The OPTIFAST total and partial meal replacement programme reduces cardiometabolic risk in adults with obesity: Secondary and exploratory analysis of the OPTIWIN study

Aim: The effects of weight loss with a partial or total meal replacement programme (MRP) on atherosclerotic cardiovascular disease (ASCVD) risk factors are not fully understood, in particular in people at higher CV risk. In the 52-week randomized controlled OPTIWIN study in men and women with obesity, meal replacement programme (total for first 26 weeks, partial for the ensuing 26 weeks) with OPTIFAST (OP) resulted in significantly greater weight loss compared with a low-calorie food-based (FB) dietary plan, both as part of a comprehensive lifestyle intervention [OP (n = 135)/FB (n = 138) week 26: -12.4%/-6.0%, p < .001; week 52: -10.5%/-5.5%, p < .001]. Here, we examined effects on ASCVD risk factors and 10-year ASCVD risk.Materials and methods: Participants with body mass index 30-55 kg/m(2) and age 18-70 years, and not on anti-obesity medications, were recruited. The effects on systolic and diastolic blood pressure (SBP, DBP), lipid parameters and 10-year ASCVD risk were analysed as changes over time using linear mixed models. Subgroup analyses were conducted for changes in SBP, DBP and ASCVD risk by categories of age (<40, 40-59, >= 60 years), baseline SBP (= 130 mmHg) and sex.Results: Baseline characteristics were well balanced (OP/FB females 86%/79%, mean age 47/47 years, body mass index 38.4/39.2 kg/m(2) , 10-year ASCVD risk <5% 87%/74%, dysglycaemia 52%/50%). At week 26, SBP/DBP were significantly reduced with OP versus FB, and a greater proportion achieved BP <= 130/80 mmHg [odds ratio 2.11 (95% confidence interval 1.10, 4.03), p = .024]. All lipid parameters as well as 10-year ASCVD risk were significantly improved with OP versus FB. A similar, but slightly attenuated pattern was observed at 52 weeks. Across subgroups, greater reductions for SBP, DBP and ASCVD risk were generally seen with OP versus FB with quantitatively higher baseline SBP and age, and in men.Conclusions: In people with obesity at low ASCVD risk, OP significantly reduced cardiovascular risk factors and 10-year predicted risk for ASCVD.