Key points Ask How does an intensive lifestyle intervention affect the association between variability in adiposity indices and cardiovascular outcomes and deaths among adults with type 2 diabetes? Findings In this cohort study of 3604 adults with type 2 diabetes, greater variability in body mass index and waist circumference was independently associated with increased risks of cardiovascular events, cardiovascular mortality, and all-cause mortality in the control group. In the intensive lifestyle intervention group, no association was observed between the variability of these indices and the results. Meaning These findings suggest that weight fluctuations during weight loss attempts may lead to increased cardiovascular and mortality risk among people with type 2 diabetes. |
Type 2 diabetes and obesity are common in the United States. Obesity is associated with the development of type 2 diets. Controlling obesity is associated with better outcomes in people with type 2 diabetes. Consequently, the American Diabetes Association recommends weight loss interventions for patients who are overweight or obese and type 2 diabetes.
Lifestyle interventions frequently lead to transient weight loss; with repeated and interrupted attempts often resulting in significant weight fluctuations, a process called weight cycling. Fluctuations in body weight are associated with increased risks of adverse health outcomes, regardless of the degree of obesity.
While some studies have evaluated the association of body weight variability with cardiovascular disease (CVD) outcomes and deaths, data among people with type 2 diabetes are sparse.
Furthermore, these studies have generally focused on variability in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), a measure of overall adiposity, and did not evaluate variability in markers. of abdominal obesity, such as waist circumference (WC).
BMI captures both fat and lean mass, while WC may be more specific for adiposity.
Furthermore, abdominal obesity assessed by WC was associated with adverse cardiovascular outcomes, whereas general obesity (as measured by BMI) without abdominal obesity was not. Furthermore, to our knowledge, how intensive weight loss interventions affect the association of variability in adiposity measures with adverse health outcomes in people with type 2 diabetes has not been previously studied.
The Action for Health in Diabetes (Look AHEAD) study included an intensive lifestyle intervention (ILI) to achieve weight loss, providing a unique opportunity to address such a research question.
We performed a cohort analysis of Look AHEAD data to evaluate associations of long-term variability in 2 adiposity indices (BMI and WC) with incident cardiovascular outcomes and mortality and assessed whether these associations were affected by interventions in the lifestyle with the aim of achieving weight loss among individuals. with type 2 diabetes.
importance
Body weight fluctuation is associated with increased risks of adverse health outcomes. Whether intensive weight loss interventions affect the association of variability in adiposity measures with adverse health outcomes in people with type 2 diabetes has not been previously studied.
Aim
To evaluate the associations of long-term variability in adiposity indices with cardiovascular disease (CVD) outcomes and whether these associations are affected by intensive lifestyle intervention among adults with type 2 diabetes.
Design, environment and participants
This prospective cohort study included participants in the Action for Health in Diabetes (Look AHEAD) trial without CVD at baseline (August 2001 to April 2004). The Look AHEAD study included 16 centers in the United States. Data analysis was carried out from December 2020 to June 2021.
Exhibitions
Variability of body mass index (BMI) and waist circumference (WC) across 4 annual visits, assessed using coefficient of variation (CV), independent variability of the mean (VIM), and standard deviation ( SD).
Main results and measures
The main outcomes were (1) all-cause mortality, (2) cardiovascular deaths (deaths from myocardial infarction [MI] or stroke), and (3) CVD events (MI, stroke, or death from cardiovascular causes). ).
Results
Among 3,604 study participants (mean [SD] age, 58.4 [6.6] years; 2,240 [62.3%] female; 1,364 [37.7%] black participants; 2,404 [66%] white participants) , there were 216 CVD events, 33 CVD deaths, and 166 deaths over a median of 6.7 years.
In the control group, the hazard ratios (HR) for the highest quartile (quartile 4) compared to the lowest quartile (quartile 1) of BMI CV were 4.06 (95% CI, 2.06). 17-7.57), 15.28 (95% CI, 2.89-80.90) and 2.16 (95% CI, 1.21-3.87) for all-cause mortality, mortality by CVD and cardiovascular events, respectively.
In the intervention group, the corresponding HRs were 0.99 (95% CI, 0.45 to 2.16), 1.14 (95% CI, 0.12 to 10.53), and 0.77 ( 95% CI, 0.40 to 1.49) for quartile 4 versus quartile 1. WC, in the control group, the HRs for quartile 4 versus quartile 1 were 1.84 (95% CI, 0.40 to 1.49). 1.01-3.35), 6.46 (95% CI, 1.16-36.01) and 1.28 (95% CI, 0.72-2.29).
In the intervention group, the HRs were 1.23 (95% CI, 0.61 to 2.46), 0.55 (95% CI, 0.15 to 2.11), and 0.70 (95% CI, 0.15 to 2.11). 95%, 0.39 to 1.25) for quartile 4 versus quartile 1.
Conclusions and relevance
In this cohort study of people with type 2 diabetes, greater variability in adiposity indices was associated with a significantly higher risk of CVD outcomes and death in the control group, but not in the intensive intervention group. of life.
