Diet-based weight loss improves biomarkers of endothelial function

Weight loss induced by diet appears to improve biomarkers of endothelial function, according to a study. This intervention suggests a potential strategy to lower the risk of atherosclerosis.

“The present systematic review and meta-analysis revealed that diet-induced weight loss may improve biomarkers of endothelial function, but the effects may require further verification given the high heterogeneity and bias present across studies,” the investigators said.

The databases of Embase and Medline were searched from inception through November 2022 for studies meeting the following criteria: adult participants (≥18 years) without exclusion for health status, dietary interventions for weight loss, and measurements of changes in endothelial function biomarkers. The investigators then conducted random-effect meta-analysis and meta-regression.

Thirty-seven studies with a total of 1,449 participants met the eligibility criteria. Duration of studies ranged from 3 to 52 weeks. Overall, diet-based weight loss led to significant improvements in biomarkers of endothelial function (standardized mean difference [SMD], 0.65, 95 percent confidence interval [CI], 0.49‒0.81; p<0.001; I², 91.9 percent). [Eur J Clin Nutr 2023;77:927-940]

In subgroup analyses, weight loss resulted in significantly improved levels of E-selectin (p<0.001), intercellular adhesion molecule-1 (ICAM-1; p<0.001), vascular cell adhesion molecule-1 (VCAM-1; p<0.001), nitrite/nitrate (NOx; p<0.001), and vascular endothelial growth factor (VEGF; p<0.001). On the other hand, no significant improvement was seen for von Willebrand Factor (vWF).

Meta-regression analysis revealed that changes in biomarkers of endothelial function were not influenced by age, body mass index, quality of the studies, or the amount of weight lost. Of note, there was significant heterogeneity for the effects of weight loss on changes in these biomarkers.

A previous meta-analysis had also examined the impact of weight loss on endothelial function and revealed a significant increase in flow mediated dilation by 3.29 percent following an average weight loss of 8.6 kg. [Atherosclerosis 2015;239:21-30]

In another systematic review and meta-analysis, weight loss through bariatric surgery improved levels of ICAM-1 and E-selectin. These results were consistent with changes in ICAM-1 and E-selectin seen in the present review. [Obes Surg 2020;30:3549-3560]

“Here we found that weight loss significantly improved levels of VCAM-1,” the investigators. “However previous studies testing the effect of weight loss on VCAM-1 have conflicting results.”

The study by Seyyedi and colleagues found no improvement in VCAM-1 levels following weight loss, but other studies showed a decrease in VCAM-1 levels. [Obes Surg 2020;30:3549-3560; J Nutr Gerontol Geriatr 2019;38:33-49; Nutr Metab Cardiovasc Dis 2006;16:524-530]

“However, the study by Seyyedi [and colleagues] used bariatric surgery as a weight loss strategy and therefore results may be not comparable to the effects reported in this meta-analysis due to the potential effect of the surgical procedures on circulating levels of VCAM-1,” the investigators said.

“More research is required into recently discovered endothelial function biomarkers such as endothelial microparticles and endothelial progenitor cells,” they added.