Introduction People with Type 2 Diabetes (T2D) are predisposed to heart failure (HF). South Asian (SA) people are disproportionally affected by T2D. Weight management orientated lifestyle treatments have proven successful in the reversal of T2D in the overweight population. There are no studies comparing the effect of a low-energy meal-replacement plan (MRP) on cardiovascular structure and function between South Asians (SA) and White Europeans (WE).
Objective To ascertain if there was a difference in the cardiovascular structural and functional outcomes between SA and WE living with obesity and T2D undergoing a LCD.
Methods Asymptomatic adults living with obesity and T2D and no cardiovascular disease were randomised to a low-energy (∼810 kcal/day) MRP as part of the DIASTOLIC randomised controlled trial (NCT02932436). Participants underwent clinical and metabolic profiling, echocardiography, and comprehensive multiparametric cardiovascular magnetic resonance imaging with myocardial blood flow quantification. Data was collected at baseline and the change at 12weeks were compared between SA and WE in the MRP group only. Change between the groups was compared using linear regression with baseline data corrected for sex and the regression model for change correcting for baseline measures.Results:Fifteen WE participants and 12 SAs were randomised to the MRP. All WE participants completed the 12- week MRP compared to only 8 SAs. Table 1 details the baseline demographics and anthropometric measures between the groups corrected for sex. SA were younger than WE and systolic BP was lower in SA but there were no other significant differences. There were also no significant differences in renal function, fasting glucose or HbA1c, lipid profile, baseline C-peptide, insulin, adiponectin, and HOMA IR between groups. BNP was significantly higher in the WE group ((13.5 (8.5 - 23.7) ng/l) compared to the SA group ((6.9 (4.1 - 11.7) ng/l) (P<0.05). Both groups showed a dramatic decrease in weight and BMI, with mean change in weight of -15.0 ± 3.8kg in WE and -12.0 ± 5.6kg in SA. Both groups showed a significant decrease in insulin -18.0 (-24.8, -11.1) in WE and -14.8 (-28.7, -0.8) in SA and HOMA IR. The changes in glucose, insulin, adiponectin and leptin between groups were not statistically significant.Following the MRP there was a reduction in ejection fraction, reduced resting myocardial blood flow and a trend to worsening peak early diastolic strain rate in both ethnic groups (Table 2). LV end-diastolic volume increased and Mass/Volume decreased in the WE group but not in the SA group and the between group difference for Mass/volume trended towards significance. There was no significant difference between the groups for E/A or E/e’ on echocardiography or other measures of cardiac function on CMR.
Conclusion The compliance of the SA population to a LCD was reduced by a third compared to age matched WE with full compliance. Although similar improvements in insulin resistance and weight loss were achieved, there was trend towards less reverse concentric remodelling in the SA group and larger studies with longer follow up periods will be required to assess if the cardiovascular responses to weight loss are equally beneficial in ethnic minority populations.
Conflict of Interest None
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