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November 30, 2017Journal of International Crisis and Risk Communication ResearchOpen Access

Intramyocellular triacylglycerol accumulation across weight loss strategies; Sub-study of the CENTRAL trial

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Why the study?

Does a Mediterranean/low-carbohydrate diet combined with physical activity alter intramyocellular triacylglycerol accumulation compared to a low-fat diet in sedentary adults with abdominal obesity or dyslipidemia?

Population

277 sedentary adults with abdominal obesity or dyslipidemia, mean age 47.9, 86.4% male, mean BMI 30.6 kg/m2…

Comparison

Mediterranean/low-carbohydrate diet with or… vs Low-fat diet with or without moderate intense…

Design

RCT, Randomly assigned, without stratification, to one of two equally…

Follow-up

18 months

Key result

A Mediterranean/low-carbohydrate diet combined with physical activity significantly increased intramyocellular triacylglycerol by 56% over 18 months compared to other weight loss strategies.

Authors

YGYftach GepnerISIlan ShelefDSDan Schwarzfuchs

Discussion

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Overview

Mediterranean/low-carb diet plus activity raises IMTG during weight loss; challenges presumed link to cardiometabolic harm in obese adults.

Study Design

Type

RCT (n=277)

Blinding

Single-blind (fitness instructor and MRI observers blinded)

Randomization

Randomized to low-fat or Mediterranean/low-carbohydrate diet, then re-randomized to physical activity or no physical activity

Multicenter

No

Structured PICO

Does a Mediterranean/low-carbohydrate diet combined with physical activity alter intramyocellular triacylglycerol accumulation compared to a low-fat diet in sedentary adults with abdominal obesity or dyslipidemia?

P
Population
277 sedentary adults (mean age 47.9 years, 13.6% female) with abdominal obesity or dyslipidemia, followed for 18 months.
I
Intervention
Mediterranean/low-carbohydrate (MED/LC) diet (hypocaloric, restricting carbohydrates to <40 g/day initially, including 28g/day of walnuts) with or without moderate intense physical activity (PA+) added at 6 months, for a total of 18 months.
C
Comparator
Low-fat (LF) diet (hypocaloric, limiting total fat intake to 30% of daily caloric intake) with or without moderate intense physical activity (PA+) added at 6 months, for a total of 18 months.
O
Outcome
Changes in intramyocellular triacylglycerol (IMTG) over 18 months of intervention measured by magnetic resonance imaging (MRI).surrogate

Main Result

Effect estimate: 0.56% absolute increase (56% relative change) (95% CI 0.21-0.91)

p-value: p=0.002

A Mediterranean/low-carbohydrate diet combined with physical activity significantly increases intramyocellular triacylglycerol during moderate weight loss, but this increase is not independently associated with worsened cardiometabolic risk.

Limitations

  • Exercise intensity and type assessment was limited due to reliance on self-reported questionnaires and gym entry records
  • Reliance on self-reported dietary intake
  • Free fat mass and total fat mass were not measured
  • Small sample size of women limits generalizability to females
  • Exercise intensity and type of exercise assessment was limited due to reliance on self-report and gym entry records
  • Free fat mass and total fat mass measurements were not measured
  • Small sample size of women

Cite This Study

Gepner et al. (2017) conducted an RCT in Abdominal obesity or dyslipidemia (n=277). Mediterranean/low-carbohydrate diet with physical activity vs. Low-fat diet and/or no physical activity was evaluated on Change in intramyocellular triacylglycerol (IMTG) (0.56% absolute increase (56% relative change), 95% CI 0.21-0.91, p=0.002). A Mediterranean/low-carbohydrate diet combined with physical activity significantly increased intramyocellular triacylglycerol by 56% over 18 months compared to other weight loss strategies.

synapsesocial.com/papers/6a203e25873164a424ebb5d0https://doi.org/10.1371/journal.pone.0188431
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