Utility of anthropometric indicators to screen for clustered cardiometabolic risk factors in children and adolescents

2019 ◽  
Vol 32 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Teresa Maria Bianchini de Quadros ◽  
Alex Pinheiro Gordia ◽  
Alynne Christian Ribeiro Andaki ◽  
Edmar Lacerda Mendes ◽  
Jorge Mota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Screening Tools ◽  
Northeastern Brazil ◽  
Lipoprotein Cholesterol ◽  
Anthropometric Indicators ◽  
Significant Difference

Abstract Background Anthropometric indicators are associated with cardiometabolic risk factors (CMRF), but there is no consensus as to which indicator is the most suitable to screen for clustered CMRF. This study aimed to evaluate the utility of five anthropometric indicators to screen for clustered CMRF in children and adolescents. Methods A cross-sectional study was conducted in 1139 schoolchildren aged 6–17 years from Northeastern Brazil. Body weight, height, waist circumference (WC) and subscapular (SSF) and triceps skinfold thickness (TSF) were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The following CMRF were evaluated: elevated total cholesterol, low high-density lipoprotein-cholesterol (HDL-C), elevated low-density lipoprotein-cholesterol (LDL-C), high triglyceride concentration, hyperglycemia and high blood pressure. The participants were categorized into no CMRF, 1 CMRF, 2 CMRF and ≥3 CMRF. Receiver operating characteristic (ROC) curves were constructed to assess the accuracy of the anthropometric indicators in predicting CMRF for age group and sex. Results Poor associations were observed between the anthropometric indicators and 1 CMRF (accuracy of 0.49–0.64). The indicators showed moderate associations with 2 CMRF (accuracy of 0.57–0.75) and ≥3 CMRF (accuracy of 0.59–0.79). In general, TSF exhibited the worst performance in predicting CMRF, followed by WHtR. The highest accuracies were observed for BMI, WC and SSF, with no significant difference between these indicators. Conclusions The routine use of BMI, WC and SSF as epidemiological screening tools for clustered CMRF in childhood and adolescence should be encouraged.

Cardiometabolic risk factors in children and adolescents from southern Brazil: comparison to international reference values

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Letícia Welser ◽  
Rodrigo Antunes Lima ◽  
João Francisco Silveira ◽  
Lars Bo Andersen ◽  
Karin Allor Pfeiffer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Risk Score ◽  
Reference Values ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol ◽  
International Reference ◽  
The Metabolic Syndrome

Abstract Objectives To compare cardiometabolic risk factors of Brazilian children and adolescents with international reference values. Cardiometabolic risk factors constitute the Metabolic Syndrome, whose evaluation is important to assess pediatric populations’ health and potential to experience metabolic disorders. Methods Cross-sectional study that included 2,250 randomly selected children and adolescents (55.6% girls), aged 6 to 17. Cardiometabolic parameters (body mass index [BMI], waist circumference [WC], systolic and diastolic blood pressures [SBP and DBP], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], TC:HDL-C ratio, triglycerides [TG], glucose and peak oxygen uptake [VO2peak]), and clustered risk scores were compared to international age- and sex-specific reference values. A clustered risk score was calculated by summing the WC, glucose, SBP, TG, and the TC:HDL-C ratio Z-scores divided by five. A second clustered was calculated including VO2peak (inverted) Z-score, but divided by six. Results The clustered risk score, considering the all ages sample, was better in the Brazilian boys (−0.20 [−0.41;0.01] and −0.18 [−0.37;0.01], including or not VO2peak, respectively) but not significantly, and worse in girls (0.24 [0.05;0.43] and 0.28 [0.11;0.44], including or not VO2peak, respectively) than the international reference. Additionally, Brazilian youth had a statistically better profile in TC, LDL-C, HDL-C, TC:HDL-C ratio, and VO2peak (only girls) as well as a worse profile in BMI, WC, SBP, DBP, TG (only girls), and VO2peak (only boys). Conclusions The clustered cardiometabolic risk score (including or not VO2peak), considering the all ages sample, was better in the Brazilian boys, but not significantly, and worse in girls compared to the international reference.

