Age- and sex-specific effects of a long-term lifestyle intervention on body weight and cardiometabolic health markers in adults with prediabetes: results from the diabetes prevention study PREVIEW

Abstract

Aims/hypothesis Lifestyle interventions are the first-line treatment option for body weight and cardiometabolic health management. However, whether age groups or women and men respond differently to lifestyle interventions is under debate. We aimed to examine age- and sex-specific effects of a low-energy diet (LED) followed by a long-term lifestyle intervention on body weight, body composition and cardiometabolic health markers in adults with prediabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance). Methods This observational study used longitudinal data from 2223 overweight participants with prediabetes in the multicentre diabetes prevention study PREVIEW. The participants underwent a LED-induced rapid weight loss (WL) period followed by a 3 year lifestyle-based weight maintenance (WM) intervention. Changes in outcomes of interest in prespecified age (younger: 25–45 years; middle-aged: 46–54 years; older: 55–70 years) or sex (women and men) groups were compared. Results In total, 783 younger, 319 middle-aged and 1121 older adults and 1503 women and 720 men were included in the analysis. In the available case and complete case analyses, multivariable-adjusted linear mixed models showed that younger and older adults had similar weight loss after the LED, whereas older adults had greater sustained weight loss after the WM intervention (adjusted difference for older vs younger adults −1.25% [95% CI −1.92, −0.58], p<0.001). After the WM intervention, older adults lost more fat-free mass and bone mass and had smaller improvements in 2 h plasma glucose (adjusted difference for older vs younger adults 0.65 mmol/l [95% CI 0.50, 0.80], p<0.001) and systolic blood pressure (adjusted difference for older vs younger adults 2.57 mmHg [95% CI 1.37, 3.77], p<0.001) than younger adults. Older adults had smaller decreases in fasting and 2 h glucose, HbA1c and systolic blood pressure after the WM intervention than middle-aged adults. In the complete case analysis, the above-mentioned differences between middle-aged and older adults disappeared, but the direction of the effect size did not change. After the WL period, compared with men, women had less weight loss (adjusted difference for women vs men 1.78% [95% CI 1.12, 2.43], p<0.001) with greater fat-free mass and bone mass loss and smaller improvements in HbA1c, LDL-cholesterol and diastolic blood pressure. After the WM intervention, women had greater fat-free mass and bone mass loss and smaller improvements in HbA1c and LDL-cholesterol, while they had greater improvements in fasting glucose, triacylglycerol (adjusted difference for women vs men −0.08 mmol/l [−0.11, −0.04], p<0.001) and HDL-cholesterol. Conclusions/interpretation Older adults benefited less from a lifestyle intervention in relation to body composition and cardiometabolic health markers than younger adults, despite greater sustained weight loss. Women benefited less from a LED followed by a lifestyle intervention in relation to body weight and body composition than men. Future interventions targeting older adults or women should take prevention of fat-free mass and bone mass loss into consideration. Clinical trial registration number ClinicalTrials.gov NCT01777893. Graphical abstract

Sex differences in endocannabinoids during 3 years of Mediterranean diet intervention: Association with insulin resistance and weight loss in a population with metabolic syndrome

“…These results were independent of baseline characteristics (e.g., greater body weight of men). Our results add to existing evidence about the sex-specific effects of a lifestyle intervention on weight loss, cardiometabolic health and insulin resistance ( 9 , 59 – 63 ).…”

Age-specific difference in the association between prediabetes and subclinical atherosclerosis: an analysis of a chinese prospective cohort study

“…Current ADA guidelines recommended that adults with prediabetes be screened every year for diabetes and be referred to a lifestyle intervention to encourage weight loss [ 16 ]. Nevertheless, the diabetes prevention study PREVIEW, which included younger, middle-aged and older adults, found that older adults benefited less from a lifestyle intervention in relation to cardiometabolic health markers than younger adults, despite greater weight loss [ 23 ]. The findings of the current study support less aggressive treatment to cardiovascular disease prevention in older adults with prediabetes than in middle-aged ones with prediabetes, given the low risk of subclinical atherosclerosis among older adults with prediabetes in this study.…”

The role of age on the risk relationship between prediabetes and major morbidities and mortality: analysis of the Hong Kong diabetes surveillance database of 2 million Chinese adults

“…It is noteworthy that a post-hoc analysis of the diabetes prevention study PREVIEW also suggested that younger adults achieved greater improvement in body composition and cardiometabolic markers from lifestyle intervention than older adults. 32 Our results called for age-stratified preventive strategies, in particular early screening for prediabetes and intervention in young people who have the potential to benefit more from the prevention efforts. Secondly, prediabetes itself is associated with major clinical events even excluding people who subsequently developed diabetes and adjusting for metabolic factors.…”