Discussion
obesity, inflammation, T2D
CVD, INFLAMMATION, VASODILATION, OBESITY
In this second study from an open-label RCT [Population-based studies have provided evidence that correction of a suboptimal diet may be a powerful approach to reduce the risk of CVD [There might, however, be transient effects of an increased intake of fat on endothelial function that are attenuated or eventually lost over time. Thus, the brachial FMD increased markedly in response to a low-fat diet for 3 weeks, but not with a VLCD in patients with T2D, even though both groups lost abdominal weight [Markers of systemic low-grade inflammation such as IL-6 and hsCRP are often elevated in obesity and T2D and associated with an increased risk of CVD [The strengths of the present study include the randomized design, the well-matched study groups, and the sample size, which according to a non-inferiority analysis was sufficiently large to rule out a change in FMD higher than 20%. In addition, the participants were instructed to maintain their level of physical activity and medication, which allowed us to study the isolated effect of a non-calorie-restricted LCD, which is feasible for patients with T2D under free-living conditions. The limitations include the unblinded (open-label) study design, the lack of strict control with regard to changes in physical activity, medication, and diet macronutrient composition including different types of fat, the latter leading to a higher intake of saturated fat than generally recommended. Moreover, the inability to demonstrate a between-group difference in change of IL-6 and hsCRP levels despite a reduction of both markers in the LCD group suggests that a larger sample size would have been needed to make a conclusion whether a LCD reduces low-grade-inflammation.In summary, the present study provides evidence that a LCD high in fat for 6 months in patients with T2D instructed to maintain their daily energy intake and level of physical activity does not adversely affect neither the endothelium-dependent (FMD) nor –independent (NID) vasodilation in the brachial artery or selected markers of systemic low-grade inflammation compared with a control diet low in fat. These findings together with the previously reported lack of changes in blood lipids and blood pressure [