Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes
Richard F. Hamman , MD, DRPH 1 ,
Rena R. Wing , PHD 2 ,
Sharon L. Edelstein , SCM 3 ,
John M. Lachin , SCD 3 ,
George A. Bray , ...MD 4 ,
Linda Delahanty , MS, RD 5 ,
Mary Hoskin , MS, RD 6 ,
Andrea M. Kriska , PHD 7 ,
Elizabeth J. Mayer-Davis , PHD 8 ,
Xavier Pi-Sunyer , MD 9 ,
Judith Regensteiner , PHD 1 ,
Beth Venditti , PHD 7 ,
Judith Wylie-Rosett , EDD, RD 10 and
for the Diabetes Prevention Program Research Group
1 University of Colorado at Denver and Health Sciences Center, Denver, Colorado
2 Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
3 Biostatistics Center, George Washington University, Washington, DC
4 Pennington Biomedical Research Center, Baton Rouge, Louisiana
5 Diabetes Research Center, Massachusetts General Hospital, Boston, Massachussetts
6 Southwestern Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
7 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
8 University of South Carolina School of Public Health, Columbia, South Carolina
9 Roosevelt-St. Luke’s Hospital, New York, New York
10 Albert Einstein College of Medicine, Bronx, New York
Address correspondence and reprint requests to Richard F. Hamman, MD, DrPH, Diabetes Prevention Program Coordinating Center,
The Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852. E-mail: dppmail{at}biostat.bsc.gwu.edu
Abstract
OBJECTIVE —Diabetes Prevention Program (DPP) participants randomized to the intensive lifestyle intervention (ILS) had significantly
reduced risk of diabetes compared with placebo participants. We explored the contribution of changes in weight, diet, and
physical activity on the risk of developing diabetes among ILS participants.
RESEARCH DESIGN AND METHODS —For this study, we analyzed one arm of a randomized trial using Cox proportional hazards regression over 3.2 years of follow-up.
RESULTS —A total of 1,079 participants were aged 25–84 years (mean 50.6 years, BMI 33.9 kg/m 2 ). Weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 95% CI 0.35–0.51;
P < 0.0001). For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity.
Lower percent of calories from fat and increased physical activity predicted weight loss. Increased physical activity was
important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved
the physical activity goal had 44% lower diabetes incidence.
CONCLUSIONS —Interventions to reduce diabetes risk should primarily target weight reduction.
DPP, Diabetes Prevention Program
IGR, insulin-to-glucose ratio
ILS, intensive lifestyle intervention
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Accepted June 5, 2006.
Received March 14, 2006.
DIABETES CARE
In this longitudinal study of black girls and white girls, the authors measured habitual levels of recreational activity from the age of 8 or 9 through the age of 18 or 19 years. The level of ...physical activity declined precipitously over time, so that by the age of 18 or 19, 56 percent of black girls and 31 percent of white girls reported no habitual recreational activity. Predictors of declines in physical activity among black girls, white girls, or both included lower levels of parental education, higher body-mass index, pregnancy, and cigarette smoking.
By the age of 18 or 19, 56 percent of black girls and 31 percent of white girls report no habitual recreational activity.
Since the early 1960s, the prevalence of obesity in female children and adolescents in the United States has more than doubled, with the greatest increase among black girls.
1
Periodic surveys show no concomitant increase in food intake.
2
,
3
Analogous information on trends in activity level in this population is not available. It has been conjectured that adolescents have become less active in recent years, and that this trend may be responsible for the increased prevalence of obesity.
4
–
8
In cross-sectional studies, activity levels have been reported to drop by as much as 50 percent during adolescence.
7
,
8
Although white girls . . .