Assessment of the correlation between the atherogenic index of plasma and cardiometabolic risk factors in children and adolescents: might it be superior to the TG/HDL-C ratio?

2017 ◽  
Vol 30 (9) ◽  
Author(s):  
Nalan Hakime Nogay
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Strong Correlation ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Atherogenic Index ◽  
Fasting Period ◽  
Atherogenic Index Of Plasma ◽  
The Mean

AbstractBackground:Most of the studies investigating the correlation between the atherogenic index of plasma (AIP) and cardiometabolic risk factors have been conducted with adults, while only a limited number of related studies that involved children and adolescents has been conducted. The purpose of this study is to assess the correlation between the AIP and other cardiometabolic risk factors in adolescents.Methods:This study was conducted with 310 girls and 90 boys who were between the ages of 6 and 18 years. After a 10-h fasting period, the biochemical values of the participants were measured in the morning. The anthropometric measurements of the participants were also taken. The AIP was calculated as Log10 (triglycerides/high density lipoprotein-cholesterol; TG/HDL-C).Results:In adolescents between the ages of 12 and 18, the mean AIP of the group with TG ≥130 mg/dL was significantly higher than that of the groups with TG of 90–129 mg/dL and <90 mg/dL. There was a strong correlation between TG and AIP for both boys and girls among the children and adolescents, while there was a strong correlation between the TG/HDL-C ratio and TG only in the boys who were within the 6–11-year-old age group.Conclusions:An increase in AIP is associated with cardiovascular risk factors in children and adolescents other than those seen in adults. Based on the TG/HDL-C ratio, the AIP may be superior as a complementary index in the assessment of cardiometabolic risks in children and adolescents.

scholarly journals Nutritional Status and Cardiometabolic Risk Factors in Institutionalized Adults with Cerebral Palsy

Medicina ◽  
2019 ◽  
Vol 55 (5) ◽  
pp. 157 ◽  
Author(s):  
Aurora Norte ◽  
Coral Alonso ◽  
José Miguel Martínez-Sanz ◽  
Ana Gutierrez-Hervas ◽  
Isabel Sospedra
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cerebral Palsy ◽  
Nutritional Status ◽  
Cardiometabolic Risk ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol

Background and Objectives: Cerebral palsy (CP) is a set of permanent disorders that limit physical activity and increase the risk of developing other diseases, such as metabolic syndrome (MS). Adequate nutrition can contribute to the prevention of associated symptoms. The main objective of this study is to evaluate the nutritional status and the prevalence of cardiometabolic risk factors in adults with CP and Gross Motor Function Classification System (GMFCS) levels between IV and V. Materials and Methods: A sample of 41 adults with CP and GMFCS levels from IV to V were studied. The variables used in the study were age, sex, weight, height, mean age, and GMFCS level range. To evaluate nutritional status, body mass index and the Mini Nutritional Assessment (MNA), a nutritional screening tool, were used. To assess cardiometabolic risk, data on obesity, central obesity, blood pressure, fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were collected. Results: More than 80% of the population studied was malnourished or at risk of malnutrition, according to the MNA tool classification ranges, and around 35% of the studied population was within the underweight range. Regarding cardiometabolic risk factors, only one adult with CP was diagnosed with MS. Conclusions: The studied population of adults with CP and GMFCS levels between IV and V is not a population at risk of MS; however, the high prevalence of malnutrition, as well as some of the most prevalent cardiovascular risk factors, should be taken into consideration.

