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1 Internal Medicine, Washington University in St.Louis, St.Louis, Missouri, United States
2 Geriatrics and Nutritional Science, Washington University School of Medicine, Missouri, United States
3 Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States; Internal Medicine, Washington University, Campus Box 8113, Saint Louis, Missouri, 63110, United States
4 Internal Medicine, Washington University, 63110, Missouri, United States
5 Washington University, United States; Internal Medicine, Washington University in St.Louis, St.Louis, Missouri, United States; United States; Geriatrics and Nutritional Science, Washington University School of Medicine, Missouri, United States
6 Section of Applied Physiology, Washington University School of Medicine, St. Louis, Missouri, United States
* To whom correspondence should be addressed. E-mail: lfontana{at}im.wustl.edu.
Coronary heart disease (CHD) risk factors and the risk of CHD increase with increased adiposity. Fat loss induced by negative energy balance improves all metabolic CHD risk factors. To determine whether fat loss induced by long-term calorie restriction (CR) or increased energy expenditure induced by exercise (EX) has different effects on CHD risk factors in non-obese subjects, we conducted a 1-year controlled trial involving 48 non-obese subjects who were randomly assigned to 1 of 3 groups: CR = 20% calorically restricted diet (n=18); EX = 20% increase in energy expenditure through daily exercise with no increase in energy intake (n=18); or HL = healthy lifestyle guidelines (n=10). Subjects were 29 women and 17 men aged 57±3 yr, with body mass index 27.3±2.0 kg/m2. Assessments included total body fat by DXA, lipoproteins, blood pressure, HOMA-IR index, C-reactive protein (CRP) and estimated 10-yrs CHD risk score. Body fat decreased by 6.3±3.8 kg in CR, 5.6±4.4 kg in EX and 0.4±1.7 kg in HL, which corresponded to reductions of 24.9%, 22.3%, and 1.2% of baseline body fat mass, respectively. These CR- and EX-induced energy deficits were accompanied by reductions in most of the major CHD risk factors, including plasma LDLc, Tchol:HDL ratio, HOMA-IR index and CRP concentrations, that were similar in the two intervention groups. Data from the present study provide evidence that CR- and EX- induced negative energy balance result in substantial and similar improvements in the major risk factors for CHD in normal-weight and overweight middle-aged adults.
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