Yaşam Tarzı Değişikliğiyle Kilo Kaybının LDL Kolesterol Üzerine Etkisi: Retrospektif Kohort Çalışması

Yıl 2024, Cilt: 18 Sayı: 3, 357 - 363, 05.09.2024

Hülya Güç , Neslişah Gürel Köksal , Mehmet Sargın

https://doi.org/10.21763/tjfmpc.1412471

Öz

Amaç: Bu araştırmada etkili bir yaşam tarzı değişikliği (YTD) ile obez hastaların lipit düzeylerinde yüzde kaç oranında düşüş sağlanabileceği ve etkili lipit düşüşü için en az ne kadar kilo verilmesi gerektiği araştırılmak istenmiştir.
Gereç ve Yöntem: Çalışmamız retrospektif bir kohort çalışmasıdır. Çalışmaya obezite polikliniğinde izlenen, hiperlipidemi tanısı alıp herhangi bir hiperlipidemi tedavisi kullanmayan 71 hasta dahil edilmiştir. Hastaların ilk gelişte ve 6. aydaki yüksek yoğunluklu lipoprotein kolesterol (HDL-K), düşük yoğunluklu lipoprotein kolesterol (LDL-K), total kolesterol, trigliserit, vücut yağ oranı ve kitlesi, beden kitle indeksi (BKİ), boy, kilo bilgileri kaydedilmiştir. Çalışmamızda hastalar (6 ay sonraki takiplerindeki kilo düşüş oranları baz alınarak) önceki kilolarına göre %10 dan daha az kilo verenler ve %10 ve daha fazla kilo verenler olarak iki gruba ayrılarak lipit parametreleri karşılaştırılmıştır.
Bulgular: Kilo verme oranlarına göre sınıflandırılan hastaların LDL-K düşüş oranları karşılaştırıldığında; %10 ve daha fazla kilo verenlerin LDL-K düşüş oranları (1. Grup= %18.48) %10 ’un altında kilo verenlere göre (2. Grup= %13.04) anlamlı olarak daha fazlaydı (p=0.011). Total kolesterol düşüş oranları da 1. Grupta 2. Gruba göre anlamlı olarak daha fazlaydı (p=0.015).
Sonuç: Birinci basamak yaklaşımında kardiyovasküler riski azaltmak için birincil ve ikincil korunmanın uygulanması önemli bir konudur. Hiperkolesterolemi tespit edilen obez hastalarda hedeflenen LDL-K değerlerine ulaşmak amacıyla hastalara yaşam tarzı değişiklikleri önerilmeli ve en az %10 kilo vermenin önemine vurgu yapılmalıdır.

Anahtar Kelimeler

yaşam tarzı değişiklikleri, hiperlipidemi, primer koruma

The Effect Of Weight Loss With Lifestyle Changes On LDL Cholesterol: Retrospective Cohort Study

Öz

Aim: This study aimed to investigate the rate of decrease in lipid levels with effective lifestyle changes (LC) and the minimum body weight loss necessary for effective lipid reduction in obese patients.
Method: The study is a retrospective cohort study. The study included 71 patients who were followed up in the obesity clinic, who were diagnosed with hyperlipidemia but did not use any hyperlipidemia treatment. The patients' high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, triglyceride, body fat ratio and mass, body mass index (BMI), height and weight information were recorded at the first visit and the 6th month. In our study, patients were divided into two groups (based on the weight loss rates in the 6-month follow-up) those who lost less than 10% of their previous weight and those who lost 10% or more weight and their lipid parameters were compared.
Results: LDL-C reduction rates of patients classified according to their weight loss rates were found to be statistically significantly (p=0.011) higher in those with 10% or more weight loss than (group 1=18.48%) in those with less than 10% weight loss (group 2=13.04%). Total cholesterol reduction rates were also significantly (p=0.015) higher in the 1st group than in the 2nd group. According to the findings of our study, at least 10% weight loss is required to decrease total cholesterol and LDL-C significantly.
Conclusion: Implementation of primary and secondary prevention strategies to reduce the risk of cardiovascular disease is important in the context of primary care. To reach the targeted LDL-C values, the weight monitoring of obese patients should be considered, and the importance of losing at least 10% of weight as one of the first steps should be emphasized.

