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Effects of dietary-based weight loss interventions on biomarkers of endothelial function: a systematic review and meta-analysis

European Journal of Clinical Nutrition volume 77, pages 927–940 (2023)Cite this article

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Abstract

Endothelial dysfunction is closely linked to the development of atherosclerosis. This systematic review and meta-analysis reviewed the evidence on the effect of weight loss, achieved by dietary-based interventions, on biomarkers of endothelial function (EF). Two databases (Medline, Embase) were searched from inception until November 2022 for studies that met the following criteria: 1) adult subjects (≥ 18 years) without exclusion for health status, 2) dietary interventions for weight loss, and 3) measurements of changes in EF biomarkers. Random-effect meta-analysis and meta-regression were performed. Thirty-seven articles including 1449 participants were included in the systematic review. Study duration ranged from 3-52 weeks. Overall, weight loss significantly improved biomarkers of EF [standardised mean difference (SMD):0.65; 95%CI:0.49,0.81; P < 0.001;I2 = 91.9%]. Subgroup analyses showed weight loss significantly improved levels of E-selectin (P < 0.001), intercellular adhesion molecule-1 (ICAM-1) (P < 0.001), vascular cell adhesion molecule-1 (VCAM-1) (P < 0.001), nitrite/nitrate (NOx) (P < 0.001) and vascular endothelial growth factor (VEGF) (P < 0.001). Conversely, there was no significant improvement for von Willebrand Factor (vWF). Meta-regression analysis revealed that changes in EF biomarkers were not affected by age, BMI, quality of the studies or the amount of weight lost. A significant heterogeneity was observed for the effects of weight loss on changes in EF biomarkers. Dietary-induced weight loss may be associated with biomarkers changes indicating an improvement of EF, and it may represent a potential strategy to reduce atherosclerotic risk.

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Fig. 1: Flow diagram outlining the selection process of the studies included in the systematic review and meta-analysis.
Fig. 2: Forest plots displaying the effects of weight loss on overall and individual biomarkers of endothelial function.

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Funding

This research was funded by Nottingham University.

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Authors and Affiliations

  1. School of Life Sciences, The University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, NG7 2UH, UK

    Rishabh Mathur, Zhara Ahmid & Mario Siervo

  2. College of Medicine, University of Al-Mustansiriyah, Baghdad, Iraq

    Ammar W. Ashor

  3. Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK

    Oliver Shannon

  4. Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK

    Blossom C. M. Stephan

  5. Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, WA, Australia

    Blossom C. M. Stephan & Mario Siervo

  6. School of Population Health, Curtin University, Perth, WA, Australia

    Mario Siervo

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  1. Rishabh Mathur
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Contributions

MS conceptualized the study. RM, ZA and MS conducted the search and screened the articles. RM and MS conducted the analysis and wrote the manuscript. MS is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the discussion and interpretation of data, and reviewed / critically edited the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Mario Siervo.

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Mathur, R., Ahmid, Z., Ashor, A.W. et al. Effects of dietary-based weight loss interventions on biomarkers of endothelial function: a systematic review and meta-analysis. Eur J Clin Nutr 77, 927–940 (2023). https://doi.org/10.1038/s41430-023-01307-6

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  • DOI: https://doi.org/10.1038/s41430-023-01307-6

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