Clustering of Cardiometabolic Risk Factors among Children and Adolescents in a Rural Community in Ondo, Southwest Nigeria

2019 ◽  
Vol 66 (4) ◽  
pp. 366-376
Author(s):  
Akinwumi Ayodeji Akinbodewa ◽  
Ademola Oluseyi Adejumo ◽  
Oluwakemi Abiola Lamidi ◽  
Ogunleye Adeyemi
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Children And Adolescents ◽  
Cardiovascular Health ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Serum Levels ◽  
High Serum ◽  
Cardiometabolic Risk Factors ◽  
Cross Sectional

Abstract Background Clustering of cardiometabolic risk factors is rapidly becoming prevalent among children and adolescents with grave implications for their cardiovascular health. We set out to determine prevalence and pattern of clustering of risk factors and, identify factors (if any) that determine their clustering. Methods A cross-sectional study of children (3–9 years) and adolescents (10–17 years) in a rural, agrarian community. Their blood pressure, body mass index and lipids were measured. Data was analyzed with SPSS 20. Results A total of 114 (M : F, 1 : 1.1) subjects were studied. The mean age of children and adolescents were 5.6 ± 2.1 and 12.9 ± 2.2 years respectively. The most prevalent cardiometabolic risk factors were elevated non-high density lipoprotein-cholesterol (HDL-c; 39.5%), low HDL-c (33.3%), prehypertension (12.3%) and overweight (9.6%). The prevalence of hypertension was higher among females (11.9% vs. 1.8%, p = 0.024) and adolescents (13.2% vs. 1.6%, p = 0.037). Serum levels of non-HDL-c was higher among adolescents than children (50.9% vs. 29.5%, p = 0.013). At least one risk factor was present in 68.4% of the subjects. Clustering of two and three risk factors were present in 18.4% and 6.1%. The presence of prehypertension (χ2 23.93, p &lt; .001), hypertension (χ2 12.19, p = 0.002), high serum non-HDL-c (χ2 6.336, p = 0.011) and high serum total cholesterol (TC; χ2 8.810, p &lt; 0.001) were associated with clustering of cardiometabolic risk factors. Conclusion The burden of cardiometabolic risk factors among children and adolescents is high. Identified determinants of risk factor clustering were prehypertension, hypertension, non-HDL-c and TC.

scholarly journals Prevalence of Selected Cardiometabolic Risk Factors in The Global ART-Naïve HIV Infected Population: A Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Peter Vanes Ebasone ◽  
Nasheeta Peer ◽  
Anastase Dzudie ◽  
Andre Pascal Kengne
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiometabolic Risk ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol ◽  
People Living With Hiv ◽  
Cardiometabolic Diseases ◽  
Increased Risk

Abstract Background People living with HIV/AIDS (PLHIV) are at increased risk of cardiometabolic diseases attributable to the effects of the virus, antiretroviral therapy (ART) and traditional risk factors found in the general population. Most studies have focused on assessing the effect of ART on cardiometabolic disease in PLHIV with fewer studies assessing the cardiometabolic risk profile prior to any exposure to ART. Therefore, this protocol is for a systematic review and meta-analysis to estimate the global prevalence of selected cardiometabolic risk factors in ART-naïve PLHIV and their association with HIV specific factors. Methods We shall conduct a systematic search of published literature for observational studies on the prevalence of obesity, hypertension, diabetes and dyslipidaemia (high Low-Density Lipoprotein Cholesterol, high Total Cholesterol, high Triglyceride, low High-Density Lipoprotein Cholesterol) in ART-naïve PLHIV and their association with HIV specific characteristics. We will search PubMed-MEDLINE, CINAHL, SCOPUS, Academic Search Premier, Africa-Wide Information and Africa Journals Online databases to identify relevant studies published before March 2021. Two authors will independently screen, select studies, extract data and conduct risk of bias assessments. Disagreements between the two authors will be resolved by consensus or consulting a third reviewer. Data consistently reported across studies will be pooled using random-effects meta-analysis. Heterogeneity will be evaluated using Cochrane’s Q statistic and quantified using I2 statistics. The Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines are used for the reporting of this systematic review protocol. Discussion This review will help determine the burden of selected cardiometabolic diseases in ART-naïve HIV-infected populations and the contribution of HIV infection, independent of ART, to cardiometabolic diseases in PLHIV. It will provide new information that can help orientate future research and potentially guide healthcare policy making. This is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine with protocol ethical clearance number (UCT HREC 350/2021). Registration PROSPERO: CRD42021226001

scholarly journals Waist circumference and low high-density lipoprotein cholesterol as markers of cardiometabolic risk in Kenyan adults

