%置信区间，+66.6 至+112.6mm3）相比，颈动脉 VWV 消退的参与者（平均减少，-128.0mm3；95%置信区间，-148.1 至-107.9mm3）体重减轻更多（-5.3 公斤与-3.2 公斤；P=0.03），收缩压降低更多（-6.8 毫米汞柱与-1.1 毫米汞柱；P=0.009），总同型半胱氨酸降低更多（-0.06 毫摩尔/升与+1.44 毫摩尔/升；P=0.04），载脂蛋白 A1 升高更多（+0.05 克/升与+0.00 克/升；P=0.06）。在多变量回归模型中，只有收缩压的下降仍然是颈动脉 VWV（beta=0.23；P=0.01）和内膜-中膜厚度（beta=0.28；P=0.008）水平随后显著回归的独立可改变预测因素。
两年的减肥饮食可以显著消退可测量的颈动脉 VWV。在低脂、地中海或低碳水化合物策略中效果相似，似乎主要是通过减肥引起的血压下降介导的。临床试验注册-http://www.clinicaltrials.gov。独特标识符：NCT00160108。
