Effects of lifestyle intervention on plasma trimethylamine N-oxide in obese adults

Melissa L. Erickson, Steven K. Malin, Zeneng Wang, J. Mark Brown, Stanley L. Hazen, John P. Kirwan

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Accumulating evidence linking trimethylamine N-oxide (TMAO) to cardiovascular disease (CVD) risk has prompted interest in developing therapeutic strategies to reduce its production. We compared two lifestyle intervention approaches: hypocaloric versus eucaloric diet, combined with exercise, on TMAO levels in relation to CVD risk factors. Sixteen obese adults (66.1 ± 4.4 years, BMI (body mass index): 35.9 ± 5.3 kg/m 2 , fasting glucose: 106 ± 16 mg/dL, 2-h PPG (postprandial glucose): 168 ± 37 mg/dL) were randomly assigned to 12 weeks of exercise (5 days/week, 80–85% HR max (maximal heart rate)) plus either a hypocaloric (HYPO) (−500 kcal) or a eucaloric (EU) diet. Outcomes included plasma TMAO, glucose metabolism (oral glucose tolerance test (OGTT) and euglycemic-hyperinsulinemic clamps for glucose disposal rates (GDR)), exercise capacity (VO 2max , maximal oxygen consumption), abdominal adiposity (computed tomography scans), cholesterol, and triglycerides. Results showed that body composition (body weight, subcutaneous adiposity), insulin sensitivity, VO 2max , and cholesterol all improved (p < 0.05). HYPO decreased the percentage change in TMAO compared to an increase after EU (HYPO: −31 ± 0.4% vs. EU: 32 ± 0.6%, p = 0.04). Absolute TMAO levels were not impacted (HYPO: p = 0.09 or EU: p = 0.53 group). The change in TMAO after intervention was inversely correlated with baseline visceral adipose tissue (r = −0.63, p = 0.009) and GDR (r = 0.58, p = 0.002). A hypocaloric diet and exercise approach appears to be effective in reducing TMAO. Larger trials are needed to support this observation.

Original languageEnglish (US)
Article number179
Issue number1
StatePublished - Jan 1 2019
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Food Science
  • Nutrition and Dietetics


  • Caloric restriction
  • Cardiovascular disease risk factors
  • Exercise
  • Gut microbiome
  • Lifestyle intervention
  • Obesity
  • Trimethylamine N-oxide


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