Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the Diabetes Prevention Program

Diabetes Care. 2014 Oct;37(10):2738-45. doi: 10.2337/dc14-0018. Epub 2014 Jul 14.

Abstract

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: β = -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 (β = 0.91 mg/dL per cycle; P = 0.02), HOMA-IR (β = 0.25 units per cycle; P = 0.04), and systolic blood pressure (β = 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.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Body Weight / physiology
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / etiology*
  • Diabetes Mellitus / prevention & control
  • Female
  • Humans
  • Incidence
  • Life Style
  • Male
  • Metabolic Diseases / epidemiology
  • Metabolic Diseases / etiology*
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Weight Loss / physiology*
  • Weight Reduction Programs

Substances

  • Blood Glucose