Comparison of effects of diet versus exercise weight loss regimens on LDL and HDL particle size in obese adults

Background: Obesity is associated with an atherogenic lipid profile characterized by a predominance of small LDL and HDL particles. Weight loss, by dietary restriction or exercise, increases LDL particle size. Whether these interventions can augment HDL size in conjunction with LDL size remains unknown. Objective: This study compared the effects of alternate day fasting (ADF), calorie restriction (CR), and endurance exercise on LDL and HDL particle size in overweight and obese subjects. Methods: In a 12-week parallel-arm trial, adult subjects (n = 60) were randomized to 1 of 4 groups: 1) ADF (75% energy restriction for 24-h alternated with ad libitum feeding for 24-h), 2) CR (25% energy restriction every day), 3) exercise (moderate intensity training 3 x/week), or 4) control. Results: Body weight was reduced (P < 0.001) by ADF, CR, and exercise (5.2 +/- 1.1%, 5.0 +/- 1.4%, 5.1 +/- 0.9%, respectively). Plasma LDL cholesterol decreased (P < 0.05) with ADF (10 +/- 4%) and CR (8 +/- 4%), whereas HDL cholesterol increased (P < 0.05) with exercise (16 +/- 5%). Integrated LDL particle size was augmented (P = 0.01) by ADF and CR. The proportion of small LDL particles decreased (P = 0.04) with ADF only, and the proportion of large HDL particles increased (P = 0.03) with exercise only. Conclusion: These results indicate that dietary restriction increases LDL particle size, while endurance training augments HDL particle size, with minimal weight loss. None of these interventions concomitantly increased both LDL and HDL particle size, however.