Age- and sex-specific effects of a long-term lifestyle intervention on body weight and cardiometabolic health markers in adults with prediabetes: results from the diabetes prevention study PREVIEW

Ruixin Zhu, Ionut Craciun, Jan Bernhards-Werge, Elli Jalo, Sally D Poppitt, Marta P Silvestre, Maija Huttunen-Lenz, Melitta A McNarry, Gareth Stratton, Svetoslav Handjiev, Teodora Handjieva-Darlenska, Santiago Navas-Carretero, Jouko Sundvall, Tanja C Adam, Mathijs Drummen, Elizabeth J Simpson, Ian A Macdonald, Jennie Brand-Miller, Roslyn Muirhead, Tony LamPia S Vestentoft, Kristine Færch, J Alfredo Martinez, Mikael Fogelholm, Anne Raben

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
2 Downloads (Pure)

Abstract

AIMS/HYPOTHESIS: Lifestyle interventions are the first-line treatment option for body weight and cardiometabolic health management. However, whether age groups or women and men respond differently to lifestyle interventions is under debate. We aimed to examine age- and sex-specific effects of a low-energy diet (LED) followed by a long-term lifestyle intervention on body weight, body composition and cardiometabolic health markers in adults with prediabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance).

METHODS: This observational study used longitudinal data from 2223 overweight participants with prediabetes in the multicentre diabetes prevention study PREVIEW. The participants underwent a LED-induced rapid weight loss (WL) period followed by a 3 year lifestyle-based weight maintenance (WM) intervention. Changes in outcomes of interest in prespecified age (younger: 25-45 years; middle-aged: 46-54 years; older: 55-70 years) or sex (women and men) groups were compared.

RESULTS: In total, 783 younger, 319 middle-aged and 1121 older adults and 1503 women and 720 men were included in the analysis. In the available case and complete case analyses, multivariable-adjusted linear mixed models showed that younger and older adults had similar weight loss after the LED, whereas older adults had greater sustained weight loss after the WM intervention (adjusted difference for older vs younger adults -1.25% [95% CI -1.92, -0.58], p<0.001). After the WM intervention, older adults lost more fat-free mass and bone mass and had smaller improvements in 2 h plasma glucose (adjusted difference for older vs younger adults 0.65 mmol/l [95% CI 0.50, 0.80], p<0.001) and systolic blood pressure (adjusted difference for older vs younger adults 2.57 mmHg [95% CI 1.37, 3.77], p<0.001) than younger adults. Older adults had smaller decreases in fasting and 2 h glucose, HbA 1c and systolic blood pressure after the WM intervention than middle-aged adults. In the complete case analysis, the above-mentioned differences between middle-aged and older adults disappeared, but the direction of the effect size did not change. After the WL period, compared with men, women had less weight loss (adjusted difference for women vs men 1.78% [95% CI 1.12, 2.43], p<0.001) with greater fat-free mass and bone mass loss and smaller improvements in HbA 1c, LDL-cholesterol and diastolic blood pressure. After the WM intervention, women had greater fat-free mass and bone mass loss and smaller improvements in HbA 1c and LDL-cholesterol, while they had greater improvements in fasting glucose, triacylglycerol (adjusted difference for women vs men -0.08 mmol/l [-0.11, -0.04], p<0.001) and HDL-cholesterol.

CONCLUSIONS/INTERPRETATION: Older adults benefited less from a lifestyle intervention in relation to body composition and cardiometabolic health markers than younger adults, despite greater sustained weight loss. Women benefited less from a LED followed by a lifestyle intervention in relation to body weight and body composition than men. Future interventions targeting older adults or women should take prevention of fat-free mass and bone mass loss into consideration.

CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01777893.

Original languageEnglish
Pages (from-to)1262-1277
JournalDiabetologia
Volume65
Issue number8
Early online date25 May 2022
DOIs
Publication statusPublished - Aug 2022

Keywords

  • Cardiovascular disease
  • Men
  • Middle-aged people
  • Obesity
  • Older people
  • Weight loss
  • Weight loss maintenance
  • Women
  • Young people

Fingerprint

Dive into the research topics of 'Age- and sex-specific effects of a long-term lifestyle intervention on body weight and cardiometabolic health markers in adults with prediabetes: results from the diabetes prevention study PREVIEW'. Together they form a unique fingerprint.

Cite this