Intervention-specific association of weight variability with major adverse cardiovascular events in overweight or obese adults with type 2 diabetes mellitus

Background

Weight variability is associated with cardiovascular outcomes in diabetic patients. However, the effect of higher weight variability caused by intensive lifestyle intervention (ILI) on cardiovascular outcomes in diabetic patients is not well established. We aimed to evaluate the intervention-specific association between weight variability with major adverse cardiovascular event (MACE) among overweight or obese adults with diabetes.

Methods

In 3,859 participants from the Action for Health in Diabetes (Look AHEAD) trial, multivariate-adjusted Cox regression models were used to evaluate the associations of weight variability measured by variability independent of the mean (VIM) with MACE and secondary outcomes in intensive lifestyle intervention (ILI) and diabetes support & education (DSE) arm, respectively.

Results

During a median follow-up of 9.6 years, 255 (12.9%) participants in the ILI arm and 247 (13.2%) participants in the DSE arm developed MACE. Participants with the highest quartile of weight variability (VIM Q4) experienced a 2.23-fold higher risk of MACE compared with the lowest quartile (VIM Q1) in the DSE arm (hazard ratio [HR] 2.23; 95% CI 1.51–3.30), but not the ILI arm (HR 1.05; 95% CI 0.73–1.50). Moreover, compared with the lowest weight variability (VIM Q1), participants with the highest weight variability (VIM Q4) were not associated with all secondary outcomes in the ILI arm (all P>0.05) but were associated with the higher risks of secondary cardiovascular composite outcome (HR 1.88; 95% CI 1.20–2.95), all-cause mortality (HR 3.19; 95% CI 1.75–5.82), and myocardial infarction (HR 1.95; 95% CI 1.12–3.37) in the DSE arm.

Conclusions

Among the overweight or obese individuals with type 2 diabetes mellitus, rising weight variability was independently associated with increased MACE risks in the DSE arm but not the ILI arm. Therefore, a guideline-recommended ILI strategy for weight loss should be adopted to improve cardiovascular outcomes without considering the effect of high weight variability.

Funding Acknowledgement

Type of funding sources: None.

[Morphological classification of mandible posterior region based on cone beam CT images]

Objective: To classify the morphology of mandible posterior region and provide reference for the planning of dental implantation. Methods: Cone beam CT data of 208 patients were collected. The CT data were imported into CS 3D imaging V3 software and then the morphology of mandible posterior region were analyzed. The types of premolar and molar mandible cross-section morphology were recorded, classified and analyzed. Results: The results showed that type A (vertical type) (79%-96%) was the most common in the premolars, whereas type B (inclined type) (36%-37%) and type C (lingual inverted concave) (30%-54%) were the most common types in the molars, followed type D (absorption severe type) (2%-5%). There was a statistically significant differences in tooth positions (P<0.001), tooth deficiency aspect (P<0.001) and different side (P=0.013), different age (P<0.001), and different gender (P=0.007). Conclusions: Using cone beam CT to determine the morphology of mandible may be a reference for the planning of dental implantation.