The Association of Prior Intensive Lifestyle Intervention and Diabetes Support and Education with Frailty Prevalence at Long-Term Follow-up in the Action for Health in Diabetes Extension Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab312 ◽

2021 ◽

Author(s):

Sara E Espinoza

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Lifestyle Intervention ◽

Frailty Phenotype ◽

Intensive Lifestyle Intervention ◽

Look Ahead ◽

Long Term Follow Up ◽

Overweight Or Obesity

Abstract Background Frailty is common in older adults with obesity and diabetes. We compared prevalence of the frailty phenotype between intervention groups in long-term follow-up of Look AHEAD, a randomized trial comparing a multidomain intensive lifestyle intervention (ILI) that promoted weight loss and physical activity with a diabetes support and education (DSE) control group in adults with type 2 diabetes and overweight or obesity. Methods Participants included 2,979 individuals randomized to ILI or DSE in 2001-04 who completed frailty assessment in Look AHEAD - Extension Wave 1 (2016-2018) at average age of 72.1 ± 6.2 years. Frailty was assessed using a modified frailty phenotype (excluding weight loss) defined as the presence of 3 or more of: weakness, slow gait speed, low physical activity, and exhaustion. Frailty odds by intervention assignment (DSE vs. ILI) were estimated using multivariable logistic regression, adjusting for sex, clinic site, and time since randomization. Results At median follow-up of 14.0 years [IQR: 13.8-14.1], frailty prevalence was 10.9% in ILI compared with 11.6% in DSE (odds ratio for frailty in ILI vs. DSE =0.94, 95% confidence interval = 0.75-1.18, P =0.60). Frailty was more prevalent in participants who were older, female, non-white, of lower socioeconomic status, and at baseline had a higher BMI and waist circumference, longer duration of diabetes, history of CVD, and metabolic syndrome. Conclusions Prior randomization to ILI compared with DSE was not associated with a lower prevalence of frailty after a median follow-up of 14.0 years in adults with diabetes and overweight or obesity.

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Abstract 14192: Breakfast Consumption is Associated With Weight Loss During an Intensive Lifestyle Intervention for Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Look AHEAD Trial

Circulation ◽

10.1161/circ.142.suppl_3.14192 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Daisy Duan ◽

Scott J Pilla ◽

Jeanne M Clark ◽

Nisa M Maruthur

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Lifestyle Intervention ◽

Caloric Intake ◽

Activity Level ◽

Breakfast Consumption ◽

Intensive Lifestyle Intervention ◽

Look Ahead

Background: Breakfast skipping is linked to obesity and related cardiometabolic outcomes in observational studies, but the association between breakfast eating and weight loss is not well-established. We examined if weight loss outcomes in Look AHEAD were related to breakfast consumption frequency (BCF). Methods: We included a subset of participants (n=3862) from the public access dataset of Look AHEAD, an RCT that compared intensive lifestyle intervention (ILI) to diabetes support and education (DSE) control in adults with overweight/obesity and type 2 diabetes. A self-reported questionnaire collected BCF over a 7-day week annually. This value (0-7) was averaged across 4 years of the intervention to calculate an average BCF. We used robust multivariable linear regression analysis to estimate the association between % weight change and 4-year average BCF controlling for baseline sociodemographics, BMI, and diabetes-related variables. In separate models, we adjusted for self-reported caloric intake (n=880) and self-reported physical activity level (n=735) among those with data. Results: 4-year average BCF was similar in DSE (n=1914) and ILI (n=1948) arms, with a median of 7 days (IQR 6-7) for both arms (p=0.11). Each 1 day increase in average BCF was associated with an additional 0.43% weight loss in the ILI arm (p=0.002) but not in the DSE arm (β-coefficient 0.04% weight loss; p=0.73; p-interaction for arm x BCF=0.01). This association in the ILI arm remained significant after adjustment for daily caloric intake (p=0.04) but not after adjustment for physical activity (p=0.16). Conclusions: Breakfast consumption was associated with greater weight loss in subjects who received ILI, which was attenuated after adjustment for caloric intake and physical activity. To optimize weight loss interventions, the relationship between breakfast consumption and other weight loss behaviors should be further explored.

