Abstract 5137: Normalization of Visceral Adiposity is a Better Therapeutic Target Than Normalisation of Body Weight: Evidence From the Synergie Trial
A moderate weight loss of 5 to 10% has been shown to induce several improvements in the cardiometabolic profile of high risk obese patients and is therefore generally recommended as a clinically meaningful therapeutic target. The SYNERGIE study is a lifestyle modification program which aims at reshaping the nutritional and physical activity habits of sedentary men with visceral obesity. In the present analyses, 101 healthy men aged 30 to 65 years without diabetes but characterized by visceral obesity and by the high triglyceride-low HDL cholesterol atherogenic dyslipidemia were assigned to a personalized nutritional and physical activity management program which included a monthly visit. In response to the intervention program, men of the study decreased their body weight, waist circumference (Δ=−9 cm, p<0.0001) and their visceral adipose tissue (VAT) (Δ=−79 cm2, p<0.0001). The intervention program also significantly improved several metabolic parameters such as HDL cholesterol (Δ=+0.13 mmol/l, p<0.0001) and triglycerides levels (Δ =−0.6 mmol/l, p<0.0001) as well as glucose and insulin homeostasis variables. However, when compared to a control group of healthy nonobese men (mean BMI=24 kg/m2, n=65), men of the intervention group did not fully normalize their cardiometabolic profile after 1-year. In order to further explore this issue, men of the intervention group were classified into quartiles of VAT accumulation achieved after 1-year. In comparison with men in the top VAT quartile, men in the lowest VAT quartile had markedly improved cardiometabolic profile. Moreover, when compared to nonobese controls, men who reached low levels of VAT were characterized by a lower VAT accumulation (100 cm vs. 124 cm) despite higher body weight (80 kg vs. 73 kg) and body mass index (27 kg/m2 vs. 24 kg/m2) than healthy nonobese controls. These men were also characterized by “normalized” HDL cholesterol (1.17 mmol/l), triglycerides (1.58 mmol/l), glucose (5.8 mmol/l), apolipoprotein B (0.97 mg/dl) and apolipoprotein AI (1.35 g/l) compared to nonobese controls. These results suggest that VAT may represent a better therapeutic target than the normalisation of body weight in the management of cardiometabolic risk in high risk abdominally obese men.