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Effects of Weight Loss, Weight Cycling, and Weight Loss Maintenance on Diabetes Incidence and Change in Cardiometabolic Traits in the Diabetes Prevention Program

OBJECTIVE: This study examined specific measures of weight loss in relation to incident diabetes and improvement in cardiometabolic risk factors.RESEARCH DESIGN AND METHODS: This prospective, observational study analyzed nine weight measures, characterizing baseline weight, short- versus long-term weight loss, short- versus long-term weight regain, and weight cycling, within the Diabetes Prevention Program (DPP) lifestyle intervention arm (n = 1,000) for predictors of incident diabetes and improvement in cardiometabolic risk factors over 2 years.RESULTS: Although weight loss in the first 6 months was protective of diabetes (hazard ratio [HR] 0.94 per kg, 95% CI 0.90, 0.98; P < 0.01) and cardiometabolic risk factors (P < 0.01), weight loss from 0 to 2 years was the strongest predictor of reduced diabetes incidence (HR 0.90 per kg, 95% CI 0.87, 0.93; P < 0.01) and cardiometabolic risk factor improvement (e.g., fasting glucose: beta = -0.57 mg/dL per kg, 95% CI -0.66, -0.48; P < 0.01). Weight cycling (defined as number of 5-lb [2.25-kg] weight cycles) ranged 0-6 times per participant and was positively associated with incident diabetes (HR 1.33, 95% CI 1.12, 1.58; P < 0.01), fasting glucose (beta = 0.91 mg/dL per cycle; P = 0.02), HOMA-IR (beta = 0.25 units per cycle; P = 0.04), and systolic blood pressure (beta = 0.94 mmHg per cycle; P = 0.01). After adjustment for baseline weight, the effect of weight cycling remained statistically significant for diabetes risk (HR 1.22, 95% CI 1.02, 1.47; P = 0.03) but not for cardiometabolic traits.CONCLUSIONS: Two-year weight loss was the strongest predictor of reduced diabetes risk and improvements in cardiometabolic traits.

Primary Author
Delahanty,L. M.
Pan,Q.
Jablonski,K. A.
Aroda,V. R.
Watson,K. E.
Bray,G. A.
Kahn,S. E.
Florez,J. C.
Perreault,L.
Franks,P. W.
for the Diabetes Prevention Program Research Group

Author Address
Diabetes Research Center, Massachusetts General Hospital, Boston, MADepartment of Medicine, Harvard Medical School, Boston, MA [email protected].; The Biostatistics Center, George Washington University, Rockville, MD.; The Biostatistics Center, George Washington University, Rockville, MD.; MedStar Health Research Institute, Hyattsville, MD, and Georgetown University School of Medicine, Washington, DC.; The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.; Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.; Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA.; Diabetes Research Center, Massachusetts General Hospital, Boston, MADepartment of Medicine, Harvard Medical School, Boston, MACenter for Human Genetic Research, Department of Medicine, Massachusetts General Hospital, Boston, MAProgram in Medical and Population Genetics, Broad Institute, Cambridge, MA.; Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.; Department of Clinical Sciences, Lund University, Malmo, SwedenDepartment of Nutrition, Harvard School of Public Health, Boston, MA.

Volume
37

Issue
10

Start Page
2738

Other Pages
45

Publisher
by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered

Author Address
Diabetes Research Center, Massachusetts General Hospital, Boston, MADepartment of Medicine, Harvard Medical School, Boston, MA [email protected].; The Biostatistics Center, George Washington University, Rockville, MD.; The Biostatistics Center, George Washington University, Rockville, MD.; MedStar Health Research Institute, Hyattsville, MD, and Georgetown University School of Medicine, Washington, DC.; The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.; Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.; Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA.; Diabetes Research Center, Massachusetts General Hospital, Boston, MADepartment of Medicine, Harvard Medical School, Boston, MACenter for Human Genetic Research, Department of Medicine, Massachusetts General Hospital, Boston, MAProgram in Medical and Population Genetics, Broad Institute, Cambridge, MA.; Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.; Department of Clinical Sciences, Lund University, Malmo, SwedenDepartment of Nutrition, Harvard School of Public Health, Boston, MA.

PMID
25024396

PMCID
PMC4170126


Reference Type
Journal Article

Periodical Full
Diabetes care

Publication Year
2014

ISSN/ISBN
1935-5548

Document Object Index
C_140018 [pii]

Accession Number
dc14-0018