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Al Fatly M, Mulder MT, Roeters van Lennep J, Blom HJ, Berk KAC. The effect of diet-induced weight loss on circulating homocysteine levels in people with obesity and type 2 diabetes. Nutr J 2024; 23:2. [PMID: 38167024 PMCID: PMC10763019 DOI: 10.1186/s12937-023-00908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND/AIMS Having type 2 diabetes (T2D) in combination with being overweight results in an additional increase in cardiovascular disease (CVD) risk. In addition, T2D and obesity are associated with increased levels of total homocysteine (tHcy), possibly contributing to the CVD risk. Weight loss dieting has positive effects on several CVD risk factors, but whether it affects tHcy remains unclear. Therefore, the aim of this study was to determine the effect of a calorie restricted diet on tHcy in overweight people with T2D. METHODS In this post-hoc analysis of the POWER study, adults with T2D and a BMI greater than 27 kg/m² were included from the outpatient diabetes clinic of the Erasmus Medical Center, Rotterdam. The patients were subjected to a very low-calorie diet with fortified meal replacements for 20 weeks. Before and after this intervention, blood samples were collected to measure tHcy and other CVD risk factors like glycaemic and lipid parameters. RESULTS 161 overweight participants with T2D were included, with a mean age of 54 years (range 26-74), mean weight of 104.6 ± 19.9 kg and mean HbA1c of 62.7 ± 14.3 mmol/mol. At baseline, men displayed higher tHcy than women, and tHcy level was positively correlated with body weight and triglyceride levels, while it was negatively correlated with renal function and HDL cholesterol. During the intervention, bodyweight was reduced by a mean of 9.7% (from 104.6 ± 19.9 to 94.5 ± 18.1 kg p < 0.001), and all measured glycaemic and lipid blood parameters improved significantly. However, tHcy remained unchanged (from 12.1 ± 4.1 to 12.1 ± 4.2 umol/L, p = 0.880). The change in tHcy during the intervention was negatively associated with the change in weight and BMI (p = 0.01 and p = 0.008, respectively). People who lost < 10 kg (n = 92) had a mean tHcy change of -0.47 umol/L, while people who lost more than ≥ 10 kg (n = 69) had a mean tHcy change of 0.60 umol/L (p = 0.021). CONCLUSION In conclusion, our data show that a calorie restricted diet does not affect tHcy in people with T2D and obesity, despite the use of meal replacements fortified with folic acid and vitamin B12. Our data showed a negative correlation between change in tHcy levels and weight loss, suggesting that people who lost more weight (> 10 kg) showed an increase in tHcy. Future studies should explore the potential increase in tHcy induced by weight loss dieting and target the question if tHcy reduction strategies during weight loss could be clinically beneficial.
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Affiliation(s)
- Meryem Al Fatly
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeanine Roeters van Lennep
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henk J Blom
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Genetics, Center of lysosomal and metabolic disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kirsten A C Berk
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands.