This study, examining the longitudinal relation among physical activity, body mass index, and development of type 2 diabetes in a high-risk population, is unique because diabetes was determined by ...oral glucose tolerance testing rather than by self-report. A physical activity questionnaire assessing past year leisure and occupational activity was administered to 1,728 nondiabetic Pima individuals aged 15–59 years as part of a series of clinic examinations in the Gila River Indian Community from 1987 to 2000. During an average follow-up period of 6 years, 346 subjects developed diabetes. Using time-dependent Cox proportional hazards modeling adjusting for age, the authors found that total activity was related to diabetes incidence in women and men (p < 0.05 in women only). After additional adjustment for body mass index, the relation between activity and diabetes incidence was weakened in both men and women. When the age-adjusted diabetes incidence rates were examined by levels of activity stratified by tertile of body mass index, the diabetes incidence rate remained lower in more active than in less active men and women from all body mass index groups, with the exception of the middle body mass index tertile in men (p < 0.05 in women only). These results suggest that the adoption and maintenance of a physically active lifestyle can play a significant role in preventing type 2 diabetes.
Capicua ( CIC )-rearranged sarcomas are an aggressive subset of undifferentiated round cell sarcomas. CIC::DUX4, the proto-typical CIC fusion oncoprotein is associated with rapid clinical progression ...and chemotherapy resistance leading to poor clinical outcomes. Recent studies have identified additional CIC fusions (CIC::NUTM1, CIC::FOXO4, and CIC::LEUTX) that largely retain CIC-binding specificity but leverage C-terminal binding partners (NUTM1, FOXO4, and LEUTX) to potentially activate transcriptional programs that drive oncogenesis. Moreover, the recent development of preclinical models to study CIC::DUX4 sarcoma have advanced our understanding of the underlying biological mechanisms and uncovered key dependencies that can be translated into rational therapies. In this review, we will highlight these recent advancements in CIC -rearranged sarcoma biology with a vision for clinical translation to improve patient outcomes.
The role of physical activity in preventing obesity during adolescence remains unknown. We examined changes in activity in relation to changes in body-mass index (BMI) and adiposity in a cohort of ...1152 black and 1135 white girls from the USA, who were followed up prospectively from ages 9 or 10 to 18 or 19 years.
BMI and sum of skinfold thickness were assessed annually, whereas habitual activity was assessed at years 1 (baseline), 3, 5, and 7–10. Each girls' overall activity status was categorised as active, moderately active, or inactive. Longitudinal regression models examined associations between changes in activity and in overall activity status with changes in BMI and in sum of skinfold thickness.
Each decline in activity of 10 metabolic equivalent MET-times per week was associated with an increase in BMI of 0·14 kg/m
2 (SE 0·03) and in sum of skinfold thickness of 0·62 mm (0·17) for black girls, and of 0·09 kg/m
2 (0·02) and 0·63 mm (0·13) for white girls. At ages 18 or 19 years, BMI differences between active and inactive girls were 2·98 kg/m
2 (p<0·0001) for black girls and 2·10 kg/m
2 (p<0·0001) for white girls. Similar results were apparent for sum of skinfold thickness. For moderately active girls, changes in BMI and sum of skinfold thickness were about midway between those for active and inactive girls.
Changes in activity levels of US girls during adolescence significantly affected changes in BMI and adiposity. Thus, preventing the steep decline in activity during adolescence is an important method to reduce obesity.
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DOBA, GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SIK, UILJ, UKNU, UL, UM, UPCLJ, UPUK, VSZLJ
The Diabetes Prevention Program (DPP) behavioral lifestyle intervention was effective among a diverse sample of adults with prediabetes. Demonstrated effectiveness in translated versions of the DPP ...lifestyle intervention (such as Group Lifestyle Balance, DPP-GLB) led to widescale usage with national program oversight and reimbursement. However, little is known about the success of these DPP-translation programs across subgroups of sociodemographic factors. This current effort investigated potential disparities in DPP-translation program primary goal achievement (physical activity and weight) by key sociodemographic factors.
Data were combined from two 12-month community-based DPP-GLB trials among overweight/obese individuals with prediabetes and/or metabolic syndrome. We evaluated change in weight (kilograms and percent) and activity (MET-hrs/week) and goal achievement (yes/no; ≥5% weight loss and 150 min per week activity) after 6 and 12 months of intervention within and across subgroups of race/ethnicity (non-Hispanic white, non-Hispanic black), employment status, education, income, and gender.
