The Legacy Effect in the Prevention of Cardiovascular Disease

Esmel, Esther Viñas; Álvarez, José Naval; Meseguer, Emilio Sacanella

doi:10.3390/nu12113227

Cited by 12 publications

(10 citation statements)

References 66 publications

(105 reference statements)

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“…Such legacy benefits for ongoing, although declining, reduction in risk factors for cardiovascular disease have been shown to improve major clinical outcomes in studies of interventions for hypertension and high lipid levels. 23 24 25 We found no evidence that providing support for specific maintenance of weight loss during the programme reduced the regain in weight. Instead, programmes that are widely available to allow individuals to re-engage when they want to might be the best strategy for supporting longer term lower rates of change in weight.…”

Section: Discussionmentioning

confidence: 60%

Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

Hartmann‐Boyce

Theodoulou

Oke

et al. 2021

BMJ

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Objective To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. Design Systematic review and meta-analysis. Data sources Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme. Review methods Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane’s risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested. Results Data were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight. Conclusion Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found. Study registration PROSPERO CRD42018105744.

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Section: Discussionmentioning

confidence: 60%

Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

Hartmann‐Boyce

Theodoulou

Oke

et al. 2021

BMJ

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“…147 The evidence that a temporary period of blood pressure reduction reduces CVD is less clear, but evidence from animal models and estimates from trials suggest similar legacy effects from even temporary reductions in blood pressure. [148][149][150] These observed reductions in cardiovascular risk factors were observed from BWMPs relative to comparators (sometimes active treatments) of around 2 to 3 kg. Other analyses of this data set showed that some programs give much larger end-of-program weight losses compared with no weight loss support; for example, programs providing meal replacement.…”

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis

Hartmann‐Boyce

Theodoulou

Oke

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS: Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS: One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11–360) months after program end were included. Median baseline participant body mass index was 33 kg/m 2 ; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS: Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42018105744.

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“…This has been the experience from the dietary practices of the population in Okinawa centenarians [41]. But a longitudinal study on remission of T2D based on a plant-based diet as a primary intervention remains unknown [42].…”

Section: Discussionmentioning

confidence: 99%

Remission of Type 2 Diabetes with High-Fiber, Low-Fat, and Calorie Restricted Plant-Based Diet Study

Gunadhar¹

2023

Int J Diabetes Clin Res

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Background: Type 2 Diabetes (T2D) is a chronic progressive disease, and its prevalence is on the rise around the world. Despite advances in pharmacotherapy, mitigating the burden of the disease on individuals, societies and the healthcare system remains a challenge. Remission has emerged as a therapeutic target in T2D with wide range of interventions. A plant-based diet seems to be promising to achieve this goal. Objective:The present study is conducted to establish the feasibility of achieving remission of type 2 diabetes with a plant-based diet in a cohort of free-living individuals.Methods: This cohort of patients were referred to our Wellness Clinic for management of various cardiovascular conditions and associated metabolic disorders. They were educated and counseled to adopt a plant-based diet while receiving standard medical treatment. The present study included non-pregnant adults 20 years and older, mostly elderly, with the diagnosis of T2D (HbA1c > 6.5%), with or without on antidiabetic medications. The remission of diabetes is defined as improving HbA1c to < 6.1%, without antidiabetic medications except metformin. Results:The cohort is composed of 83 patients with mean age 70.1 (SD +/-9.64) years and 36% were women. The results are reported as disease status at the time of diagnosis (1), disease status immediately prior to adoption of diet (2), and disease status post diet at 3-6 months (3), and disease status post diet after 6 months (4) (Table 1). For comparison, the averages of the two pre-diet parameters and the averages of the two post-diet parameters are given in this summary (Table 2). These are -BMI (kg/m2) 32.93 has changed to 29.85, a decrease of 3.08 (-9.35%) with p < 0.0000, systolic blood pressure (mm of Hg) 133.21 has changed to 131.09, a decrease of 2.12 (-1.59%) with p = 0.1054, diastolic blood pressure (mm of Hg) 74.81 increased to 73.02, a decrease of 1.79 (-2.39%) with p = 0.2592, Hemoglobin A1c 7.3% changed to 5.82%, a decrease of 1.48 points (-20.27%), p < 0.0000, fasting glucose (mg/ dl) 137.30 changed to 108.53 mg/dl , a decrease of 28.77 points (-20.95%), p < 0.0000, HDL cholesterol (mg/dl) 44.44 changed to 45.01, an increase of 0.66 points (+1.49%), p 0.4841, LDL cholesterol (mg/dl) 84.08 changed to 74.43, a decrease of 9.65 points (-11.48%), p 0.0011, Triglyceride (mg/dl) 164.48 decreased to 122.47, a decrease of 42.01 points (-25.54%), p 0.0149. Conclusion:A plant-based diet has been successful in achieving remission of type 2 diabetes in this group of patients, even in their advanced age.

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The Legacy Effect in the Prevention of Cardiovascular Disease

Cited by 12 publications

References 66 publications

Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis

Remission of Type 2 Diabetes with High-Fiber, Low-Fat, and Calorie Restricted Plant-Based Diet Study

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