- Department of Internal Medicine, section of Dietetics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Berk KA, Borgeraas H, Narverud I, Mulder MT, Øyri LKL, Verhoeven AJM, Småstuen MC, Bogsrud MP, Omland T, Hertel JK, Gjevestad E, Nordstrand N, Holven KB, Hjelmesæth J. Differential effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) and fatty acids. Lipids Health Dis 2022; 21:145. [PMID: 36577984 PMCID: PMC9795629 DOI: 10.1186/s12944-022-01756-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Limited evidence suggests that surgical and non-surgical obesity treatment differentially influence plasma Lipoprotein (a) [Lp(a)] levels. Further, a novel association between plasma arachidonic acid and Lp(a) has recently been shown, suggesting that fatty acids are a possible target to influence Lp(a). Here, the effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) were compared, and it was examined whether the effects were mediated by changes in plasma fatty acid (FA) levels. METHODS The study includes two independent trials of patients with overweight or obesity. Trial 1: Two-armed intervention study including 82 patients who underwent a 7-week low energy diet (LED), followed by Roux-en-Y gastric bypass and 52-week follow-up (surgery-group), and 77 patients who underwent a 59-week energy restricted diet- and exercise-program (lifestyle-group). Trial 2: A clinical study including 134 patients who underwent a 20-week very-LED/LED (lifestyle-cohort). RESULTS In the surgery-group, Lp(a) levels [median (interquartile range)] tended to increase in the pre-surgical LED-phase [17(7-68)-21(7-81)nmol/L, P = 0.05], but decreased by 48% after surgery [21(7-81)-11(7-56)nmol/L, P < 0.001]. In the lifestyle-group and lifestyle-cohort, Lp(a) increased by 36%[14(7-77)-19(7-94)nmol/L, P < 0.001] and 14%[50(14-160)-57(19-208)nmol/L, P < 0.001], respectively. Changes in Lp(a) were independent of weight loss. Plasma levels of total saturated FAs remained unchanged after surgery, but decreased after lifestyle interventions. Arachidonic acid and total n-3 FAs decreased after surgery, but increased after lifestyle interventions. Plasma FAs did not mediate the effects on Lp(a). CONCLUSION Bariatric surgery reduced, whereas lifestyle interventions increased plasma Lp(a), independent of weight loss. The interventions differentially influenced changes in plasma FAs, but these changes did not mediate changes in Lp(a). TRIAL REGISTRATION Trial 1: Clinicaltrials.gov NCT00626964. Trial 2: Netherlands Trial Register NL2140 (NTR2264).
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Affiliation(s)
- Kirsten A. Berk
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Dietetics, Erasmus Medical Center, Rotterdam, The Netherlands, Erasmus University MC, Rotterdam, The Netherlands
| | - Heidi Borgeraas
- grid.417292.b0000 0004 0627 3659Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ingunn Narverud
- grid.55325.340000 0004 0389 8485Norwegian National Advisory Unit On Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Monique T. Mulder
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Linn K. L. Øyri
- grid.5510.10000 0004 1936 8921Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Adrie J. M. Verhoeven
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Milada Cvancarova Småstuen
- grid.417292.b0000 0004 0627 3659Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway ,grid.412414.60000 0000 9151 4445Department of Nutrition and Management, Oslo Metropolitan University, Oslo, Norway
| | - Martin P. Bogsrud
- grid.55325.340000 0004 0389 8485Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Omland
- grid.411279.80000 0000 9637 455XDepartment of Cardiology, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921K.G. Jebsen Center of Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens Kristoffer Hertel
- grid.417292.b0000 0004 0627 3659Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Espen Gjevestad
- grid.417292.b0000 0004 0627 3659Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway ,grid.417292.b0000 0004 0627 3659Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway ,grid.446099.60000 0004 0448 0013Norwegian Police University College, Stavern, Norway
| | - Njord Nordstrand
- grid.411279.80000 0000 9637 455XDepartment of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Kirsten B. Holven
- grid.55325.340000 0004 0389 8485Norwegian National Advisory Unit On Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jøran Hjelmesæth
- grid.417292.b0000 0004 0627 3659Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway ,grid.5510.10000 0004 1936 8921Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Development of the Brazilian Version of a Pan-Canadian Behavior Change Program and Its Health and Fitness Outcomes. J Clin Med 2022; 11:jcm11195926. [PMID: 36233793 PMCID: PMC9573575 DOI: 10.3390/jcm11195926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic diseases are a major health problem worldwide, especially in lower-income jurisdictions. Considering this scenario, the World Health Organization has recently established, as a research priority, preventive interventions for populations from lower-income countries, such as the middle-income country of Brazil. The purpose of this article is to describe the components of a pan-Canadian lifestyle program adapted to Brazilians and to report its health and fitness outcomes. A 12-week program called ACCELERATION was translated and culturally adapted to Brazilians. A quasi-randomized controlled trial was designed, consisting of weekly emails and educational videos addressing risk factors for chronic disease. Health and fitness measures included body composition, cardiovascular variables, aerobic fitness, and muscular strength. The Brazilian experimental group showed maintenance in heart rate, blood pressure, and VO2max values while presenting an improvement of 3.3% in body fat percentage (p = 0.040, d = −0.325) and 5.1% in muscular strength (p = 0.039, d = 0.328). Overall, these results were similar to the Canadian intervention. Based on these findings, the Brazilian version of the program has the potential to contribute to the fight against chronic diseases in Brazil.