Anahtar Kelimeler

lifestyle changes, hyperlipidemia, primary prevention

Kaynakça

• 1. TÜİK, Cause of death statistics, 2020 Issue: 37243, February 23, 2023. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2020-37243 Date of Access: 31.12.2023
• 2. TEMD, Dyslipidemia diagnosis and treatment guide, 2021. Turkish Endocrinology and Metabolism Association, Calculation of total cardiovascular risk, p: 25-31. Available from: https://file.temd.org.tr/Uploads/publications/guides/documents/20211026164301-2021tbl_kilavuzb66456ad2f.pdf Date of Access: 31.12.2023
• 3. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337. doi: 10.1093/eurheartj/ehab484
• 4. SCORE2-OP working group and ESC Cardiovascular risk collaboration. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J. 2021 Jul 1;42(25):2455-2467. doi:10.1093/eurheartj/ehab312.
• 5. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi: 10.1093/eurheartj/ehz455
• 6. Arnett DK, Blumenthal RS, Albert MA, et al. ACC /AHA Guideline on the primary prevention of cardiovascular disease. circulation. 2019 Sep 10;140(11):e596-e646. doi: 10.1161/CIR.0000000000000678
• 7. Athyros, VG., Katsiki, N., Doumas, M., Karagiannis, A., & Mikhailidis, DP. Effect of tobacco smoking and smoking cessation on plasma lipoproteins and associated major cardiovascular risk factors: a narrative review. Curr Med Res Opin 2013, 29(10), 1263-1274. doi:10.1185/03007995.2013.827566
• 8. Brien, SE., Ronskley, PE., Turner, B. J., Mukamal, K. J. & Ghali, WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ 342, d636 (2011). doi: https://doi.org/10.1136/bmj.d636
• 9. Low AK, Bauldin MJ, Sumrall CD, Loustalot FV, Land KK. A Clinician’s approach to medical management of obesity. Am J Med Sci 2006;331:175-182. doi: 10.1097/00000441-200604000-00003
• 10. Mente A, de Koning L, Shannon HS, Anand SS. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Arch Stajyer Med. 2009;169:659–69. doi.org/10.1001/archinternmed.2009.38.
• 11. Capra ME, Pederiva C, Viggiano C, Fabrizi E, Banderali G, Biasucci G. Nutritional Treatment in a Cohort of Pediatric Patients with Familial Hypercholesterolaemia: Effect on Lipid Profile. Nutrients 2022;14(14):2817. doi.org/10.3390/nu14142817
• 12. Zhang R, Dong SY, Wang F, Ma C, Zhao XL, Zeng Q, Fei A. Associations between Body Composition Indices and Metabolic Disorders in Chinese Adults: A Cross-Sectional Observational Study. Chin Med J (Engl). 2018 Feb 20;131(4):379-388. doi: 10.4103/0366-6999.225059
• 13. Kaçar Mutlutürk Ü, Çiçek B, Bayram F, Doğruel F. Effect of Low Fat and Low Cholesterol Diet Intervention on LDL Subgroups in Dyslipidemic Patients: Epidemiological Observational Study. Turk J Diab Obes. August 2023;7(2):145-151. doi:10.25048/tudod.1182426
• 14. Keskin A, Aci R. Investıgatıon of Lipid Profile, Malondialdehyde, Sodium, Potassium, Chloride Levels in Rats with Weight Loss. Turk J Diab Obes. April 2022;6(1):10-15. doi:10.25048/tudod.935233
• 15. König D, Hörmann J, Predel HG, Berg A. A 12-Month Lifestyle Intervention Program Improves Body Composition and Reduces the Prevalence of Prediabetes in Obese Patients. Obes Facts. 2018;11(5):393-399. doi: 10.1159/000492604
• 16. Nordmann AJ, Nordmann A, Briel M, et al. Effects of low carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166(3):285-93. doi: 10.1001/archinte.166.3.285
• 17. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992; 56(2):320-8. doi: 10.1093/ajcn/56.2.320
• 18. Shaw K, Gennat H, O’Rourke P, et al. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817. doi: 10.1002/14651858.CD003817.pub3
• 19. Huffman KM, Hawk VH, Henes ST, et al. Exercise effects on lipids in persons with varying dietary patterns does diet matter if they exercise? Responses in studies of a targeted risk reduction intervention through defined exercise I. Am Heart J. 2012 Jul;164(1):117-24. doi: 10.1016/j.ahj.2012.04.014
• 20. Pirro M, Vetrani C, Bianchi C, et al. Joint position statement on "nutraceuticals for the treatment of hypercholesterolemia" of the Italian Society of Diabetology (SID) and of the Italian Society for the Study of Arteriosclerosis (SISA). Nutr Metab Cardiovasc Dis. 2017;27(1):2-17. doi: 10.1016/j.numecd.2016.11.122
• 21. Miettinen TA, Gylling H. Regulation of cholesterol metabolism by dietary plant sterols. Curr Opin Lipidol. 1999;10(1):9-14. doi: 10.1097/00041433-199902000-00003
• 22. Musa-Veloso K, Poon TH, Elliot JA, et al. A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: results of a meta-analysis of randomized, placebo-controlled trials. Prostaglandins Leukot Essent Fatty Acids. 2011;85(1):9-28. doi: 10.1016/j.plefa.2011.02.001
• 23. Carter SJ, Roberts MB, Salter J, Eaton CB. Relationship between Mediterranean Diet Score and atherothrombotic risk: Findings from the Third National Health and Nutrition Examination Survey (NHANES III), 1988– 1994. Atherosclerosis 2010;210:630-636. doi: 10.1016/j.atherosclerosis.2009.12.035
• 24. Perona JS, Covas MI, Fitó M, Cabello-Moruno R, Aros F, Corella D, et al. Reduction in systemic and VLDL triacylglycerol concentration after a 3-month Mediterranean-style diet in high-cardiovascular-risk subjects. J Nutr Biochem 2010;21:892-898. doi:10.1016/j.jnutbio.2009.07.005
• 25. Bajer B, Rádiková Ž, Havranová A, et al. Effect of 8-week intensive lifestyle intervention on LDL and HDL subfractions. Obes Res Clin Pract. 2019;13(6):586-593. doi:10.1016/j.orcp.2019.10.010