Original Communication Short-term changes of cardiovascular risk factors after a non- pharmacological body weight reduction program A Sartorio 1,2 *, CL Lafortuna 3 , V Vangeli 1 , A Tavani 4 , C Bosetti 4 and C La Vecchia 4,5 1 Laboratorio Sperimentale di Ricerche Endocrinologiche (LSRE), Istituto Auxologico Italiano, IRCCS, Milano, Italy; 2 Divisione Malattie Metaboliche III, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy; 3 Istituto di Tecnologie Biomediche Avanzate, CNR, Milano, Italy; 4 Istituto di Ricerche Farmacologiche ‘M Negri’, Milano, Italy; and 5 Istituto di Statistica Medica e Biometria, Universita ` degli Studi di Milano, Italy Objective: To test the short-term effectiveness of a 3 week hospital-based body weight reduction (BWR) program on selected coronary heart disease (CHD) risk factors in obese subjects. Design: Intervention study to assess the modifications in CHD risk factor scores estimated according to Framingham risk factor categories (age, total cholesterol, high density lipoprotein (HDL) cholesterol, blood pressure, diabetes and smoking). Setting: 3rd Division of Metabolic Diseases, Italian Institute for Auxology, Piancavallo (VB), Italy. Subjects: Two-hundred and sixty-eight obese patients (43 men, 225 women, age range 19 – 81 y; body mass index (BMI) range 30 – 67). Intervention: The BWR program consisted of a 3 week integrated energy-restricted diet (1200 – 1800 kcal=day), associated with moderate aerobic exercise, psychological counselling and educational lectures. Results: Substantial reductions of total cholesterol (16.7%), HDL cholesterol (14.8%), systolic (11.2%) and diastolic blood pressure (8.7%) were observed at the end of the intervention, even with relatively moderate decrease in weight (4.1%) and in persistence of elevated BMI (over 40 kg=m 2 ). The mean CHD Framingham score decreased by 16.1%, from 7.8 to 6.2. The BWR-induced changes were similar in both sexes, and across strata of age and BMI. Conclusions: The full-time participation of the patients in the hospital-based, integrated BWR program may explain the positive clinical outcome in all the subgroups considered, although the long-term results need to be quantified. Sponsorships: Partially supported by Progetti di Ricerca Corrente, Istituto Auxologico Italiano, IRCCS, Milan, Italy. Descriptors: primary health care; prevention; obesity; cardiovascular risk factors; weight reduction; diet; physical activity European Journal of Clinical Nutrition (2001) 55, 865–869 Introduction Obesity is a major risk factor for coronary heart disease (CHD). The risk of CHD is two to three times higher in obese individuals compared to those with normal weight (Negri et al, 1992; Tavani et al, 1997; Calle et al, 1999). The association is partly accounted for by other risk factors for CHD, which are also correlates of body weight, includ- ing total serum cholesterol and lipoprotein levels, blood pressure and diabetes. To date, the impact of a short-term integrated, non- pharmacological intervention of gross obesity on these risk factors and on an overall risk score for CHD (Wilson et al, 1998) has been poorly investigated, at least in quantitative terms. McDougall et al (1995) reported the effects of an intensive 12-day live-in program at a hospital-based health-center, focused on dietary modification (very low fat and strictly vegetarian diet), moderate exercise and stress management. During this short-term period, the *Correspondence: A Sartorio, Laboratorio Sperimentale di Ricerche Endocrinologiche (LSRE), Istituto Auxologico Italiano, IRCCS, Via Ariosto, 13-20145 Milano, Italy. E-mail: sartorio@auxologico.it Guarantor: A Sartorio. Contributors: AS organized the study and wrote the manuscript, CLF and VV collected the data and revised the manuscript, AT contributed to the study hypothesis, CB structured the data file, conducted the statistical analyses and revised the manuscript, CLF contributed to the study management and assisted in writing the manuscript. Received 25 October 2000; revised 9 March 2001; accepted 19 March 2001 European Journal of Clinical Nutrition (2001) 55, 865–869 ß 2001 Nature Publishing Group All rights reserved 0954–3007/01 $15.00 www.nature.com/ejcn