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Berk KA, Buijks HIM, Verhoeven AJM, Mulder MT, Özcan B, van 't Spijker A, Timman R, Busschbach JJ, Sijbrands EJ. Group cognitive behavioural therapy and weight regain after diet in type 2 diabetes: results from the randomised controlled POWER trial. Diabetologia 2018; 61:790-799. [PMID: 29318342 PMCID: PMC6448975 DOI: 10.1007/s00125-017-4531-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Weight-loss programmes for adults with type 2 diabetes are less effective in the long term owing to regain of weight. Our aim was to determine the 2 year effectiveness of a cognitive behavioural group therapy (group-CBT) programme in weight maintenance after diet-induced weight loss in overweight and obese adults with type 2 diabetes, using a randomised, parallel, non-blinded, pragmatic study design. METHODS We included 158 obese adults (median BMI 36.3 [IQR 32.5-40.0] kg/m2) with type 2 diabetes from the outpatient diabetes clinic of Erasmus MC, the Netherlands, who achieved ≥5% weight loss on an 8 week very low calorie diet. Participants were randomised (stratified by weight loss) to usual care or usual care plus group-CBT (17 group sessions). The primary outcomes were the between-group differences after 2 years in: (1) body weight; and (2) weight regain. Secondary outcomes were HbA1c levels, insulin dose, plasma lipid levels, depression, anxiety, self-esteem, quality of life, fatigue, physical activity, eating disorders and related cognitions. Data were analysed using linear mixed modelling. RESULTS During the initial 8 week dieting phase, the control group (n = 75) lost a mean of 10.0 (95% CI 9.1, 10.9) kg and the intervention group (n = 83) lost 9.2 (95% CI 8.4, 10.0) kg (p = 0.206 for the between-group difference). During 2 years of follow-up, mean weight regain was 4.7 (95% CI 3.0, 6.3) kg for the control group and 4.0 (95% CI 2.3, 5.6) kg for the intervention group, with a between-group difference of -0.7 (95% CI -3.1, 1.6) kg (p = 0.6). The mean difference in body weight at 2 years was -1.2 (95% CI -7.7, 5.3) kg (p = 0.7). None of the secondary outcomes differed between the two groups. CONCLUSIONS/INTERPRETATION Despite increased treatment contact, a group-CBT programme for long-term weight maintenance after an initial ≥5% weight loss from dieting in obese individuals with type 2 diabetes was not superior to usual care alone. TRIAL REGISTRATION Trialregister.nl NTR2264 FUNDING: The study was funded by the Erasmus MC funding programme 'Zorgonderzoek' (grant 2008-8303).
