Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study

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  • Zhu, Ruixin
  • Maija Huttunen-Lenz
  • Gareth Stratton
  • Teodora Handjieva-Darlenska
  • Svetoslav Handjiev
  • Jouko Sundvall
  • Marta P Silvestre
  • Elli Jalo
  • Kirsi H Pietiläinen
  • Tanja C Adam
  • Mathijs Drummen
  • Elizabeth J Simpson
  • Moira A Taylor
  • Sally D. Poppitt
  • Santiago Navas-Carretero
  • J Alfredo Martinez
  • Wolfgang Schlicht
  • Mikael Fogelholm
  • Jennie Brand-Miller
  • Raben, Anne

Background/Objectives: Some individuals with overweight/obesity may be relatively metabolically healthy (MHO) and have a lower risk of cardiovascular disease than those with metabolically unhealthy overweight/obesity (MUO). We aimed to compare changes in body weight and cardiometabolic risk factors and type 2 diabetes incidence during a lifestyle intervention between individuals with MHO vs MUO. 

Methods: This post-hoc analysis included 1012 participants with MHO and 1153 participants with MUO at baseline in the randomized trial PREVIEW. Participants underwent an eight-week low-energy diet phase followed by a 148-week lifestyle-based weight-maintenance intervention. Adjusted linear mixed models and Cox proportional hazards regression models were used. 

Results: There were no statistically significant differences in weight loss (%) between participants with MHO vs MUO over 156 weeks. At the end of the study, weight loss was 2.7% (95% CI, 1.7%–3.6%) in participants with MHO and 3.0% (2.1%–4.0%) in those with MUO. After the low-energy diet phase, participants with MHO had smaller decreases in triglyceride (mean difference between MHO vs MUO 0.08 mmol·L−1 [95% CI, 0.04–0.12]; P < 0.001) but similar reductions in fasting glucose and HOMA-IR than those with MUO. However, at the end of weight maintenance, those with MHO had greater reductions in triglyceride (mean difference −0.08 mmol·L−1 [−0.12–−0.04]; P < 0.001), fasting glucose, 2-hour glucose (difference −0.28 mmol·L−1 [−0.41–−0.16]; P < 0.001), and HOMA-IR than those with MUO. Participants with MHO had smaller decreases in diastolic blood pressure and HbA1c and greater decreases in HDL cholesterol after weight loss than those with MUO, whereas the statistically significant differences disappeared at the end of weight maintenance. Participants with MHO had lower 3-year type 2 diabetes incidence than those with MUO (adjusted hazard ratio 0.37 [0.20–0.66]; P < 0.001). 

Conclusions: Individuals with MUO had greater improvements in some cardiometabolic risk factors during the low-energy diet phase, but had smaller improvements during long-term lifestyle intervention than those with MHO.

TidsskriftInternational Journal of Obesity
Udgave nummer9
Sider (fra-til)833-840
Antal sider8
StatusUdgivet - 2023

Bibliografisk note

CURIS 2023 NEXS 160

Funding Information:
This work was supported by EU framework programme 7 (FP7/2007–2013) grant agreement # 312057; National Health and Medical Research Council - EU Collaborative Grant, AUS 8, ID 1067711); the Glycemic Index Foundation Australia through royalties to the University of Sydney; the New Zealand Health Research Council (grant #14/191) and University of Auckland Faculty Research Development Fund; the Cambridge Weight Plan donated all products for the low-energy diet phase; the Danish Agriculture & Food Council; the Danish Meat and Research Institute; National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK); Biotechnology and Biological Sciences Research Council (BBSRC) (UK); Engineering and Physical Sciences Research Council (EPSRC) (UK); Nutritics (Dublin) donated all dietary analyses software used by UNOTT; Juho Vainio Foundation (FIN), Academy of Finland (grant numbers: 272376, 314383, 266286, 314135), Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, Finnish Diabetes Research Foundation, University of Helsinki, Government Research Funds for Helsinki University Hospital (FIN), Jenny and Antti Wihuri Foundation (FIN), Emil Aaltonen Foundation (FIN); China Scholarship Council. The funding source had no role in the study design and conduct, data analysis, or manuscript preparation. Open access funding provided by Royal Library, Copenhagen University Library. ©

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Nature Limited.


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