Among 240 participants (85%) with complete data, most sociodemographic subgroups demonstrated significant weight loss. However, non-Hispanic white lost more weight at both 6 and 12 months compared to non-Hispanic black participants median weight loss (IQR), 6 months: 5.7% (2.7-9.0) vs. 1.5% (1.2-7.5) p = .01 and 12 months: 4.8% (1.1-9.6) vs. 1.1% (- 2.0-3.7) p = .01, respectively. In addition, a larger percentage of non-Hispanic white demonstrated a 5% weight loss at 6 and 12 months. Employment was significantly related to 12-month weight loss, with retired participants being the most successful. Men, participants with graduate degrees, and those with higher income were most likely to meet the activity goal at baseline and 12 months. Differences in physical activity goal achievement across gender, education, and income groups were significant at baseline, attenuated after 6 months, then re-emerged at 12 months.
The DPP-GLB was effective in promoting weight loss and helped to alleviate disparities in physical activity levels after 6 months. Despite overall program success, differences in weight loss achievement by race/ethnicity were found and disparities in activity re-emerged after 12 months of intervention. These results support the need for intervention modification providing more tailored approaches to marginalized groups to maximize the achievement and maintenance of DPP-GLB behavioral goals.
NCT01050205 , NCT02467881 .
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Accelerometers were incorporated in the 2003-2004 National Health and Nutritional Examination Survey (NHANES) study cycle for objective assessment of physical activity. This is the first time that ...objective physical activity data are available on a nationally representative sample of U.S. residents. The use of accelerometers allows researchers to measure total physical activity, including light intensity and unstructured activities, which may be a better predictor of health outcomes than structured activity alone. The aim of this study was to examine objectively determined physical activity levels by sex, age and racial/ethnic groups in a national sample of U.S. adults.
Data were obtained from the 2003-2004 NHANES, a cross-sectional study of a complex, multistage probability sample of the U.S. population. Physical activity was assessed with the Actigraph AM-7164 accelerometer for seven days following an examination. 2,688 U.S. adults with valid accelerometer data (i.e. at least four days with at least 10 hours of wear-time) were included in the analysis. Mean daily total physical activity counts, as well as counts accumulated in minutes of light, and moderate-vigorous intensity physical activity are presented by sex across age and racial/ethnic groups. Generalized linear modeling using the log link function was performed to compare physical activity in sex and racial/ethnic groups adjusting for age.
Physical activity decreases with age for both men and women across all racial/ethnic groups with men being more active than women, with the exception of Hispanic women. Hispanic women are more active at middle age (40-59 years) compared to younger or older age and not significantly less active than men in middle or older age groups (i.e. age 40-59 or age 60 and older). Hispanic men accumulate more total and light intensity physical activity counts than their white and black counterparts for all age groups.
Physical activity levels measured objectively by accelerometer demonstrated that Hispanic men are, in general, more active than their white and black counterparts. This appears to be in contrast to self-reported physical activity previously reported in the literature and identifies the need to use objective measures in situations where the contribution of light intensity and/or unstructured physical activity cannot be assumed homogenous across the populations of interest.
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Aims/hypothesis
The Diabetes Prevention Program (DPP) lifestyle intervention successfully achieved its goal of increasing leisure physical activity levels. This current study examines whether the ...lifestyle intervention also changed time spent being sedentary and the impact of sedentary time on diabetes development in this cohort.
Methods
3,232 DPP participants provided baseline data. Sedentary behaviour was assessed via an interviewer-administered questionnaire and reported as time spent watching television specifically (or combined with sitting at work). Mean change in sedentary time was examined using repeated measures ANCOVA. The relationship between sedentary time and diabetes incidence was determined using Cox proportional hazards models.