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Affiliation(s)
- Kirsten A Berk
- Section of Pharmacology, Vascular and Metabolic Diseases Section, Department of Internal Medicine, Erasmus MC - Office D435, 's Gravendijkwal 230, PO-Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Hanneke I M Buijks
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Adrie J M Verhoeven
- Section of Pharmacology, Vascular and Metabolic Diseases Section, Department of Internal Medicine, Erasmus MC - Office D435, 's Gravendijkwal 230, PO-Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Monique T Mulder
- Section of Pharmacology, Vascular and Metabolic Diseases Section, Department of Internal Medicine, Erasmus MC - Office D435, 's Gravendijkwal 230, PO-Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Behiye Özcan
- Section of Pharmacology, Vascular and Metabolic Diseases Section, Department of Internal Medicine, Erasmus MC - Office D435, 's Gravendijkwal 230, PO-Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Adriaan van 't Spijker
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Reinier Timman
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Jan J Busschbach
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Eric J Sijbrands
- Section of Pharmacology, Vascular and Metabolic Diseases Section, Department of Internal Medicine, Erasmus MC - Office D435, 's Gravendijkwal 230, PO-Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Berk KA, Yahya R, Verhoeven AJM, Touw J, Leijten FP, van Rossum EF, Wester VL, Lips MA, Pijl H, Timman R, Erhart G, Kronenberg F, Roeters van Lennep JE, Sijbrands EJG, Mulder MT. Effect of diet-induced weight loss on lipoprotein(a) levels in obese individuals with and without type 2 diabetes. Diabetologia 2017; 60:989-997. [PMID: 28386638 PMCID: PMC5423997 DOI: 10.1007/s00125-017-4246-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/20/2017] [Indexed: 12/28/2022]
Abstract
AIMS/HYPOTHESIS Elevated levels of lipoprotein(a) [Lp(a)] are an independent risk factor for cardiovascular disease (CVD), particularly in individuals with type 2 diabetes. Although weight loss improves conventional risk factors for CVD in type 2 diabetes, the effects on Lp(a) are unknown and may influence the long-term outcome of CVD after diet-induced weight loss. The aim of this clinical study was to determine the effect of diet-induced weight loss on Lp(a) levels in obese individuals with type 2 diabetes. METHODS Plasma Lp(a) levels were determined by immunoturbidimetry in plasma obtained before and after 3-4 months of an energy-restricted diet in four independent study cohorts. The primary cohort consisted of 131 predominantly obese patients with type 2 diabetes (cohort 1), all participants of the Prevention Of Weight Regain in diabetes type 2 (POWER) trial. The secondary cohorts consisted of 30 obese patients with type 2 diabetes (cohort 2), 37 obese individuals without type 2 diabetes (cohort 3) and 26 obese individuals without type 2 diabetes who underwent bariatric surgery (cohort 4). RESULTS In the primary cohort, the energy-restricted diet resulted in a weight loss of 9.9% (95% CI 8.9, 10.8) and improved conventional CVD risk factors such as LDL-cholesterol levels. Lp(a) levels increased by 14.8 nmol/l (95% CI 10.2, 20.6). In univariate analysis, the change in Lp(a) correlated with baseline Lp(a) levels (r = 0.38, p < 0.001) and change in LDL-cholesterol (r = 0.19, p = 0.033). In cohorts 2 and 3, the weight loss of 8.5% (95% CI 6.5, 10.6) and 6.5% (95% CI 5.7, 7.2) was accompanied by a median increase in Lp(a) of 13.5 nmol/l (95% CI 2.3, 30.0) and 11.9 nmol/l (95% CI 5.7, 19.0), respectively (all p < 0.05). When cohorts 1-3 were combined, the diet-induced increase in Lp(a) correlated with weight loss (r = 0.178, p = 0.012). In cohort 4, no significant change in Lp(a) was found (-7.0 nmol/l; 95% CI -18.8, 5.3) despite considerable weight loss (14.0%; 95% CI 12.2, 15.7). CONCLUSIONS/INTERPRETATION Diet-induced weight loss was accompanied by an increase in Lp(a) levels in obese individuals with and without type 2 diabetes while conventional CVD risk factors for CVD improved. This increase in Lp(a) levels may potentially antagonise the beneficial cardiometabolic effects of diet-induced weight reduction.
