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

Diabetologia, Volume: 65, Issue: 8, Pages: 1262 - 1277

Swansea University Authors: Melitta McNarry Orcid Logo, Gareth Stratton Orcid Logo

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DOI (Published version): 10.1007/s00125-022-05716-3

Abstract

Aims/hypothesisLifestyle 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-en...

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Published in: Diabetologia
ISSN: 0012-186X 1432-0428
Published: Springer Science and Business Media LLC 2022
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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).MethodsThis 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&#x2013;45 years; middle-aged: 46&#x2013;54 years; older: 55&#x2013;70 years) or sex (women and men) groups were compared.ResultsIn 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 &#x2212;1.25% [95% CI &#x2212;1.92, &#x2212;0.58], p&lt;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&lt;0.001) and systolic blood pressure (adjusted difference for older vs younger adults 2.57 mmHg [95% CI 1.37, 3.77], p&lt;0.001) than younger adults. Older adults had smaller decreases in fasting and 2 h glucose, HbA1c 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&lt;0.001) with greater fat-free mass and bone mass loss and smaller improvements in HbA1c, LDL-cholesterol and diastolic blood pressure. After the WM intervention, women had greater fat-free mass and bone mass loss and smaller improvements in HbA1c and LDL-cholesterol, while they had greater improvements in fasting glucose, triacylglycerol (adjusted difference for women vs men &#x2212;0.08 mmol/l [&#x2212;0.11, &#x2212;0.04], p&lt;0.001) and HDL-cholesterol.Conclusions/interpretationOlder 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.</abstract><type>Journal Article</type><journal>Diabetologia</journal><volume>65</volume><journalNumber>8</journalNumber><paginationStart>1262</paginationStart><paginationEnd>1277</paginationEnd><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0012-186X</issnPrint><issnElectronic>1432-0428</issnElectronic><keywords>Cardiovascular disease, Men, Middle-aged people, Obesity, Older people, Weight loss, Weight loss maintenance, Women, Young people</keywords><publishedDay>1</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-08-01</publishedDate><doi>10.1007/s00125-022-05716-3</doi><url/><notes/><college>COLLEGE NANME</college><department>Engineering and Applied Sciences School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>EAAS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. This research was supported by the EU Seventh Framework Programme (FP7; 2007&#x2013;2013) (grant no. 312057); National Health and Medical Research Council (EU Collaborative Grant AUS 8, ID 1067711); Glycemic Index Foundation Australia through royalties to the University of Sydney; Health Research Council of New Zealand (grant no. 14/191) and University of Auckland Faculty Research Development Fund; Cambridge Weight Plan, which donated all products for the 8 week weight loss period; Danish Agriculture &amp; Food Council; Danish Meat 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), which donated all dietary analysis software used by the University of Nottingham; Juho Vainio Foundation (Finland); Academy of Finland (grant nos 272376, 314383, 266286 and 314135); Finnish Medical Foundation; Gyllenberg Foundation (Finland); Novo Nordisk Foundation; Finnish Diabetes Research Foundation; University of Helsinki; Government Research Funds for Helsinki University Hospital; Jenny and Antti Wihuri Foundation (Finland); Emil Aaltonen Foundation (Finland); and China Scholarship Council.</funders><projectreference/><lastEdited>2023-04-04T09:26:37.6291073</lastEdited><Created>2022-05-26T09:50:02.7750506</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2"/></path><authors><author><firstname>Ruixin</firstname><surname>Zhu</surname><orcid>0000-0003-2170-4667</orcid><order>1</order></author><author><firstname>Ionut</firstname><surname>Craciun</surname><orcid>0000-0001-6740-8113</orcid><order>2</order></author><author><firstname>Jan</firstname><surname>Bernhards-Werge</surname><orcid>0000-0002-8551-1234</orcid><order>3</order></author><author><firstname>Elli</firstname><surname>Jalo</surname><orcid>0000-0002-9987-1716</orcid><order>4</order></author><author><firstname>Sally D.