The effect of long-term weight-loss intervention strategies on the dynamics of pancreatic-fat and morphology: An MRI RCT study. (April 2018)

• Record Type: Journal Article
• Authors: Tene, Lilac; Shelef, Ilan; Schwarzfuchs, Dan; Gepner, Yftach; Yaskolka Meir, Anat; Tsaban, Gal; Zelicha, Hila; Bilitzky, Avital; Komy, Oded; Cohen, Noa; Bril, Nitzan; Rein, Michal; Serfaty, Dana; Kenigsbuch, Shira; Chassidim, Yoash; Sarusy, Benjamin; Ceglarek, Uta; Stumvoll, Michael; Blüher, Matthias; Thiery, Joachim; Stampfer, Meir J.; Rudich, Assaf; Shai, Iris
• Is Part Of: Clinical nutrition ESPEN. Volume 24(2018)
• Page Start: 82
• Page End: 89
• Publication Date: 2018-04
• Subjects: Pancreatic fat -- Diet -- Cardio-metabolic risk; FPG Fasting plasma glucose -- LF Low-fat -- 1H-MRS Magnetic resonance spectroscopy -- Med/LC Mediterranean/low-carbohydrate -- PMR Pancreatic morphology ratio -- PA Physical activity -- PUFA Polyunsaturated fatty-acids -- RCT Randomized controlled trial -- SAT Subcutaneous adipose tissue -- VAT Visceral adipose tissue -- WC Waist circumference; Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2018.01.008
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Background & aims: The ability to mobilize pancreatic-fat and the meaning of decreased fat in the pancreas remain controversial. We followed the dynamics of pancreatic-fat and its morphology during various long weight-loss induced lifestyle-interventions. Methods: In isolated workplace with monitored/provided lunch, we randomly assigned healthy persons with abdominal obesity or dyslipidemia for one of two 18-month equal-caloric diets: low-fat (LF) or Mediterranean/low-carbohydrate (Med/LC, with provided 1oz walnuts/day), with or without added moderate exercise (supervised gym membership). We used magnetic-resonance-imaging to quantify pancreatic-fat and morphology. Results: At baseline, 277 eligible participants (mean age = 48 years; 88% men; pancreatic-fat = 17.4 ± 5.1%) had higher pancreatic-fat in men (17.7 ± 4.9% vs 14.9 ± 5.5% in women; p = 0.004). Following 18-month intervention (adherence = 86.3%) and moderate weight-loss (mean = −3.0 ± 5.5 kg), pancreatic-fat decreased moderately but significantly (−0.26 ± 2.18% units; p = 0.049). Med/LC diet induced a greater decrease in pancreatic-fat compared to LF (p = 0.043), and the combination of Med/LC diet + exercise exhibited the highest reduction (−0.69% units) as compared to LF diet without exercise (+0.12%units; p = 0.027 between groups). In multivariate regression models, after further adjusted for visceral adipose-tissue (ΔVAT), pancreatic-fat loss associated with both decreases in pancreatic-morphology ratio (perimeter divided by area; beta = 0.361; p < 0.001) and superficial-subcutaneous adipose-tissue loss (beta = 0.242; p = 0.001), but not with changes in intrahepatic-fat (beta = −0.034; p = 0.638). Pancreatic-fat loss associated with increased intake of polyunsaturated-fat (beta = −0.137; p = 0.032), as with improved high-density lipoprotein-cholesterol (HDL; beta = −0.156; p = 0.023) and triglycerides/HDL ratio (beta = 0.162; p = 0.015), independently of ΔVAT, but not with glycemic–control parameters (e.g. HbA1c, HOMA-IR and HOMA-beta; p > 0.2 for all). Conclusions: Pancreatic-fat loss is mainly associated with improved lipid, rather than glycemic profiles. Med/LC diet, mostly with exercise, may benefit pancreatic-fat loss. Pancreatic-morphology could serve as a biomarker of pancreatic-fat state. (ClinicalTrials.gov identifier:NCT01530724 )