American Diabetes Association
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Does the effect of a 3-year lifestyle intervention on body weight and cardiometabolic health differ by prediabetes metabolic phenotype? A post-hoc analysis of the PREVIEW study

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posted on 2022-06-13, 15:39 authored by Ruixin Zhu, Elli Jalo, Marta P. Silvestre, Sally D. Poppitt, Teodora Handjieva-Darlenska, Svetoslav Handjiev, Maija Huttunen-Lenz, Kelly Mackintosh, Gareth Stratton, Santiago Navas-Carretero, Kirsi H. Pietiläinen, Elizabeth Simpson, Ian A. Macdonald, Roslyn Muirhead, Jennie Brand-Miller, Mikael Fogelholm, Kristine Færch, J. Alfredo Martinez, Margriet S. Westerterp-Plantenga, Tanja C. Adam, Anne Raben



To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype.


This post-hoc analysis of the multi-center, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1510 participants with prediabetes (BMI≥25 kg·m-2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal HbA1c (<39 mmol·mol-1) and 25% had intermediate HbA1c (39–47 mmol·mol-1). Participants underwent an 8-week diet-induced rapid weight loss followed by a 148-week lifestyle-based weight-maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used.


In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks -3.5% [95%CI, -4.7%, -2.3%]) than those with iIFG (mean -2.5% [-3.6%, -1.3%]) relative to baseline (P=0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal vs intermediate HbA1c had similar WL over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-hour glucose (adjusted between-group difference at 156 weeks -0.54 mmol·L-1 [-0.70, -0.39]; P<0.001), and triglycerides (difference -0.07 mmol·L-1 [-0.11, -0.03]; P<0.001) during the lifestyle intervention. 


Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c. 


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 8-weeks weight loss period. 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.