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 WCmen = 4,38  1,7 cm vs WCwomen = 3,7  2,0 cm; WHRmen = 0,03  0,01 vs WHRwomen = 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.