CARDIOLOGY BY DR SEBASTIAAN HAMMER Effect of diet on cardiac function in
obese diabetic patients: an MRI study Cardiac MRI was used to analyze the effect of diet on cardiac function and pericardial fat in obese diabetic patients. It was found that a restricted calorie diet leads to loss of fat around the heart and improved heart function in patients with type 2 diabetes. After 16 weeks, none of the patients in the study required insu- lin. More than a year after returning to a regular diet, heart function remained improved.
A
low-calorie diet elimi- nates insulin dependence and leads to improved heart function in obese
patients with type 2 diabetes, accord- ing to a study presented at last year’s meeting of the Radiological Society of North America (RSNA). “Lifestyle interventions may have more powerful beneficial cardiac effects than medication in these patients,” said the study’s lead author, Sebastiaan Hammer, M.D., Ph.D., “It is striking to see how a relatively sim- ple intervention of a very low calorie diet effectively cures type 2 diabe- tes mellitus. Moreover, these effects are long term, illustrating the poten- tial of this method.” Pericardial fat is visceral fat compartment around the heart that can be detrimental to cardiac function, especially in people with metabolic disease. Dr. Hammer and colleagues set out to determine the long-term effects of initial weight loss induced by caloric restriction on pericardial fat and cardiac function in obese patients with type 2 diabetes. Using cardiac MRI, the researchers
analyzed cardiac function and peri- cardial fat in 15 patientswith type 2 diabetes before and after four months of a diet consisting of 500 calories
The author: Dr Sebastiaan Hammer is at the Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
14 FigUre 1. Magnetic resonance (4-chamber)
images of the heart of a typical patient showing fat around the heart (pericardial fat). The fat is highlighted in red in the right panel.
DI EUROPE
Transverse magnetic resonance images of the abdomen show subcutaneous and intra-abdominal fat content of a typical patient before (A) and after 4 months of caloric restriction (B). Panel C shows fat depots after an additional follow-up of 14 months..
APRIL/MAY 2012
daily. Changes in body mass index (BMI) were also measured. The results showed that caloric restric- tion resulted in a decrease in BMI from 35.3 to 27.5 over four months. Pericardial fat decreased from 39 mil- liliters (ml) to 31 ml, and E/A ratio improved from 0.96 to 1.2. After an additional 14 months of follow-up on a regular diet, BMI increased to 31.7, but pericardial fat only increased slightly to 32 ml. E/A ratio after fol- low-up was 1.06. “Our results show that 16 weeks
of caloric restriction improved heart function in these patients,” Dr. Ham- mer said. “More importantly, despite regain of weight, these beneficial car- diovascular effects were persistent over the long term.” Dr. Hammer pointed out that
these findings stress the importance of including imaging strategies in these types of therapy regimens. “MRI clearly showed all the
changes in fat compartments, struc- tural changes in the heart and improvements in diastolic function,
A typical patient before (left), and after 16 weeks of caloric restriction (right).
making it a very effective method of quantifying the effects of metabolic interventions,” he said. While these results are promising,
not all patients are eligible for this type of therapy. “It is of utmost importance to follow such a complicated inter- vention under strict medical supervi- sion,” Dr. Hammer said, “especially as patients may be able to stop all anti- diabetic therapy from Day 1”.
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