Editorial: The ICCR has had another successful joint meeting with the EAS in Hamburg

The International Chair on Cardiometabolic Risk (ICCR) has organized another successful and well attended symposium at the European Atherosclerosis Society (EAS) meeting held from June 20 to 23, 2010 in Hamburg, Germany. This joint ICCR/EAS symposium, co-chaired by Prof. Marja-Riitta Taskinen from University of Helsinki, Finland and by Prof. Luc Van Gaal from University of Antwerp, Belgium, was entitled “Physical activity, healthy eating and CVD risk” and included three plenary lectures. Dr. Taskinen introduced the session by reminding the audience of the ICCR mission which is to promote research and education activities on abdominal obesity and related cardiometabolic risk. She also invited the participants to the 2nd International Congress on Abdominal Obesity which will be held in Buenos Aires Argentina from February 24-26, 2011. The first lecture was given by Prof. Nick Wareham from the University of Cambridge. Dr. Wareham, who is a well published and well recognized epidemiologist/diabetologist, discussed the tools currently available to estimate/assess physical activity in epidemiological studies and presented evidence from a large prospective observational study conducted in the UK for which he is one of the co-investigators, the EPIC-Norfolk study, that simple questions to assess work-re

lated and leisure-time physical activity could even lead to the re-classification of a given individual’s risk of coronary heart disease (CHD) estimated by common global risk assessment tools such as the Framingham risk score (Atherosclerosis. 2010; 209: 261-5). Therefore, although physicians do not have the time and the resources to assess cardiorespiratory fitness, a powerful discriminant of CHD risk and a physiological marker of physical activity, these results from EPIC-Norfolk clearly show that simple questions about physical activity, which can be administrated in little time by primary care physicians and at no cost, should be considered to improve the evaluation of the patient’s global cardiovascular disease (CVD) risk. Dr. Wareham reminded the audience that it is very difficult to precisely assess physical activity with tools currently available. He also mentioned that work is in progress to develop better approaches to assess physical activity which could be used in large epidemiological studies and hopefully in clinical practice.

His lecture was followed by Prof. Jean-Pierre Després from the Québec Heart and Lung Institute at Université Laval, Québec, Canada, who presented the results of a 3-year lifestyle modification program (the SYNERGIE study) which was specifically designed to be implemented in clinical practice for the management of men with intra-abdominal (visceral) obesity. The SYNERGIE investigators found that a monthly visit to a dietitian and to a kinesiologist (exercise specialist) would induce over the long-term a substantial loss of intra-abdominal adipose tissue measured by computed tomography. Such loss of intra-abdominal fat was even observed among a subgroup of men who lost little body weight in response to the 3-year lifestyle modification program. Indeed, many subjects improved their cardiorespiratory fitness and showed a substantial loss of intra-abdominal adipose without major changes in their body weight. Such loss of intra-abdominal adipose tissue was better predicted by changes in waist circumference than by weight loss. Thus, the SYNERGIE study showed that a monthly visit to a team of health professionals could be relevant to help high-risk intra-abdominally obese patients reshape their nutritional and physical activity habits. Further analyses are currently underway to better understand the respective contributions of the changes in the quality of the diet vs. changes in physical activity/exercise habits (volume and intensity) to the improvements in the cardiometabolic risk profile produced by this program.

Finally, in addition to the quality of the food that we eat, Dr. Frank Hu from the School of Epidemiology of the University of Harvard reviewed evidence that the consumption of sugar-sweetened beverages (SSBs) could increase the risk of obesity, type 2 diabetes and CVD. Dr. Hu presented the results of a literature review on the topic that his group recently published in Circulation in which the conclusion was reached that the consumption of SSBs increased not only the risk of obesity but also of type 2 diabetes and of CVD. He also reviewed the possible mechanisms involved in this relationship. Among several possibilities, SSBs could contribute to the passive overconsumption of calories as the consumption of liquid calories is not accompanied by compensatory reduction in the intake of calories from solid foods. Thus, the liquid calories just add to the consumption of calories provided by solid foods. In addition, this consumption of rapidly absorbed sugar could contribute to increase the glycemic load of the overall diet, promoting an oversecretion of insulin which could lead to hyperinsulinemia, insulin resistance and related atherothrombotic, inflammatory abnormalities. Thus, these abnormalities linked to an overconsumption of sugar could increase the risk of type 2 diabetes and CVD. In this regard, the American Heart Association has published a position statement on the risk associated with an excess consumption of added sugar. Overall, Dr. Hu’s data suggest that physicians should pay attention not only to what their patients eat but also to what they drink.

The meeting was closed by Dr. Van Gaal who reminded the audience that physical activity/exercise and healthy eating habits are the cornerstone of primary prevention of type 2 diabetes and CVD. He also pointed out that there is overwhelming evidence that a physically active lifestyle is associated with a cardiometabolic risk profile predictive of a reduced risk of type 2 diabetes and CVD. We now have evidence that it is possible to reshape the lifestyle habits of high-risk abdominally obese patients and that moderate weight loss in these patients could be associated with a substantial loss of intra-abdominal/ectopic fat. Finally, when efforts are devoted to improve the dietary habits of our patients, careful attention should be given to what they drink as their hydration habits may contribute to an overconsumption of useless calories derived from added sugar.