Results
During the DPP follow-up (mean: 3.2 years), sedentary time declined more in the lifestyle than the metformin or placebo participants (
p
< 0.05). For the lifestyle group, the decrease in reported mean television watching time (22 95% CI 26, 17 min/day) was greater than in the metformin or placebo groups (
p
< 0.001). Combining all participants together, there was a significantly increased risk of developing diabetes with increased television watching (3.4% per hour spent watching television), after controlling for age, sex, treatment arm and leisure physical activity (
p
< 0.01), which was attenuated when time-dependent weight was added to the model.
Conclusions/interpretation
In the DPP, the lifestyle intervention was effective at reducing sedentary time, which was not a primary goal. In addition, in all treatment arms, individuals with lower levels of sedentary time had a lower risk of developing diabetes. Future lifestyle intervention programmes should emphasise reducing television watching and other sedentary behaviours in addition to increasing physical activity.
Trial registration:
ClinicalTrials.gov NCT00004992
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background: Weighted hula-hoops have gained popularity, but whether they indeed reshape the trunk or have beneficial metabolic effects in overweight subjects is unknown. Objectives: To determine ...effects of hula-hooping and walking matched for energy expenditure on android fat %, trunk muscle mass, and metabolic parameters in a randomized cross-over study. Design: We recruited 55 overweight nondiabetic subjects, who were randomized to hula-hooping (HULA) for 6 weeks using a 1.5-kg weighted hula-hoop followed by walking (WALK) for another 6 weeks or vice versa. The increments in energy expenditure were similar by HULA and WALK. Body composition (dual-energy X-ray absorptiometry) and metabolic parameters were measured at baseline and after HULA and WALK. The primary endpoint was the change in fat % in the android region. Results: A total of 53subjects (waist 92 ± 1 cm, body mass index 28 ± 1 kg/m 2 ) completed the study. Body weight changed similarly (–0.6 ± 0.2 vs. –0.5 ± 0.2 kg, nonsignificant; HULA vs. WALK). During the intervention the subjects hula-hooped on average 12.8 ± 0.5 min/day and walked 9,986 ± 376 steps/day. The % fat in the android region decreased significantly by HULA but not by WALK (between-group change p < 0.001). Trunk muscle mass increased more by HULA than by WALK (p < 0.05). Waist circumference decreased more by HULA than by WALK (–3.1 ± 0.3 cm vs. –0.7 ± 0.4 cm, p < 0.001; HULA vs. WALK). WALK but not HULA significantly lowered systolic blood pressure and increased HDL cholesterol while HULA significantly decreased LDL cholesterol. Conclusions: Hula-hooping with a weighted hula-hoop can be used to decrease abdominal fat % and increase trunk muscle mass in overweight subjects. Its LDL lowering effect resembles that described for resistance training.
Objective:
Cardiovascular risk remains high despite statin use. Overweight/obese diabetic persons usually have normal/low LDL‐cholesterol but high C‐reactive protein (CRP) levels. We aimed to examine ...the effects of intensive lifestyle intervention for weight loss (ILI) on CRP levels in overweight/obese diabetic individuals by statin use.
Design and Methods:
Look AHEAD was a randomized trial in overweight/obese type 2 diabetic individuals testing whether ILI would reduce cardiovascular mortality, when compared to usual care. CRP changes in 1,431 participants with biomarker levels, who remained on or off statin treatment for 1 year, were evaluated.
Results:
The reduction in CRP levels with ILI at 1 year in men and women on statins was −44.9 and −42.3%, respectively, compared to −13.7 and −21.0% for those on statins and usual care (P < 0.0001). At 1 year, median CRP levels were: 1.8 mg L−1 in participants randomized to ILI on statin therapy; 2.6 mg L−1 for those on statins randomized to usual care and 2.9 mg L−1 for participants not on statins but randomized to ILI. Weight loss was associated with 1‐year CRP reduction (P < 0.0001) in statin and nonstatin users.
Conclusions:
Our findings suggest that in overweight/obese diabetic persons, ILI and statin therapy may have substantial additive anti‐inflammatory benefits.
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