Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

Abstract

Background Weight management is strongly promoted for overweight or obese patients with type 2 diabetes (T2DM) by current guidelines. However, the prognostic impact of weight loss achieved without behavioural intervention on the mortality and cardiovascular (CV) outcomes in diabetic patients is still contested. Methods We searched the PubMed, Embase, and Cochrane Library databases for studies that investigated the association of weight loss or weight variability with mortality and CV outcomes. Results of studies that measured weight loss by percentage weight loss from baseline and stratified it as > 10% and 5–10% or studies that computed weight variability were pooled using random effects model. Study quality was evaluated using the Newcastle–Ottawa Scale. Results Thirty eligible studies were included in the systematic review and 13 of these were included in the meta-analysis. Large weight loss (> 10%) was associated with increased risk of all-cause mortality (pooled hazard ratio (HR) 2.27, 95% CI 1.51–3.42), composite of major CV events (pooled HR 1.71, 95% CI 1.38–2.12) and CV mortality (pooled HR 1.50, 95% CI 1.27–1.76) among T2DM patients. Moderate weight loss showed no significant association with all-cause mortality (pooled HR 1.17, 95% CI 0.97–1.41) or CV outcomes (pooled HR 1.12, 95% CI 0.94–1.33). Weight variability was associated with high hazard of all-cause mortality (pooled HR 1.54, 95% CI 1.52–1.56). Conclusions Large weight loss and large fluctuations in weight are potential markers of increased risk of mortality and CV events in T2DM patients. Maintaining a stable weight may have positive impact in these patients.

High‐ and normal‐protein diets improve body composition and glucose control in adults with type 2 diabetes: a randomized trial

“…It was also hypothesized that the HP group would result in preferential loss of fat mass compared with FFM, which was also not supported. A recent review suggested that weight loss could increase the risk of mortality for those recently diagnosed with T2D, potentially as a result of a decline in appendicular lean mass [37]. Although appendicular body composition was not analyzed for the present study, whole‐body FFM was only slightly reduced, with no significant differences between groups.…”

Indigenous Indian Guggul extract augments saxagliptin effect against diabetes-induced complications

“…STZ is a glucose analogue and it accumulates in β-cells of the pancreas forming an alkylating agent which brings out the diabetogenic action of this compound 16 . The uncontrolled high blood sugar levels due to STZ-diabetes induction lead to increased urination, excessive thirst, increased metabolism, protein catabolism, and muscle oxidative damage resulting in unintended weight loss 17 . In the present study, a sharp decline in the weight of the diabetic control group could be attributed to the unavailability of glucose to the cells which compels the body to burn fat causing a reduction in body weight.…”

Cardiovascular Risk Reduction in Type 2 Diabetes: Further Insights into the Power of Weight Loss and Exercise

“…Copyright © 2023 Korean Endocrine Society www.e-enm.org 303 ated with major weight loss (>10%) among type 2 diabetes patients [9]. Another systematic review and meta-analysis of 14 observational studies and three clinical trials examining behavioral weight changes and cardiovascular disease in patients with type 2 diabetes showed that weight gain was linked to a significantly higher hazard of cardiovascular events and all-cause mortality compared to no weight change [10].…”