The Extent of Lifestyle-Induced Weight Loss Determines the Risk of Prediabetes and Metabolic Syndrome Recurrence during a 5-Year Follow-Up

Abstract

It is controversial whether lifestyle-induced weight loss (LIWL) intervention provides long-term benefit. Here, we investigated whether the degree of weight loss (WL) in a controlled LIWL intervention study determined the risk of prediabetes and recurrence of metabolic syndrome (MetS) during a 5-year follow-up. Following LIWL, 58 male participants (age 45–55 years) were divided into four quartiles based on initial WL: Q1 (WL 0–8.1%, n = 15), Q2 (WL 8.1–12.8%, n = 14), Q3 (WL 12.8–16.0%, n = 14), and Q4 (WL 16.0–27.5%, n = 15). We analyzed changes in BMI, HDL cholesterol, triglycerides (TGs), blood pressure, and fasting plasma glucose (FPG) at annual follow-up visits. With a weight gain after LIWL between 1.2 (Q2) and 2.5 kg/year (Q4), the reduction in BMI was maintained for 4 (Q2, p = 0.03) or 5 (Q3, p = 0.03; Q4, p < 0.01) years, respectively, and an increase in FPG levels above baseline values was prevented in Q2–Q4. Accordingly, there was no increase in prediabetes incidence after LIWL in participants in Q2 (up to 2 years), Q3 and Q4 (up to 5 years). A sustained reduction in MetS was maintained in Q4 during the 5-year follow-up. The present data indicate that a greater initial LIWL reduces the risk of prediabetes and recurrence of MetS for up to 5 years.

Five percent weight loss is a significant 1-year predictor and an optimal 5-year cut-off for reducing the number of obesity-related cardiovascular disease risk components: the Japan Obesity and Metabolic Syndrome Study

“…Accordingly, these findings highlight the possibility that weight loss of ≥7.5%, at least ≥5.0%, would be desirable for patients with obesity to improve obesity-related CVD risk components in the first 3 months to 5 years. In this context, a previous study reported that weight loss within the first two months predicted long-term weight loss for up to 8 years ( 23 ), further suggesting the significance of optimizing the outcome during early intervention periods to exhibit long-term beneficial effects ( 8 ). Moreover, obesity exacerbates MetS ( 24 ), thereby highlighting the need to achieve weight loss to counterbalance the detrimental effects of obesity.…”

“…Long-term maintenance of weight loss has been challenging because weight is typically lost rapidly by intervention but followed by progressive regain ( 8 , 12 ); it is reported that ≥90% of individuals regained some of the weight after weight loss ( 25 , 26 ). In the present study, outpatients with obesity continuously underwent physician-supervised intervention for up to 5 years, and 47.7%, 39.1%, and 24.1% of these patients achieved ≥3.0%, ≥5.0%, and ≥7.5% weight loss from baseline at the 5-year follow-up, respectively.…”

“…Our findings further suggest the clinical significance of ≥5.0% weight loss to reduce the obesity-related CVD risk score in patients with obesity. Although a loss of ≥7.5% weight exhibited beneficial effects on obesity-related CVD risk score over a 5-year follow-up period, ≥7.5% weight loss might be a high-hurdle setting as realistic weight goals due to challenging characteristics of maintaining long-term weight loss ( 8 , 28 ). Conversely, the optimal cut-off value for weight loss to reduce obesity-related CVD risk score components was 5.0% at 1 and 5 years, and a loss of ≥5.0% weight was a significant predictor of improving obesity-related CVD risk components at 1 year.…”

“…Furthermore, a previous study reported that a 6-month lifestyle-induced weight loss program resulting in a >16% weight loss from baseline had a positive impact on MetS prevalence in Caucasian participants. This effect was observed over a 5-year follow-up period after the end of the program ( 8 ). In Japanese patients with obesity or MetS, a loss of ≥3.0% of baseline weight by a 6-month lifestyle modification program also improved obesity-related metabolic derangements at 6 months of follow-up after the end of the intervention ( 9 ).…”

“…Because an increase in the number of MetS components elevates the risk of CVD incident ( 11 ), it is necessary to identify how much weight loss from baseline could reduce one or more MetS components in patients with obesity. Moreover, the extent of weight loss that exhibits long-term beneficial effects on the cumulative MetS components needs to be clarified, although the relationship between long-term weight loss and the cumulative number of MetS components has not been fully elucidated due to the challenging characteristics of maintaining weight loss ( 8 , 12 ). To date, no prospective studies have addressed these issues in patients with obesity.…”