Cardiovascular effects of intensive lifestyle intervention in adults with overweight/obesity and type 2 diabetes according to body weight time in range

Liu, Menghui; Huang, Rihua; Xu, Lin; Zhang, Shaozhao; Zhong, Xiangbin; Chen, Xiaohong; Lin, Yani; Xiong, Zhenyu; Wang, Lichun; Liao, Xinxue; Zhuang, Xiaodong

doi:10.1016/j.eclinm.2022.101451

Cited by 4 publications

(5 citation statements)

References 37 publications

(40 reference statements)

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“…The Look AHEAD trial further investigated the cardiovascular effects by providing weight loss–oriented lifestyle management in individuals with T2D and overweight or obesity but found a nonsignificant difference between the ILI and DSE groups . Several post hoc analyses were conducted and demonstrated achieving greater weight loss magnitudes, maintaining weight loss, and increasing PA volumes were associated with a lower risk of cardiovascular events . Of note, these clinical trials did not consider the joint association of weight loss and increasing PA.…”

Section: Discussionmentioning

confidence: 99%

“…14 Several post hoc analyses were conducted and demonstrated achieving greater weight loss magnitudes, maintaining weight loss, and increasing PA volumes were associated with a lower risk of cardiovascular events. 8,10,11 Of note, these clinical trials did not consider the joint association of weight loss and increasing PA. Compared with weight loss only or exercise only, prior studies reported a greater visceral fat reduction and insulin sensitivity improvement when incorporating both.…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining a meaningful magnitude of weight loss is considered and recommended as a primary treatment goal for T2D . Increasing moderate-to-vigorous physical activity (PA) volume is a beneficial lifestyle change and a conventional manner of weight loss, and higher PA volume or weight loss has beem associated with a lower risk of cardiovascular events . However, the evidence supporting lifestyle-induced weight loss and increased PA are classified as level B in guidelines, indicating that the recommendations are based on limited randomized clinical trials (RCTs) .…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Increasing moderate-to-vigorous physical activity (PA) volume is a beneficial lifestyle change and a conventional manner of weight loss, 3,[5][6][7] and higher PA volume or weight loss has beem associated with a lower risk of cardiovascular events. [8][9][10][11] However, the evidence supporting lifestyle-induced weight loss and increased PA are classified as level B in guidelines, indicating that the recommendations are based on limited randomized clinical trials (RCTs). 3,5,7,12 Prior large RCTs, including Look AHEAD (Action for Health in Diabetes), DIRECT, and the Diabetes Prevention Program, attempted to investigate the cardiovascular benefits of weight loss and increased PA volume among individuals with prediabetes or T2D, but no relationship between lifestyle-induced weight loss and cardiovascular benefits has been reported.…”

Section: Introductionmentioning

confidence: 99%

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Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity

Huang,

Zhuang,

Huang

et al. 2024

JAMA Netw Open

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ImportancePrior findings from the Look AHEAD trial showed no significant reduction in the risk of cardiovascular events by lifestyle-induced weight loss among individuals with type 2 diabetes (T2D) and overweight or obesity. However, physical activity (PA) may modify the changes in cardiovascular risk associated with weight loss.ObjectiveTo examine the joint association of weight loss and PA with the risk of adverse cardiovascular events in patients with T2D and overweight or obesity.Design, Setting, and ParticipantsThis cohort study was a post hoc analysis of the Look AHEAD randomized clinical trial, which compared the cardiovascular effects of weight loss by intensive lifestyle intervention vs diabetes support and education among individuals with T2D and overweight or obesity. The study was conducted from June 2001 to September 2012, and participants were patients in the substudy of accelerometry-measured PA from 8 locations in the United States. Data were analyzed from June to August 2023.ExposuresBody weight change and accelerometer-derived PA volume across the first 4 years.Main Outcomes and MeasuresThe primary outcome was a composite cardiovascular outcome including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina.ResultsAmong a total of 1229 participants (mean [SD] age, 60 [7] years; 533 male [43%]), 333 (27%) achieved and maintained weight loss for the first 4 years. Among the individuals who maintained weight loss, 105 (32%) maintained high PA volume. During a median of 9.5 years of follow-up, 198 participants (16.1%) experienced the primary outcome. Compared with those with low PA volume and no weight loss (105 [15.8%]), maintaining high PA volume and weight loss was associated with a 61% lower risk of the primary end point (hazard ratio, 0.39; 95% CI, 0.19-0.81; P = .01). However, there was no significant difference in the risk of the primary end point among those with either weight loss only or high PA only. The multiplicative interaction between weight loss and PA for the risk of cardiovascular events was also significant (P for interaction = .01).Conclusions and RelevanceIn this cohort study, maintaining weight loss and higher PA volume was associated with a lower risk of the composite cardiovascular outcome. The findings suggest that the cardiovascular benefits of PA may vary and be enhanced by weight loss among individuals with T2D and overweight or obesity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity