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247600
Author(s):  
Daniel Faurholt-Jepsen ◽  
Henrik Friis ◽  
David L. Mwaniki ◽  
Michael K. Boit ◽  
Lydia U. Kaduka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Waist Circumference ◽  
High Density Lipoprotein ◽  
Lipid Profile ◽  
Hepatic Steatosis ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
High Density ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol

Background Abdominal obesity predict metabolic syndrome parameters at low levels of waist circumference (WC) in Africans. At the same time, the African lipid profile phenotype of low high-density lipoprotein (HDL) cholesterol without concomitant elevated triglyceride levels renders high triglyceride levels detrimental to cardiometabolic health unsuitable for identifying cardiometabolic risk in black African populations. Objectives We aimed to identify simple clinical measures for cardiometabolic risk based on WC and HDL in an adult Kenyan population in order to determine which of the two predictors had the strongest impact. Methods We used linear regression analyses to assess the association between the two exposure variables WC and HDL with cardiometabolic risk factors including ultrasound-derived visceral (VAT) and subcutaneous adipose tissue (SAT) accumulation, fasting and 2-h venous glucose, fasting insulin, fasting lipid profile, and blood pressure in adult Kenyans (n = 1 370), and a sub-population with hyperglycaemia (diabetes and pre-diabetes) (n = 196). The same analyses were performed with an interaction between WC and HDL to address potential effect modification. Ultrasound-based, semi-quantitative hepatic steatosis assessment was used as a high-risk measure of cardiometabolic disease. Results Mean age was 38.2 (SD 10.7) (range 17–68) years, mean body mass index was 22.3 (SD 4.5) (range 13.0–44.8) kg/m2, and 57.8% were women. Cardiometabolic risk was found in the association between both WC and HDL and all outcome variables (p<0.05) except for HDL and SAT, fasting and 2-h venous glucose. Additive cardiometabolic risk (WC and HDL interaction) was found for SAT, low-density lipoprotein cholesterol, and triglycerides. No differences in the association between WC and HDL and the outcome variables were found when comparing the full study population and the hyperglycaemia sub-population. Increase in WC and HDL were both associated with hepatic steatosis (OR 1.09, p<0.001, and OR 0.46, p = 0.031, respectively). Conclusion In adult Kenyans, increasing WC identified more cardiometabolic risk factors compared to HDL.

scholarly journals Patterns of Weight Change One Year after Delivery Are Associated with Cardiometabolic Risk Factors at Six Years Postpartum in Mexican Women

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 170 ◽  
Author(s):  
Diana C. Soria-Contreras ◽  
Belem Trejo-Valdivia ◽  
Alejandra Cantoral ◽  
María Luisa Pizano-Zárate ◽  
Andrea A. Baccarelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Weight Change ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol ◽  
Postpartum Weight ◽  
One Year

