Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus Four-Year Results of the Look AHEAD Trial

被引：968

作者：

Wing, Rena R.

Bahnson, Judy L.

Bray, George A.

Clark, Jeanne M.

Coday, Mace

Egan, Caitlin

Espeland, Mark A.

Foreyt, John P.

Gregg, Edward W.

Goldman, Valerie

Haffner, Steven M.

Hazuda, Helen

Hill, James O.

Horton, Edward S.

Hubbard, Van S.

Jakicic, John

Jeffery, Robert W.

Johnson, Karen C.

Kahn, Steven

Killean, Tina

Kitabchi, Abbas E.

Lewis, Cora E.

Manus, Cathy

Maschak-Carey, Barbara J.

Michaels, Sara

Montez, Maria

Montgomery, Brenda

Nathan, David M.

Patricio, Jennifer

Peters, Anne

Pi-Sunyer, Xavier

Pownall, Henry

Reboussin, David

Rejeski, Jack

Rubin, Richard

Safford, Monika

Skarphol, Tricia

Van Dorsten, Brent

Wadden, Thomas A.

Wagenknecht, Lynne

Wesche-Thobaben, Jacqueline

West, Delia S.

Williamson, Donald

Yanovski, Susan Z.

机构：

[1] Department of Psychiatry, Miriam Hospital, Brown Medical School, Providence, RI 02860

[2] Wake Forest University, Winston-Salem, NC

[3] Pennington Biomedical Research Center, Baton Rouge, LA

[4] University of Pittsburgh, Pittsburgh, PA

[5] Johns Hopkins Medical Institutions, Baltimore, MD

[6] University of Tennessee Health Science Center, University of Tennessee East

[7] Baylor College of Medicine, Houston, TX

[8] Centers for Disease Control and Prevention, Atlanta, GA

[9] Harvard Center, Massachusetts General Hospital, Boston, MA

[10] University of Texas Health Science Center, San Antonio, TX

[11] University of Colorado Health Sciences Center, Denver, CO

[12] Joslin Diabetes Center, Boston, MA

[13] National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

[14] University of Minnesota, Minneapolis, MN

[15] VA Puget Sound Health Care System, University of Washington

[16] Southwestern American Indian Center, Phoenix, AZ

[17] Southwestern American Indian Center, Shiprock, NM

[18] University of Alabama, Birmingham, AL

[19] University of Pennsylvania, Philadelphia, PA

[20] St. Luke's Roosevelt Hospital Center, New York, NY

[21] University of Southern California, Los Angeles, CA

来源：

ARCHIVES OF INTERNAL MEDICINE | 2010年 / 170卷 / 17期

基金：

美国国家卫生研究院;

关键词：

CARDIORESPIRATORY FITNESS; DISEASE MORTALITY; METABOLIC SYNDROME; ALL-CAUSE; EXERCISE; MEN; DIET; PREVENTION; REDUCTION; FAT;

D O I：

10.1001/archinternmed.2010.334

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study. Methods: The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment. Results: Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (-6.15% vs -0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A(1c) level (-0.36% vs -0.09%; P < .001), (-2.92 vs -2.48 mm Hg; P = .01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (-25.56 vs -19.75 mg/ dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (-11.27 vs -12.84 mg/dL; P = .009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A(1c), levels, systolic blood pressure, and high-density lipoprotein cholesterol levels. Conclusions: Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemic control, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial.

引用

页码：1566 / 1575

页数：10

共 51 条

[41] Impact of high-normal blood pressure on the risk of cardiovascular disease. [J].

Vasan, RS ;

Larson, MG ;

Leip, EP ;

Evans, JC ;

O'Donnell, CJ ;

Kannel, WB ;

Levy, D .

NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (18) :1291-1297

[42] Two-year changes in lipids and lipoproteins associated with the maintenance of a 5% to 10% reduction in initial weight: Some findings and some questions [J].

Wadden, TA ;

Anderson, DA ;

Foster, GD .

OBESITY RESEARCH, 1999, 7 (02) :170-178

[43]

Wadden TA, 2006, OBESITY, V14, P737

[44] One-year Weight Losses in the Look AHEAD Study: Factors Associated With Success [J].

Wadden, Thomas A. ;

West, Delia S. ;

Neiberg, Rebecca H. ;

Wing, Rena R. ;

Ryan, Donna H. ;

Johnson, Karen C. ;

Foreyt, John P. ;

Hill, James O. ;

Trence, Dace L. ;

Vitolins, Mara Z. .

OBESITY, 2009, 17 (04) :713-722

[45] Sodium reduction and weight loss in the treatment of hypertension in older persons - A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE) [J].

Whelton, PK ;

Appel, LJ ;

Espeland, MA ;

Applegate, WB ;

Ettinger, WH ;

Kostis, JB ;

Kumanyika, S ;

Lacy, CR ;

Johnson, KC ;

Folmar, S ;

Cutler, JA .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 279 (11) :839-846

[46] Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure - The trials of hypertension prevention, phase II [J].

Whelton, PK ;

Appel, L ;

Charleston, J ;

Dalcin, A ;

Haythornthwaite, J ;

Rosofsky, W ;

Wanek, K ;

Walker, G ;

Oberman, A ;

Bragg, C ;

Fouad, M ;

Krekeler, Y ;

Owens, A ;

Raczynski, J ;

Raines, J ;

Smith, D ;

Bolt, RJ ;

Belden, L ;

Salonga, A ;

Guly, T ;

Millstone, M ;

Smith, T ;

Salonga, J ;

Jones, DW ;

Hinton, LA ;

King, N ;

Kirchner, KA ;

Sadler, C ;

Payne, T ;

Adair, C ;

Russell, C ;

Graham, J ;

Isaacs, I ;

Cameron, ME ;

Satterfield, S ;

Applegate, WB ;

Bottom, J ;

Brewer, A ;

Coday, M ;

Jensen, B ;

Miller, C ;

Miller, ST ;

Randle, J ;

Randolph, LG ;

Slawson, D ;

Sousoulas, B ;

Sullivan, J ;

Lasser, NL ;

Lasser, VI ;

Batey, DM .

ARCHIVES OF INTERNAL MEDICINE, 1997, 157 (06) :657-667

[47]

Wing R.R., 2004, HDB OBESITY CLIN APP, V2nd

[48] LONG-TERM EFFECTS OF MODEST WEIGHT-LOSS IN TYPE-II DIABETIC-PATIENTS [J].

WING, RR ;

KOESKE, R ;

EPSTEIN, LH ;

NOWALK, MP ;

GOODING, W ;

BECKER, D .

ARCHIVES OF INTERNAL MEDICINE, 1987, 147 (10) :1749-1753

[49]

WING RR, 1995, INT J OBESITY, V19, P67

[50]

WING RR, 1988, DIABETOLOGIA, V31, P902

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