Impact of Physical Activity on Dynamics of Intrapericardial and Extrapericardial Fat Tissues during Long-Term Dietary Intervention

Gal Tsaban ¹ Arik Wolak ⁶ Hila Avni-Hasid ¹ Yftach Gepner ¹ Ilan Shelef ² Yaakov Henkin ³ Dan Schwarzfuchs ^5,7 Noa Cohen ¹ Nitzan Bril ¹ Michal Rein ¹ Dana Serfaty ¹ Shira Kenigsbuch ¹ Lilac Tene ¹ Hila Zelicha ¹ Anat Yaskolka Meir ¹ Oded Komy ¹ Avital Bilitzky ¹ Yoash Chassidim ⁴ Uta Ceglarek ⁹ Michael Stumvoll ⁹ Matthias Blüher ⁹ Joachim Thiery ⁹ Dror Diker ⁸ Asaf Rudich ¹ Meir J Stampfer ¹⁰ Iris Shai ¹

¹Faculty of Health Sciences, Ben-Gurion University of the Negev
²Division of Radiology, Soroka University Medical Center
³Department of Cardiology, Soroka University Medical Center
⁴Research, Soroka University Medical Center
⁵Department of Emergency Medicine, Soroka University Medical Center
⁶Cardiac Imaging Unit, Department of Cardiology, Shaare Zedek Medical Center
⁷Department of Medicine, Nuclear Research Center Negev
⁸Internal Medicine D, Rabin Medical Center, Campus Golda
⁹Department of Medicine, University of Leipzig
¹⁰Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard School of Public Health

Aims:
We sought to evaluate impact of physical activity (PA), combined with dietary intervention, on intrapericardial-fat (IPF) and extrapericardial-fat (EPF) changes.

Methods:
We randomly assigned 80 participants with moderate abdominal-obesity for one of two isocaloric diets: Mediterranean/low-carbohydrate (MED/LC), low-fat (LF) diet. After 6-months, we randomized both dietary-groups’ participants into either diet-only intervention, or diet+PA intervention for 12 additional months. The PA groups recived free gym membership and were instructed for 80% aerobic excerise protocol. We performed whole-body magnetic-resonance-imaging (MRI) and volumetrically quantified IPF and EPF during the trial.

Results:
The participants (mean-age=48.6years; mean-body-mass-index (BMI)=31.7kg/m²; 90% men) had baseline IPF and EPF volumes of 172.4±53.3mL and 194.9±71.5mL, respectively. The 18-months moderate weight loss of 3.7kg was similar in both groups. After 18-months of intervention, IPF volume had reduced more in the diet+PA group compared with the diet-only group (-25.9+25.9mL (-15.1+15.9%) vs. -13.2+26.2mL (-7.2+14.2%), respectively;p=0.022). EPF volume changed similarly, but non-significantly (-36.0+30.6mL (-19.2+14.8%) in diet+PA group vs. -24.5+29.5mL (-12.6+16%) in diet-only group;p=0.093). LC/MED+PA intervention had a reduced three-times as much IPF volume as compared with the other intervention combinations, and specifically vs. LF-diet-only group (-37.2+27.1mL (-21.9+14.4%) vs. -10.1+27.8mL (-5.2+14.7%), respectively;p=0.008). Only in the diet+PA group, IPF proportional-reduction associated with increased high-density-lipoprotein-cholesterol(HDL-c;β=-0.365;p=0.037), decreased triglycerides (TG;β=0.593;p<0.001), TG/HDL-c ratio (β=0.534;p=0.001), and decreased homeostatic-model of insulin-resistance (HOMA-IR,β=0.526;p=0.002).

Conclusions:
Moderate, but persistent, weight loss substantially decreases both IPF and EPF volumes. Especially when induced by combining diet with PA, reductions of pericardial-adipose-tissues are associated with improved lipid profile and insulin sensitivity. PA combined with any diet, and specifically MED/LC diet, is superior to a diet-only regimen in terms of IPF burden reduction.

(ClinicalTrials.gov number, NCT01530724)

Gal Tsaban

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