Pregnancy is a contributor to the obesity epidemic in women, probably through postpartum weight retention (PPWR), weight gain (PPWG), or a combination of both (PPWR + WG). The contribution of these patterns of postpartum weight change to long-term maternal health remains understudied. In a secondary analysis of 361 women from the prospective cohort PROGRESS, we evaluated the associations between patterns of weight change one year after delivery and cardiometabolic risk factors at six years postpartum. Using principal component analysis, we grouped cardiometabolic risk factors into: (1) body mass index (BMI), waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and glucose; (2) systolic (SBP) and diastolic blood pressure (DBP); and (3) low-density lipoprotein cholesterol and total cholesterol. Using path analysis, we studied direct (patterns of weight change-outcomes) and indirect associations through BMI at six years postpartum. Around 60% of women returned to their pregestational weight (reference) by one year postpartum, 6.6% experienced PPWR, 13.9% PPWG, and 19.9% PPWR + WG. Women with PPWR + WG, vs. the reference, had higher BMI and WC at six years (2.30 kg/m2, 95% CI [1.67, 2.93]; 3.38 cm [1.14, 5.62]). This was also observed in women with PPWR (1.80 kg/m2 [0.80, 2.79]; 3.15 cm [−0.35, 6.65]) and PPWG (1.22 kg/m2 [0.53, 1.92]; 3.32 cm [0.85, 5.78]). PPWR + WG had a direct association with HOMA-IR (0.21 units [0.04, 0.39]). The three patterns of weight change, vs. the reference, had significant indirect associations with HOMA-IR, glucose, TG, HDL-c, SBP, and DBP through BMI at six years. In conclusion, women with PPWR + WG are at high-risk for obesity and insulin resistance. Interventions targeting women during pregnancy and the first year postpartum may have implications for their long-term risk of obesity and cardiovascular disease.

scholarly journals Effects of an Indoor Cycling Program on Cardiometabolic Factors in Women with Obesity vs. Normal Body Weight

2020 ◽  
Vol 17 (23) ◽  
pp. 8718
Author(s):  
Marzena Ratajczak ◽  
Damian Skrypnik ◽  
Piotr Krutki ◽  
Joanna Karolkiewicz
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Total Cholesterol ◽  
Cardiometabolic Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Normal Body Weight

The study aimed to provide evidence on the impact of indoor cycling (IC) in reducing cardiometabolic risk factors. The study compares the effects of a 3 month IC program involving three 55 min sessions per week on women aged 40–60 years, with obesity (OW, n = 18) vs. women with normal body weight (NW, n = 8). At baseline and at the end of the study, anthropometric parameters, oxygen uptake (VO2 peak), and serum parameters: glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), insulin, human anti-oxidized low-density lipoprotein antibody (OLAb), total blood antioxidant capacity (TAC), thiobarbituric acid reactive substances (TBARS), endothelial nitric oxide synthase (eNOS), C-reactive protein (CRP), lipid accumulation product (LAP), and homeostasis model assessment of insulin resistance index (HOMA IR) were determined. Before the intervention, VO2 peak and HDL-C levels were significantly lower and levels of TG, LAP, insulin, HOMA-IR, and CRP were significantly higher in the OW group compared to those in the NW group. After the intervention, only the OW group saw a decrease in body mass, total cholesterol, OLAb, TBARS, and CRP concentration and an increase in total body skeletal muscle mass and HDL-C concentration. In response to the IC training, measured indicators in the OW group were seen to approach the recommended values, but all between-group differences remained significant. Our results demonstrate that IC shows promise for reducing cardiometabolic risk factors, especially dyslipidemia. After 12 weeks of regular IC, the metabolic function of the OW group adapted in many aspects to be more like that of the NW group.

scholarly journals Prenatal Lead Exposure, Type 2 Diabetes, and Cardiometabolic Risk Factors in Mexican Children at Age 10–18 Years

2019 ◽  
Vol 105 (1) ◽  
pp. 210-218 ◽  
Author(s):  
Yun Liu ◽  
Adrienne S Ettinger ◽  
Martha Téllez-Rojo ◽  
Brisa N Sánchez ◽  
Zhenzhen Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Prenatal Exposure ◽  
Lead Exposure ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Public Hospitals ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol

Abstract Context Several cross-sectional studies have assessed the association of lead exposure with type 2 diabetes and cardiometabolic risk factors in adults; however, studies of such associations in childhood are rare. Objective We assessed the prospective associations of prenatal exposure to lead with type 2 diabetes and cardiometabolic risk factors in children. Design The Early Life Exposure in Mexico to Environmental Toxicants is a birth cohort study of pregnant women and their offspring. Setting Public hospitals in Mexico City. Patients or Other Participants Women were recruited during pregnancy; their offspring were recruited for a follow-up visit at age 10 to 18 years (n = 369). Main Outcome Measures We measured fasting serum markers of type 2 diabetes and cardiometabolic risk factors in children, including fasting glucose, insulin, and lipids. The index of insulin resistance was calculated. Results The geometric mean of maternal blood lead levels (BLLs) during pregnancy was 4.3 µg/dL (95% confidence interval [CI]): 4.0-4.6 µg/dL) in the entire sample. In boys, those with maternal BLLs ≥ 5 µg/dL (compared with those with BLLs &lt; 5 µg/dL) had significantly lower z scores for total cholesterol (β = -0.41, 95% CI: -0.71, -0.12), high-density lipoprotein cholesterol (β = -0.32, 95% CI: -0.59, -0.05), and low-density lipoprotein cholesterol (β = -0.52, 95% CI: -0.81, -0.22), adjusting for covariates. No associations were detected in girls. Conclusions In our study, we found that higher prenatal exposure to lead was associated with lower levels of cholesterol in children following a sex-specific pattern. Further studies with a larger sample size that examine whether sex is a potential modifier are needed to confirm our findings.

scholarly journals Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors

Circulation ◽  
2021 ◽  
Vol 143 (12) ◽  
pp. 1202-1214
Author(s):  
Christoph Höchsmann ◽  
James L. Dorling ◽  
Corby K. Martin ◽  
Robert L. Newton ◽  
John W. Apolzan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Usual Care ◽  
Usual Care Group ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Mean Difference ◽  
Cardiometabolic Risk Factors ◽  
Lipoprotein Cholesterol ◽  
Care Group

Background: Intensive lifestyle interventions (ILIs) are the first-line approach to effectively treat obesity and manage associated cardiometabolic risk factors. Because few people have access to ILIs in academic health centers, primary care must implement similar approaches for a meaningful effect on obesity and cardiometabolic disease prevalence. To date, however, effective lifestyle-based obesity treatment in primary care is limited. We examined the effectiveness of a pragmatic ILI for weight loss delivered in primary care among a racially diverse, low-income population with obesity for improving cardiometabolic risk factors over 24 months. Methods: The PROPEL trial (Promoting Successful Weight Loss in Primary Care in Louisiana) randomly allocated 18 clinics equally to usual care or an ILI and subsequently enrolled 803 (351 usual care, 452 ILI) adults (67% Black, 84% female) with obesity from participating clinics. The usual care group continued to receive their normal primary care. The ILI group received a 24-month high-intensity lifestyle-based obesity treatment program, embedded in the clinic setting and delivered by health coaches in weekly sessions initially and monthly sessions in months 7 through 24. Results: As recently demonstrated, participants receiving the PROPEL ILI lost significantly more weight over 24 months than those receiving usual care (mean difference, −4.51% [95% CI, −5.93 to −3.10]; P <0.01). Fasting glucose decreased more in the ILI group compared with the usual care group at 12 months (mean difference, −7.1 mg/dL [95% CI, −12.0 to −2.1]; P <0.01) but not 24 months (mean difference, −0.8 mg/dL [95% CI, −6.2 to 4.6]; P =0.76). Increases in high-density lipoprotein cholesterol were greater in the ILI than in the usual care group at both time points (mean difference at 24 months, 4.6 mg/dL [95% CI, 2.9–6.3]; P <0.01). Total:high-density lipoprotein cholesterol ratio and metabolic syndrome severity ( z score) decreased more in the ILI group than in the usual care group at both time points, with significant mean differences of the change of −0.31 (95% CI, −0.47 to −0.14; P <0.01) and −0.21 (95% CI, −0.36 to −0.06; P =0.01) at 24 months, respectively. Changes in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and blood pressure did not differ significantly between groups at any time point. Conclusions: A pragmatic ILI consistent with national guidelines and delivered by trained health coaches in primary care produced clinically relevant improvements in cardiometabolic health in an underserved population over 24 months. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02561221.

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