</firstname><surname>Poppitt</surname><orcid>0000-0002-2214-8378</orcid><order>5</order></author><author><firstname>Marta P.</firstname><surname>Silvestre</surname><orcid>0000-0001-9327-2897</orcid><order>6</order></author><author><firstname>Maija</firstname><surname>Huttunen-Lenz</surname><orcid>0000-0002-1034-1613</orcid><order>7</order></author><author><firstname>Melitta</firstname><surname>McNarry</surname><orcid>0000-0003-0813-7477</orcid><order>8</order></author><author><firstname>Gareth</firstname><surname>Stratton</surname><orcid>0000-0001-5618-0803</orcid><order>9</order></author><author><firstname>Svetoslav</firstname><surname>Handjiev</surname><orcid>0000-0002-9717-7106</orcid><order>10</order></author><author><firstname>Teodora</firstname><surname>Handjieva-Darlenska</surname><orcid>0000-0001-8307-343x</orcid><order>11</order></author><author><firstname>Santiago</firstname><surname>Navas-Carretero</surname><orcid>0000-0002-5163-2230</orcid><order>12</order></author><author><firstname>Jouko</firstname><surname>Sundvall</surname><order>13</order></author><author><firstname>Tanja C.</firstname><surname>Adam</surname><orcid>0000-0002-7840-5003</orcid><order>14</order></author><author><firstname>Mathijs</firstname><surname>Drummen</surname><orcid>0000-0003-3896-043x</orcid><order>15</order></author><author><firstname>Elizabeth J.</firstname><surname>Simpson</surname><orcid>0000-0001-9353-6258</orcid><order>16</order></author><author><firstname>Ian A.</firstname><surname>Macdonald</surname><orcid>0000-0002-7540-9850</orcid><order>17</order></author><author><firstname>Jennie</firstname><surname>Brand-Miller</surname><orcid>0000-0002-6797-8754</orcid><order>18</order></author><author><firstname>Roslyn</firstname><surname>Muirhead</surname><orcid>0000-0002-4374-0362</orcid><order>19</order></author><author><firstname>Tony</firstname><surname>Lam</surname><orcid>0000-0002-3940-7129</orcid><order>20</order></author><author><firstname>Pia S.</firstname><surname>Vestentoft</surname><orcid>0000-0002-8977-9983</orcid><order>21</order></author><author><firstname>Kristine</firstname><surname>F&#xE6;rch</surname><orcid>0000-0002-6127-0448</orcid><order>22</order></author><author><firstname>J. Alfredo</firstname><surname>Martinez</surname><orcid>0000-0001-5218-6941</orcid><order>23</order></author><author><firstname>Mikael</firstname><surname>Fogelholm</surname><orcid>0000-0001-8110-102x</orcid><order>24</order></author><author><firstname>Anne</firstname><surname>Raben</surname><orcid>0000-0001-5229-4491</orcid><order>25</order></author></authors><documents><document><filename>60086__24186__2491e688aa69418c9ee488545be98a0b.pdf</filename><originalFilename>60086.pdf</originalFilename><uploaded>2022-05-26T09:54:42.5313841</uploaded><type>Output</type><contentLength>1291078</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright: The Author(s) 2022. 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spelling 2023-04-04T09:26:37.6291073 v2 60086 2022-05-26 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 062f5697ff59f004bc8c713955988398 0000-0003-0813-7477 Melitta McNarry Melitta McNarry true false 6d62b2ed126961bed81a94a2beba8a01 0000-0001-5618-0803 Gareth Stratton Gareth Stratton true false 2022-05-26 EAAS Aims/hypothesisLifestyle 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).MethodsThis 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.ResultsIn 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, HbA1c 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 HbA1c, LDL-cholesterol and diastolic blood pressure. After the WM intervention, women had greater fat-free mass and bone mass loss and smaller improvements in HbA1c 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/interpretationOlder 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. Journal Article Diabetologia 65 8 1262 1277 Springer Science and Business Media LLC 0012-186X 1432-0428 Cardiovascular disease, Men, Middle-aged people, Obesity, Older