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Influence of exercise amount and intensity on long-term weight loss maintenance and skeletal muscle mitochondrial ROS production in humans

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2018-0577 ◽

2019 ◽

Vol 44 (9) ◽

pp. 958-964

Author(s):

Steen Larsen ◽

Sune Dandanell ◽

Kasper Birch Kristensen ◽

Sofie Drevsholt Jørgensen ◽

Flemming Dela ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Lifestyle Intervention ◽

Physical Activity Level ◽

Activity Level ◽

Ros Production ◽

Respiratory Capacity ◽

Mitochondrial Respiratory

Sustaining a weight loss after a lifestyle intervention is challenging. The objective of the present study was to investigate if mitochondrial function is associated with the ability to maintain a weight loss. Sixty-eight former participants in an 11–12-week lifestyle intervention were recruited into 2 groups; weight loss maintenance (WLM; body mass index (BMI): 32 ± 1 kg/m2) and weight regain (WR; BMI: 43 ± 2 kg/m2) based on weight loss measured at a follow-up visit (WLM: 4.8 ± 0.4; WR: 7.6 ± 0.8 years after lifestyle intervention). Maximal oxygen consumption rate, physical activity level, and blood and muscle samples were obtained at the follow-up experiment. Mitochondrial respiratory capacity and reactive oxygen species (ROS) production were measured. Fasting blood samples were used to calculate glucose homeostasis index. WR had impaired glucose homeostasis and decreased maximal oxygen uptake and physical activity level compared with WLM. The decreased physical activity in WR was due to a lower activity level at vigorous and moderate intensities. Mitochondrial respiratory capacity and citrate synthase (CS) activity was higher in WLM, but intrinsic mitochondrial respiratory capacity (mitochondrial respiratory capacity corrected for mitochondrial content (CS activity)) was similar. ROS production was higher in WR compared with WLM, which was accompanied by a decreased content of antioxidant proteins in WR. Intrinsic mitochondrial respiratory capacity in skeletal muscle is not associated with the ability to maintain a long-term weight loss. WLM had a higher maximal oxygen uptake, physical activity level, mitochondrial respiratory capacity and CS activity compared with WR. The reduced glucose tolerance was concurrent with increased ROS production per mitochondria in WR, and could also be associated with the lower physical activity level in this group.

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Long-term follow-up of an 8 week weight loss intervention: Impact of psychosocial factors

10.31274/etd-180810-126 ◽

2012 ◽

Author(s):

Sarah Davis

Keyword(s):

Weight Loss ◽

Psychosocial Factors ◽

Weight Loss Intervention ◽

Long Term Follow Up ◽

Intervention Impact

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564-P: Long-Term Follow-up of Glycemic Excursion Minimization (GEM) Compared with Weight Loss in Management of Type 2 Diabetes (T2D)

Diabetes ◽

10.2337/db21-564-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 564-P

Author(s):

DANIEL COX ◽

MATTHEW A. MONCRIEF ◽

ANTHONY L. MCCALL

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Long Term Follow Up

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Long-term follow-up and objective physical activity measurements of community-based physical interventions in adults: a systematic review and meta-analysis

The Lancet ◽

10.1016/s0140-6736(19)32893-4 ◽

2019 ◽

Vol 394 ◽

pp. S96

Author(s):

Charlotte Wahlich ◽

Umar A R Chaudhry ◽

Rebecca Fortescue ◽

Derek G Cook ◽

Shashi Hirani ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Meta Analysis ◽

Community Based ◽

Activity Measurements ◽

Long Term Follow Up

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Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Neurology ◽

10.1212/wnl.0000000000003955 ◽

2017 ◽

Vol 88 (21) ◽

pp. 2026-2035 ◽

Cited By ~ 31

Author(s):

Mark A. Espeland ◽

José A. Luchsinger ◽

Laura D. Baker ◽

Rebecca Neiberg ◽

Steven E. Kahn ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Lifestyle Intervention ◽

Cognitive Test ◽

Intervention Effect ◽

Intensive Lifestyle Intervention

Objective:To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.Methods:Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.Results:Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5–13.5) years after enrollment, when participants' mean age was 69.6 (54.9–87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.Conclusions:Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.Clinicaltrials.gov identifier:NCT00017953 (Action for Health in Diabetes).Level of evidence:This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.

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