Internal and Emergency Medicine

, Volume 7, Issue 3, pp 219–227 | Cite as

Weight loss is associated with improved endothelial dysfunction via NOX2-generated oxidative stress down-regulation in patients with the metabolic syndrome

  • Francesco Angelico
  • Lorenzo Loffredo
  • Pasquale Pignatelli
  • Teresa Augelletti
  • Roberto Carnevale
  • Antonio Pacella
  • Fabiana Albanese
  • Ilaria Mancini
  • Serena Di Santo
  • Maria Del Ben
  • Francesco Violi


The aim of this study was to assess whether adherence to a restricted-calorie, Mediterranean-type diet improves endothelial dysfunction and markers of oxidative stress in patients with metabolic syndrome. A moderately low-calorie (600 calories/day negative energy balance), low-fat, high-carbohydrate diet (<30% energy from fat, <10% from saturated fat and 55% from carbohydrate) was prescribed to 53 outpatients with the metabolic syndrome. Participants were divided into two groups according to body weight loss > or < 5% after 6 months. Group A (n = 23) showed a remarkable decrease in body weight (−6.8%), body-mass-index (−4.6%), waist circumference (−4.8%), HOMA-IR (−27.2%), plasma glucose, glycosylated haemoglobin, total and LDL-cholesterol, blood pressure, serum NOX2 (the catalytic core of NADPH oxidase) (−22.2%) and urinary8-isoprostanes (−39.0%) and an increase of serum NOx (Nitrite/Nitrate) (+116.8%) and adiponectine (+125.5%) as compared with those in group B (n = 30). A statistically significant increase in brachial artery flow-mediated dilatation was observed in group A (+24.7%; p < 0.001), while no changes were present in group B. Variations of flow-mediated dilatation were statistically and negatively correlated with changes of serum NOX2 levels (p = 0.04), body-mass-index (p < 0.01), waist circumference (0.01), glycosylated haemoglobin (p < 0.01), LDL-cholesterol (p < 0.01) and triglycerides (p < 0.05) and positively correlated with changes of serum NOx (p < 0.001) and adiponectin (p = 0.01). The results show that moderate weight loss is able to improve endothelial dysfunction in patients with the metabolic syndrome. The coexistent decrease of NOX2 activation suggests a role for oxidative stress in eliciting artery dysfunction.


Metabolic syndrome Oxidative stress Diet Endothelial dysfunction Atherosclerosis 


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Copyright information

© SIMI 2011

Authors and Affiliations

  • Francesco Angelico
    • 1
  • Lorenzo Loffredo
    • 1
  • Pasquale Pignatelli
    • 1
  • Teresa Augelletti
    • 1
  • Roberto Carnevale
    • 1
  • Antonio Pacella
    • 1
  • Fabiana Albanese
    • 1
  • Ilaria Mancini
    • 1
  • Serena Di Santo
    • 1
  • Maria Del Ben
    • 1
  • Francesco Violi
    • 1
  1. 1.I Clinica Medica, Dipartimento di Medicina Interna e Specialità MedicheLa Sapienza Università di RomaRomeItaly

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