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Affiliation(s)
- Kirsten A Berk
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Reyhana Yahya
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Adrie J M Verhoeven
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Jeanette Touw
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Frank P Leijten
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Elisabeth F van Rossum
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Vincent L Wester
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Mirjam A Lips
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Hanno Pijl
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Reinier Timman
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gertraud Erhart
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, Erasmus Medical Center, Office Ee800, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
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Levels of the soluble LDL receptor-relative LR11 decrease in overweight individuals with type 2 diabetes upon diet-induced weight loss. Atherosclerosis 2016; 254:67-72. [DOI: 10.1016/j.atherosclerosis.2016.09.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 12/31/2022]
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Berk K, Oudshoorn T, Verhoeven A, Mulder M, Roks A, Dik W, Timman R, Sijbrands E. Diet-induced weight loss and markers of endothelial dysfunction and inflammation in treated patients with type 2 diabetes. Clin Nutr ESPEN 2016; 15:101-106. [DOI: 10.1016/j.clnesp.2016.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/27/2016] [Indexed: 01/11/2023]
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Berk KA, Mulder MT, Verhoeven AJM, van Wietmarschen H, Boessen R, Pellis LP, van t Spijker A, Timman R, Ozcan B, Sijbrands EJG. Predictors of Diet-Induced Weight Loss in Overweight Adults with Type 2 Diabetes. PLoS One 2016; 11:e0160774. [PMID: 27494531 PMCID: PMC4975507 DOI: 10.1371/journal.pone.0160774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
AIMS A very low calorie diet improves the metabolic regulation of obesity related type 2 diabetes, but not for all patients, which leads to frustration in patients and professionals alike. The aim of this study was to develop a prediction model of diet-induced weight loss in type 2 diabetes. METHODS 192 patients with type 2 diabetes and BMI>27 kg/m2 from the outpatient diabetes clinic of the Erasmus Medical Center underwent an 8-week very low calorie diet. Baseline demographic, psychological and physiological parameters were measured and the C-index was calculated of the model with the largest explained variance of relative weight loss using backward linear regression analysis. The model was internally validated using bootstrapping techniques. RESULTS Weight loss after the diet was 7.8±4.6 kg (95%CI 7.2-8.5; p<0.001) and was independently associated with the baseline variables fasting glucose (B = -0.33 (95%CI -0.49, -0.18), p = 0.001), anxiety (HADS; B = -0.22 (95%CI -0.34, -0.11), p = 0.001), numb feeling in extremities (B = 1.86 (95%CI 0.85, 2.87), p = 0.002), insulin dose (B = 0.01 (95%CI 0.00, 0.02), p = 0.014) and waist-to-hip ratio (B = 6.79 (95%CI 2.10, 11.78), p = 0.003). This model explained 25% of the variance in weight loss. The C-index of this model to predict successful (≥5%) weight loss was 0.74 (95%CI 0.67-0.82), with a sensitivity of 0.93 (95% CI 0.89-0.97) and specificity of 0.29 (95% CI 0.16-0.42). When only the obese T2D patients (BMI≥30 kg/m2; n = 181) were considered, age also contributed to the model (B = 0.06 (95%CI 0.02, 0.11), p = 0.008), whereas waist-to-hip ratio did not. CONCLUSIONS Diet-induced weight loss in overweight adults with T2D was predicted by five baseline parameters, which were predominantly diabetes related. However, failure seems difficult to predict. We propose to test this prediction model in future prospective diet intervention studies in patients with type 2 diabetes.