Huang,

Zhuang,

Huang

et al. 2024

JAMA Netw Open

Self Cite

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“…A recent study found an increase in premature mortality with increasing prevalence of obesity among a population [9]. Similarly, maintaining weight loss achieved through intensive lifestyle intervention might be beneficial in terms of lowering the risk of cardiovascular events as seen in a study among adults with overweight or obesity and Type 2 diabetes mellitus [10].…”

Section: Data Management and Analysismentioning

confidence: 96%

Personalized Evidence, and Young Adults' Attitude and Behaviour Towards Type 2 Diabetes Mellitus Preventive Lifestyle Measures

Ilemona¹,

Oselenbalu²,

Hany³

2022

Int J Diabetes Clin Res

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Background: Behaviour change programmes have demonstrated diabetes risk-reduction benefits. Studies on diabetes preventive lifestyle activities largely focus on middle-aged/older adults. We investigated non-diabetic young adults' risk of developing Type 2 diabetes mellitus, and their attitudes and behaviours towards preventive lifestyle activities. Methods:A descriptive cross-sectional study on nondiabetic, young adults living in Middle Eastern countries. Data was collected and analyzed electronically.Results: Mean diabetes risk score was x = 2.8 (SD ± 1.3), and 92.6% demonstrated a low risk of developing diabetes. About 88.1% agreed on the importance of maintaining a healthy lifestyle at a young age, and 92.9% thought a healthy lifestyle would help them to stay healthy. Weekly 38.0% and another 38.0% ate fruits and vegetables respectively on 2 to 3 days only. Additionally, 85.0% indicated that their work did not involve vigorous-intensity activity, 54.9% walked or used a bicycle for at least 10 minutes, and 74.2% did not do vigorous-intensity sports/fitness/recreational activities for at least 10 minutes continuously. There was a weak and negative correlation between age and diabetes risk score (r = -0.1), and BMI was positively correlated with diabetes risk score (r = 0.63). Discussion:The participants mostly demonstrated a low risk of developing Type 2 diabetes, were overweight on average, and did not meet the recommended lifestyle practices. The reported positive attitude towards preventive lifestyle measures did not correspond to their collective reported lifestyle behaviours/practices. Conclusion:Healthcare professionals need to focus on the practical (behavioural) aspects of healthy lifestyle modification educational activities for young adult patients.

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Body weight time in target range and cardiovascular outcomes in adults with overweight/obesity and type 2 diabetes

Liu

Chen

et al. 2023

European Journal of Preventive Cardiology

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Aims Prescription of weight loss to individuals is often characterized by weight fluctuations. However, current body weight management metrics may have difficulty characterizing the changes in body weight over time. We aims to characterize the long-term changes using body weight time in target range (TTR) and test its independent association with cardiovascular outcomes. Methods We included 4,468 adults from the Look AHEAD (Action for Health in Diabetes) trial. Body weight TTR was defined as the percentage of time during which body weight was within the Look AHEAD weight loss goal range. The associations of body weight TTR with cardiovascular outcomes were analyzed using multivariable Cox modeling and restricted cubic spline function. Results Among the participants (mean age 58.9 years, 58.5% women, 66.5% White), there were 721 incident primary outcomes (cumulative incidence: 17.5%, 95% confidence interval [CI]: 16.3%-18.8%) during a median of 9.5 years of follow-up. Each 1-SD (standard deviation) increase in body weight TTR was significantly associated with a decreased risk of the primary outcome (hazard ratio [HR]: 0.84, 95% CI: 0.75-0.94) after adjusting for mean and variability of body weight and traditional cardiovascular risk factors. Further analyses using restricted cubic spline indicated the inverse association between body weight TTR and primary outcome in a dose-dependent manner. Similar associations remained significant among the participants with a lower baseline or mean body weight. Conclusion In adults with overweight/obesity and type 2 diabetes, higher body weight TTR was independently associated with lower risks of cardiovascular adverse events in a dose-response manner.

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Cardiovascular effects of intensive lifestyle intervention in adults with overweight/obesity and type 2 diabetes according to body weight time in range

Cited by 4 publications

References 37 publications

Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity

Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity

Personalized Evidence, and Young Adults' Attitude and Behaviour Towards Type 2 Diabetes Mellitus Preventive Lifestyle Measures

Body weight time in target range and cardiovascular outcomes in adults with overweight/obesity and type 2 diabetes

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