people, Weight loss, Weight loss maintenance, Women, Young people 1 8 2022 2022-08-01 10.1007/s00125-022-05716-3 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. This research was supported by the EU Seventh Framework Programme (FP7; 2007–2013) (grant no. 312057); National Health and Medical Research Council (EU Collaborative Grant AUS 8, ID 1067711); Glycemic Index Foundation Australia through royalties to the University of Sydney; Health Research Council of New Zealand (grant no. 14/191) and University of Auckland Faculty Research Development Fund; Cambridge Weight Plan, which donated all products for the 8 week weight loss period; Danish Agriculture & Food Council; Danish Meat 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), which donated all dietary analysis software used by the University of Nottingham; Juho Vainio Foundation (Finland); Academy of Finland (grant nos 272376, 314383, 266286 and 314135); Finnish Medical Foundation; Gyllenberg Foundation (Finland); Novo Nordisk Foundation; Finnish Diabetes Research Foundation; University of Helsinki; Government Research Funds for Helsinki University Hospital; Jenny and Antti Wihuri Foundation (Finland); Emil Aaltonen Foundation (Finland); and China Scholarship Council. 2023-04-04T09:26:37.6291073 2022-05-26T09:50:02.7750506 Faculty of Science and Engineering Ruixin Zhu 0000-0003-2170-4667 1 Ionut Craciun 0000-0001-6740-8113 2 Jan Bernhards-Werge 0000-0002-8551-1234 3 Elli Jalo 0000-0002-9987-1716 4 Sally D. Poppitt 0000-0002-2214-8378 5 Marta P. Silvestre 0000-0001-9327-2897 6 Maija Huttunen-Lenz 0000-0002-1034-1613 7 Melitta McNarry 0000-0003-0813-7477 8 Gareth Stratton 0000-0001-5618-0803 9 Svetoslav Handjiev 0000-0002-9717-7106 10 Teodora Handjieva-Darlenska 0000-0001-8307-343x 11 Santiago Navas-Carretero 0000-0002-5163-2230 12 Jouko Sundvall 13 Tanja C. Adam 0000-0002-7840-5003 14 Mathijs Drummen 0000-0003-3896-043x 15 Elizabeth J. Simpson 0000-0001-9353-6258 16 Ian A. Macdonald 0000-0002-7540-9850 17 Jennie Brand-Miller 0000-0002-6797-8754 18 Roslyn Muirhead 0000-0002-4374-0362 19 Tony Lam 0000-0002-3940-7129 20 Pia S. Vestentoft 0000-0002-8977-9983 21 Kristine Færch 0000-0002-6127-0448 22 J. Alfredo Martinez 0000-0001-5218-6941 23 Mikael Fogelholm 0000-0001-8110-102x 24 Anne Raben 0000-0001-5229-4491 25 60086__24186__2491e688aa69418c9ee488545be98a0b.pdf 60086.pdf 2022-05-26T09:54:42.5313841 Output 1291078 application/pdf Version of Record true Copyright: The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License true eng http://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Melitta McNarry
Gareth Stratton
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 062f5697ff59f004bc8c713955988398
6d62b2ed126961bed81a94a2beba8a01
author_id_fullname_str_mv 062f5697ff59f004bc8c713955988398_***_Melitta McNarry
6d62b2ed126961bed81a94a2beba8a01_***_Gareth Stratton
author Melitta McNarry
Gareth Stratton
author2 Ruixin Zhu
Ionut Craciun
Jan Bernhards-Werge
Elli Jalo
Sally D. Poppitt
Marta P. Silvestre
Maija Huttunen-Lenz
Melitta 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 Lam
Pia S. Vestentoft
Kristine Færch
J. Alfredo Martinez
Mikael Fogelholm
Anne Raben
format Journal article
container_title Diabetologia
container_volume 65
container_issue 8
container_start_page 1262
publishDate 2022
institution Swansea University
issn 0012-186X
1432-0428
doi_str_mv 10.1007/s00125-022-05716-3
publisher Springer Science and Business Media LLC
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
document_store_str 1
active_str 0
description Aims/hypothesisLifestyle 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).MethodsThis 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.ResultsIn 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, HbA1c 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 HbA1c, LDL-cholesterol and diastolic blood pressure. After the WM intervention, women had greater fat-free mass and bone mass loss and smaller improvements in HbA1c 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/interpretationOlder 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.
published_date 2022-08-01T14:14:19Z
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