Increased blood levels of persistent organic pollutants (POP) in obese individuals after weight loss—A review

Figures & data

Figure 1. Flow diagram showing literature selection strategy.

Table 1. Reported data from the 17 identified studies.

Authors and publication year	Country	Number of participants	Age of participants	Study names and study design	Intervention or treatment before weight loss	Average weight loss	Duration of the study	Number of POP measured	Blood fraction lipid-corrected/uncorrected	Fasting status at blood withdrawal
Dirinck et al. 2016	Belgium	184 (53 men, 131 women)	Mean age at baseline: 41 yr	Cohort study	Bariatric surgery: 66 Diet and physical activity: 118	BMI lowered by 3.4 kg/m^2	12 mo	27 PCBs	Serum samples, ng/g lipid weight	Fasting
Rantakokko et al. 2015	Finland	105 (36 men, 69 women)	47.6 yr	Cohort study, selected from the ongoing Koupio Obesity Surgery Study (KOBS)	Gastric bypass	31.7 kg	12 mo	17 POPs 13 PFASs	POPs: ng/g lipids PFASs: ng/ml	Fasting
Mullerova et al. 2015	Czech Republic	20 women	25–73 yr at baseline	Cohort study, randomly selected, long-term follow up	Low calorie diet	9.2 kg after 6 mo (+ 0.6 kg at 60 mo)	60 mo	7	Plasma samples, ng/kg	Fasting
Dirtu et al. 2013	Belgium	151 (46 men, 105 women) 44 Controls	Median age at baseline: 41 yr. Controls: 44 yr. Median age after 6 mo: 44 yr	ENDORUP (Environmental Chemicals and their Role in Obesity) ongoing prospective study	Bariatric surgery (not further specified) (66) Lifestyle counseling and diet (85)	22 kg	12 mo	64	Serum lipid weight basis (OH-CB in pg/ml)	Not specified
De Roos et al. 2012	United States	109 women	50–73 yr	The Physical Activity for Total Health study. Randomized controlled trial	Exercise intervention, comparing aerobic exercise vs stretching	Varied, self-reported	Retrospective 3 mo	45	Plasma Lipid weight basis and wet-weight basis	Fasting
Kim et al., 2011b	France	71 18 Controls	Not published	Clinical case-control study, patients referred to bariatric surgery	Gastric surgery (not further specified)	37 kg	12 mo	35	Serum: Reported as lipid weight and wet weight. Adipose tissue: Reported as lipid weight	Fasting
Lim et al. 2010	United States	1099 (539 men, 560 women)	Mean age: 60.2 yr (range: 40–85)	National Health and Nutrition Examination (NHANES), retrospective study	Unknown	Varied, self-reported	Retrospective 1–10 yr	7	Serum Lipid weight basis	Not specified
Arguin et al. 2009	Canada	37 men	21–60 yr	“The Ole Study” Study 2 randomized controlled trial	Fat-reduced diet, one-third of the group: olestra supplement	4.4 kg	3 mo	26	Plasma, reported as mass per volume of plasma	Not specified
Mullerova et al. 2008	Czech Republic	27 women, 9 controls (women)	21–74 yr (Controls: 21–64 yr)	Longitudinal intervention trial	Low calorie diet	BMI lowered by 3.3 kg/m^2	3 mo	1 (PCB 153)	Plasma, PCB 153 reported as ng/ml plasma	Fasting
Hue et al. 2006	Canada	27 men, 15 controls	Obese group: 37.9 yr Morbidly obese group: 45.5 yr Controls: 38.9 yr	Case-control study	Obese: hypocaloric diet Morbidly obese: biliopancreatic diversion with duodenal switch	Obese: 12.3 kg Morbidly obese: 64.8 kg	12 mo	25	Plasma lipid weight basis	Not specified
Charlier, Desaive, and Plomteux 2002	Belgium	30 (8 men and 22 women) 45 controls	Age not published, described as “young obese individuals”	Case-control study	Gastric bypass acc. to Capella (14) and gastric banding (16)	10% weight loss	6 mo	10	Plasma lipid weight basis	Not specified
Pelletier et al. 2002	Canada	16 men	Not published	Cohort study	Nonmacronutrient-specific energy-restricted diet and drug intervention: Fenfluramine	10.7 kg	15 weeks	26	Plasma lipid weight basis	Not specified
Imbeault et al. 2001	Canada	37 (17 men and 20 women)	36–50 yr	Cohort study	Nonmacronutrient-specific energy-restricted diet	10 kg	15 weeks	8	Plasma Lipid weight basis	Not specified
Chevrier et al. 2000	Canada	39 (18 men and 21 women) 57 Controls	Obese: 43.4 yr Controls: 42.8 yr	Case-control study	Low-fat diet (39). Of these: Drug intervention: fenfluramine (32) and placebo (7). Diet and exercise (17).	9.5 kg	15 weeks	26	Plasma, reported as µg/L Adipose tissue: Reported as µg/kg	Fasting
Schildkraut et al. 1999	United States	99 women	Mean age: 57.4 yr	Retrospective study	Unknown	Self-reported: over (17) or under (82) 5 pounds	Retrospective 1 year	20	Plasma reported in ppb	Not specified
Walford et al. 1999	United States	2	28–67 yr	Cohort study	Essentially vegetarian, nutrient-dense diet	Men: −18% Women: −10%	2 yr, 30 mo follow-up	2 (Total PCB and DDE)	Serum reported in ppb	Fasting
Backman and Kolmodin-Hedman, 1978	Sweden	8 (3 men and 5 women)	Mean age: 38.5 yr	Cohort study	Intestinal bypass, two different techniques	46.9 kg	12 mo	2 (DDE and DDT)	Plasma, DDT and DDE Reported as ng/ml Adipose tissue: Reported as ng/g	Not specified

Table 2. Percentage change of POP concentrations per kilogram weight reduction with average change, calculated from the individual five selected studies (average change in declining order).

	Dirtu et al. (2013), N = 151, lipid weight	Imbeault et al. (2001), N = 37, lipid weight	Pelletier et al. (2002), N = 16, lipid weight	Chevrier et al. (2000), N = 39, wet weight	Arguin et al. (2009), N = 27 wet weight	N= 270, Average
PCB 28			2.4	3	6.7	4
PCB 118	7.6	1.8	3.1	1.9	4	3.7
PCB 99	5.1		2.2	1.8	5.3	3.6
PCB 170	5.4		2	1.7	4.4	3.4
βHCH	4.2	2.1	2.7	1.9	6.1	3.4
PCB 153	5.2	1.8	2.5	1.6	4.8	3.2
PCB 156			3.1	2.3	4.3	3.2
p,p'-DDE	5.3	1.8	2.5	1.5	4.7	3.2
PCB 180	5.2	1.9	2.9	1.6	4	3.1
PCB 187			2.6	1.7	4.3	2.9
Oxychlor			1.8	1.4	5.4	2.9
Mirex			−0.2	0	8.6	2.8
PCB 138	4.1	1.4	2.2	1.4	5	2.8
trans-Nonachlor			2	1.2	5.2	2.8
Arochlor		1.7	2.4	1.5	5.2	2.7
p,p'-DDT	4.5		0.9	1.1	3.6	2.5
HCB		1.6	2.5	1.4	2.6	2

Figure 2. Percentage change in blood concentration of POP per kilogram weight reduction in declining order.

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