Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes

Original Research

¹Department of Psychiatry & Human Behavior, Brown Medical School, The Miriam Hospital, Providence, Rhode Island
²Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
³Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
⁴Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
⁵Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
⁶Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
⁷Centers for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado
⁸Department of Medicine, Johns Hopkins University, Baltimore, Maryland
⁹Roybal Comprehensive Health Center, Los Angeles, California

Diabetes Care 2011 Jul; 34(7): 1481-1486. https://doi.org/10.2337/dc10-2415

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Figure 1
Change in risk factors by weight loss categories for the Look AHEAD cohort. Data in all figures are presented as least square means and 95% CIs adjusted for clinical sites, age, sex, race/ethnicity, baseline weight, baseline measurement of the outcome variable, and treatment group assignment.

Table 1

Baseline characteristics by weight change category

	Total sample	Gained >2%	Stable Gained ≤2 or lost <2%	Lost ≥2 to <5%	Lost ≥5 to <10%	Lost ≥10 to <15%	Lost ≥15%	P
n	5,145	683	1,289	914	1,000	601	412
ILI group	50.1 (2,570)	12.6 (86)	21.2 (273)	47.4 (433)	74.9 (749)	90.9 (546)	94.2 (388)	<0.0001^*
Male	40.5 (2,082)	35.9 (245)	43.0 (554)	39.2 (358)	38.7 (387)	41.4 (249)	47.6 (196)	0.0311^*
Ethnicity								0.1106^*
African American	15.6 (804)	15.7 (107)	17.1 (220)	17.8 (163)	17.2 (172)	11.8 (71)	7.0 (29)
American Indian	5.0 (258)	6.3 (43)	6.6 (85)	6.0 (55)	5.1 (51)	3.0 (18)	0.2 (1)
Hispanic	13.2 (680)	13.9 (95)	11.4 (147)	14.9 (136)	12.2 (122)	15.2 (91)	9.2 (38)
White	63.2 (3,253)	60.3 (412)	61.8 (797)	58.1 (531)	62.7 (627)	67.7 (406)	81.6 (336)
Asian/Pacific Islander/other/mixed	2.9 (149)	3.8 (26)	3.1 (40)	3.2 (29)	2.8 (28)	2.3 (14)	1.9 (8)
Age	58.7 ± 6.8	57.9 ± 6.9	58.6 ± 6.9	58.9 ± 6.7	58.7 ± 6.8	59.6 ± 7.0	58.8 ± 6.7	0.0009^†
Height (cm)	167.2 ± 9.7	166.1 ± 9.7	167.9 ± 9.9	167.0 ± 9.8	167.0 ± 9.5	167.1 ± 9.8	168.7 ± 9.7	0.0001^†
Baseline BMI (kg/m²)	36.0 ± 5.9	36.3 ± 5.8	35.8 ± 5.9	35.8 ± 6.0	35.8 ± 6.1	35.7 ± 5.9	36.7 ± 5.6	0.0028^†
Baseline weight (kg)	100.7 ± 19.3	100.1 ± 18.1	101.0 ± 19.0	100.1 ± 19.5	100.2 ± 20.3	99.8 ± 18.7	104.7 ± 19.1	<0.0001^†

Table 2

Changes in CVD risk factors and association with percentage weight change for the Look AHEAD cohort

	Baseline		Change from baseline to year 1		Spearman correlation of association with percentage weight loss
	n	Mean ± SD	n	Mean ± SD	Total cohort	ILI subjects	DSE subjects
Weight (kg)	5,145	100.71 ± 19.26	4,899	−4.77 ± 7.57^*
SBP (mmHg)	5,082	128.84 ± 17.17	4,837	−4.76 ± 17.05^*	0.20^*	0.19^*	0.14^*
DBP (mmHg)	5,082	70.15 ± 9.57	4,837	−2.40 ± 8.62^*	0.12^*	0.13^*	0.08^*
Glucose	4,999	153.19 ± 45.66	4,603	−14.32 ± 46.08^*	0.27^*	0.21^*	0.14^*
HbA_1c (%)	4,999	7.28 ± 1.17	4,606	−0.39 ± 1.02^*	0.34^*	0.24^*	0.16^*
HDL cholesterol (mg/dL)	4,999	43.48 ± 11.83	4,603	2.39 ± 6.97^*	−0.23^*	−0.26^*	−0.08^*
LDL cholesterol (mg/dL)	4,998	112.31 ± 32.24	4,602	−5.47 ± 28.63^*	−0.004	0.0008	−0.02
Trigylcerides (mg/dL)^†	4,999	153 (108–219)	4,603	−12.0 (−52 to 21)^*	0.26^*	0.31^*	0.16^*

↵*P < 0.0001.
↵†For change in triglycerides, data are median (interquartile range). The signed-rank test was used to test whether the change from baseline to year 1 was different from 0.

Table 3

Odds ratio (95% CI) for the percentage of Look AHEAD cohort achieving clinically meaningful changes in CVD risk factors

Clinical criteria	Gained >2%	Stable Gained ≤2 or lost <2%	Lost ≥2 to <5%	Lost ≥5 to <10%	Lost ≥10 to <15%	Lost ≥15%
5 mmHg decrease in SBP	0.86 (0.70–1.06)	1.0	1.24 (1.02–1.50)	1.56 (1.27–1.91)	2.29 (1.79–2.93)	2.65 (2.00–3.50)
5 mmHg decrease in DBP	1.03 (0.83–1.28)	1.0	1.05 (0.86–1.28)	1.48 (1.20–1.82)	1.60 (1.25–2.06)	2.39 (1.81–3.16)
20 mg/dL decrease in glucose	1.13 (0.87–1.46)	1.0	1.75 (1.40–2.19)	3.24 (2.57–4.09)	4.07 (3.09–5.36)	7.92 (5.78–10.85)
0.05% decrease in HbA_1c	1.17 (0.91–1.50)	1.0	1.80 (1.44–2.24)	3.52 (2.81–4.40)	5.44 (4.15–7.13)	10.02 (7.31–13.73)
5 mg/dL increase in HDL	0.88 (0.71–1.11)	1.0	1.13 (0.93–1.39)	1.69 (1.37–2.07)	2.30 (1.80–2.93)	4.34 (3.30–5.72)
5 mg/dL increase in HDL (not on medications)	0.79 (0.54–1.15)	1.0	0.99 (0.71–1.39)	1.52 (1.08–2.15)	2.54 (1.68–3.82)	5.27 (3.36–8.27)
10 mg/dL decrease in LDL	1.17 (0.95–1.45)	1.0	1.05 (0.86–1.29)	1.34 (1.09–1.64)	1.26 (0.98–1.62)	1.34 (1.02–1.78)
10 mg/dL decrease in LDL (not on medications)	1.39 (0.97–1.99)	1.0	0.97 (0.69–1.36)	1.41 (1.00–2.00)	1.28 (0.83–1.96)	1.52 (0.96–2.41)
40 mg/dL decrease in triglycerides	0.80 (0.60–1.06)	1.0	1.46 (1.14–1.87)	2.20 (1.71–2.83)	3.99 (2.97–5.35)	7.18 (5.19–9.93)