4. Discussion
obesity, TMA, LCD
OBESITY, DISEASE, CVD
The primary finding from this present study is that neither LCD nor LCD+INT was effective overall at reducing plasma TMAO in women with obesity, despite lowering plasma choline. However, we did observe that both treatments were effective at reducing TMAO in women with higher baseline levels. This is consistent with prior work demonstrating that participants with a median plasma TMAO level below 4.72 μM were free of CVD [TMAO precursors are relevant to disease development, as choline, TMA, and carnitine levels have been associated with increased CVD risk [This study has limitations that may influence our interpretations. The present investigation only included women, so the results may not be generalizable to men. In fact, studies with similarly aged male and female cohorts have demonstrated lower TMAO levels in females than men [In conclusion, overall, neither LCD nor LCD+INT for 2 weeks was effective at reducing plasma TMAO in women with obesity. However, in women with higher circulating baseline TMAO levels, both treatments lowered plasma TMAO. This is consistent with our observation that LCD, with or without INT treatment, is effective at lowering choline, a key precursor to TMAO. The clinical relevance of lower TMAO metabolism in women with obesity is unclear; however, lower TMA and carnitine concentrations were related to improved central hemodynamics, which may promote CVD risk reduction. Therefore, additional studies are necessary to understand how lifestyle interventions and/or medications that influence the gut may reduce TMAO among individuals with obesity to combat CVD.