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Affiliation(s)
- Kirsten A. Berk
- Department of Internal Medicine, Section Pharmacology Vascular and Metabolic diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, unit of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Monique T. Mulder
- Department of Internal Medicine, Section Pharmacology Vascular and Metabolic diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adrie J. M. Verhoeven
- Department of Internal Medicine, Section Pharmacology Vascular and Metabolic diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Ruud Boessen
- Department of Microbiology & Systems Biology, TNO Zeist, Zeist, The Netherlands
| | - Linette P. Pellis
- Department of Microbiology & Systems Biology, TNO Zeist, Zeist, The Netherlands
| | - Adriaan van t Spijker
- Department of Psychiatry, unit of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, unit of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Behiye Ozcan
- Department of Internal Medicine, Section Pharmacology Vascular and Metabolic diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric J. G. Sijbrands
- Department of Internal Medicine, Section Pharmacology Vascular and Metabolic diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
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Structured hypocaloric diet is more effective than behavioral therapy in reducing metabolic syndrome in Mexican postmenopausal women: a randomized controlled trial. Menopause 2015; 21:711-20. [PMID: 24378762 DOI: 10.1097/gme.0000000000000160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to compare the effects of a lifestyle intervention using a behavioral therapy (BT) approach with the effects of a cardioprotective structured hypocaloric diet on metabolic syndrome in Mexican postmenopausal women. METHODS This study is a randomized clinical trial (2006-2009) of Mexican postmenopausal women with metabolic syndrome (Adult Treatment Panel III criteria) who were recruited from the Postmenopause Clinic of the National Institute of Perinatology in Mexico City. Women were assigned to one of two groups--group 1 (structured hypocaloric diet; n = 63): energy restriction (-300 to -500 kcal/d) emphasizing cardioprotective dietary changes; and group 2 (BT; n = 55): goal setting, problem-solving, and stimulus control to achieve cardioprotective dietary and lifestyle recommendations. Metabolic syndrome prevalence, as well as weight, waist circumference, fat mass, and fasting biochemical markers (glucose and lipid profile), were measured at baseline and at 2, 4, and 6 months after the intervention. Metabolic syndrome risk (relative risk and absolute risk reduction), mean differences between groups, and logistic regression were evaluated using Statistical Package for the Social Sciences software, version 17.0. RESULTS A total of 118 women were studied (mean [SD] age, 53.81 [6.43] y). No baseline differences were observed between groups. At the end of the study, a higher reduction in metabolic syndrome prevalence was observed in group 1 (-38.1%) compared with group 2 (-12.7%; relative risk, 0.237; 95% CI, 0.092-0.608; P = 0.003). The effect was maintained even when adjusted by age, hormone therapy and antihypertensive drug use. CONCLUSIONS A cardioprotective structured hypocaloric diet is more effective than the BT approach in reducing metabolic syndrome after 6 months of intervention. Both strategies have positive effects on different individual cardiovascular risk factors.
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Lou Q, Chen Y, Guo X, Yuan L, Chen T, Wang C, Shen L, Sun Z, Zhao F, Dai X, Huang J, Yang H. Diabetes Attitude Scale: validation in type-2 diabetes patients in multiple centers in China. PLoS One 2014; 9:e96473. [PMID: 24802805 PMCID: PMC4011833 DOI: 10.1371/journal.pone.0096473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/09/2014] [Indexed: 02/05/2023] Open
Abstract
Objective The aim of the paper is to report the development and psychometric testing of Diabetes Attitude Scale. Method A prospective study was performed. The cultural equivalency and content validity of the Diabetes Attitude Scale were determined by panels of endocrinologists, physiologists, nurses and dieticians. An accurate and usable translation was obtained for each of five subscales examining attitudes on need for special training, the seriousness of type-2 diabetes, the need for controlling the condition, its psychosocial impact and the degree of autonomy given to patients in decision making. The validation was derived from 5961 patients with type-2 diabetes, recruited from 50 centers in 29 provinces throughout China between March 1st and September 30th, 2010. Results The modified Diabetes Attitude Scale showed an acceptable level of internal consistency. The strength of the inter-correlations among the domains of five subscales suggests that the instrument measures related but separate domains of patients' attitudes toward diabetes. Moreover, the test-retest intraclass correlation coefficients were high enough to support the stability of the Chinese version of the third version of the scale. Conclusions The psychometric properties of the Chinese version of Diabetes Attitude Scale demonstrated satisfactory validity and reliability and appeared to effectively evaluate attitudes toward diabetes in patients with type-2 diabetes.
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Affiliation(s)
- Qingqing Lou
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu Province, China
- Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, Zhejiang Province, China
| | - Yufeng Chen
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- * E-mail:
| | - Li Yuan
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tao Chen
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chun Wang
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Li Shen
- Peking University First Hospital, Beijing, China
| | - Zilin Sun
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Fang Zhao
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Xia Dai
- First Affiliated Hospital, Guangxi Medical University, Nanning, Jiangsu Province, China
| | - Jin Huang
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Huiying Yang
- The First Affiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China
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