Association of the Magnitude of Weight Loss and Physical Fitness Change on Long-term CVD outcomes: The Look AHEAD Study

Details

• Alternative Title:
  Lancet Diabetes Endocrinol
• Personal Author:
  Gregg, Edward W.
• Corporate Authors:
  The Look AHEAD Study Group
• Description:
  Background
  
  The Look AHEAD Study found no significant reduction in cardiovascular disease (CVD) incidence among adults with diabetes enrolled in an intensive weight loss intervention (ILI) compared to those randomized to diabetes support and education (DSE). We examined whether CVD incidence in Look AHEAD varied by weight or fitness change.
  
  Methods
  
  Among overweight or obese adults people aged 45–76 with type 2 diabetes in the Look AHEAD study, this observational analysis examined the association of magnitude of weight loss (N=4834) and fitness change (N=4406) over the first year with CVD incidence over a median 10.2 years of follow-up. The primary outcome was a composite of CVD death, myocardial infarction, stroke, or angina hospitalization; the secondary outcome included the same indices plus coronary–artery bypass grafting, carotid endartectomy, percutaneous coronary intervention, hospitalization for congestive heart failure, peripheral vascular disease, or total mortality. Analyses adjusted for baseline differences in weight or fitness, demographics and CVD risk factors.
  
  Findings
  
  In analyses of the full cohort combining ILI and DSE, persons who lost > 10% body weight in the first year had 21% lower risk of the primary outcome (HR=0.79, 95% CI, 0.64 to 0.98) and a 24% reduced risk of the secondary outcome (HR=0.76, 95% CI, 0.63 to 0.91) relative to those with stable weight/weight gain. Achieving a > 2 MET fitness change was associated with a significant reduction in the secondary outcome (HR=0.77, 95% CI, 0.61 – 0.96) but not the primary outcome (HR=0.78, 0.60 – 1.03). In analyses treating the DSE as the referent group, ILI participants with > 10% weight losses had a 20% lower risk of the primary outcome (HR=0.80 (95% CI, 0.65 – 0.99) and a 21% reduced risk of the secondary outcome (0.79 (95% CI, 0.66 – 0.95); fitness change was not significantly associated with either outcome.
  
  Interpretation
  
  This secondary analysis of Look AHEAD suggests an association between the magnitude of intentional weight loss and CVD incidence.
  
  
• Keywords:
  Aged Cardiovascular Diseases Cohort Studies Diabetes Mellitus, Type 2 Disease Management Female Health Education Humans Life Style Male Middle Aged Obesity Physical Fitness Weight Loss

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• Source:
  Lancet Diabetes Endocrinol. 4(11):913-921
• Pubmed ID:
  27595918
• Pubmed Central ID:
  PMC5094846
• Document Type:
  Journal Article
• Funding:
  U01 DK057151/DK/NIDDK NIH HHSUnited States/ ; U01 DK057154/DK/NIDDK NIH HHSUnited States/ ; U01 DK056992/DK/NIDDK NIH HHSUnited States/ ; U01 DK057171/DK/NIDDK NIH HHSUnited States/ ; U01 DK057182/DK/NIDDK NIH HHSUnited States/ ; U01 DK057136/DK/NIDDK NIH HHSUnited States/ ; U01 DK057002/DK/NIDDK NIH HHSUnited States/ ; U01 DK057177/DK/NIDDK NIH HHSUnited States/ ; M01 RR001066/RR/NCRR NIH HHSUnited States/ ; U01 DK057078/DK/NIDDK NIH HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U01 DK057008/DK/NIDDK NIH HHSUnited States/ ; U01 DK057149/DK/NIDDK NIH HHSUnited States/ ; M01 RR001346/RR/NCRR NIH HHSUnited States/ ; P30 DK048520/DK/NIDDK NIH HHSUnited States/ ; U01 DK057135/DK/NIDDK NIH HHSUnited States/ ; UL1 RR024153/RR/NCRR NIH HHSUnited States/ ; P30 DK046204/DK/NIDDK NIH HHSUnited States/ ; M01 RR002719/RR/NCRR NIH HHSUnited States/ ; M01 RR000056/RR/NCRR NIH HHSUnited States/ ; U01 DK057219/DK/NIDDK NIH HHSUnited States/ ; U01 DK057131/DK/NIDDK NIH HHSUnited States/ ; M01 RR000051/RR/NCRR NIH HHSUnited States/ ; UL1 TR001120/TR/NCATS NIH HHSUnited States/ ; U01 DK056990/DK/NIDDK NIH HHSUnited States/ ; U01 DK057178/DK/NIDDK NIH HHSUnited States/
• Volume:
  4
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ba39e29576be9059c4865d90616673b6120cea10a6e10fff58fd5f95c3fdfc77
• Download URL:
  https://stacks.cdc.gov/view/cdc/42713/cdc_42713_DS1.pdf
• File Type:
  [PDF - 406.69 KB ]