Comparison of reducing epicardial fat by exercise, diet or bariatric surgery weight loss strategies: a systematic review and meta‐analysis

Abstract

The objectives were to determine whether epicardial fat (EAT) is subject to modification, and whether various strategies accomplish this end point and the relationship between weight loss and EAT. A systematic review of the literature following meta-analysis guidelines was conducted using the search strategy 'epicardial fat' OR 'epicardial adipose tissue' AND 'diet' OR 'exercise' OR 'bariatric surgery (BS)' OR 'change in body weight' limited to humans. Eleven articles were identified with 12 intervention approaches of which eight studies showed a statistically significant reduction in EAT. A random-effects meta-analysis suggests an overall significant reduction of 1.12 standardized units (95% CI = [-1.71, -0.54], P value < 0.01). While there is a large amount of heterogeneity across study groups, a substantial amount of this variability can be accounted for by considering intervention type and change in body mass index (BMI). These variables were incorporated into a random-effects meta-regression model. Using this analysis, significant EAT reduction occurred with diet and BS but not with exercise. BMI reductions correlated significantly with EAT reductions for diet-based interventions, i.e. for some but not all interventions. In conclusion, EAT, a factor that is significantly associated with coronary artery disease, can be modified. The type of intervention, in addition to the amount of weight loss achieved, is predictive of the amount of EAT reduction.

Epicardial adipose tissue: at the heart of the obesity complications

“…However, the amount of EAT reduction cannot be predicted by the overall amount of weight loss, as most impressively demonstrated by the finding that, in spite of the much greater reduction in body weight occurred by means of bariatric surgery, EAT decrease was similar to that observed in the group of patients undergone dietary intervention [72]. This could suggest that there is a limit on the possible EAT reduction in humans consistently with the Fig.…”

“…Weight loss following dietary as well as bariatric surgery interventions was significantly associated with reductions in EAT, whereas the impact of physical exercise on EAT amount is less established [72]. The effect on EAT by medications has been also evaluated.…”

Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study

“…A recent meta-analysis demonstrated that significant EAT reduction can be achieved with diet and bariatric surgery [31]. In some, but not all diet-based interventions, EAT reduction correlated with BMI reduction [31]. On the contrary, in our study, BMI reduction did not correlate with the decrease of EAT after 24 weeks of treatment.…”

“…As our patients were started on a dietary plan and lost weight, it would be intuitive to affirm that EAT reduction was reflecting the BMI reduction. A recent meta-analysis demonstrated that significant EAT reduction can be achieved with diet and bariatric surgery [31]. In some, but not all diet-based interventions, EAT reduction correlated with BMI reduction [31].…”

Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation: Electrophysiologic substrates for atrial fibrillation

“…The effect of weight loss on the amount of adipose tissue around the heart has been demonstrated in several studies and several trials have also supported the benefit of weight management on AF burden. 30,31 Thus, a preventive strategy incorporating risk factor management should effectively reduce AF burden.…”