Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, MA, USA.
Diabetes Care. 2013 Jan;36(1):34-40. doi: 10.2337/dc12-0733. Epub 2012 Nov 5.
To identify the most important pretreatment characteristics and changes in psychological and behavioral factors that predict weight outcomes in the Diabetes Prevention Program (DPP).
Approximately 25% of DPP lifestyle intervention participants (n = 274) completed questionnaires to assess weight history and psychological and behavioral factors at baseline and 6 months after completion of the 16-session core curriculum. The change in variables from baseline to 6 months was assessed with t tests. Multivariate models using hierarchical logistic regression assessed the association of weight outcomes at end of study with each demographic, weight loss history, psychological, and behavioral factor.
At end of study, 40.5% had achieved the DPP 7% weight loss goal. Several baseline measures (older age, race, older age when first overweight, fewer self-implemented weight loss attempts, greater exercise self-efficacy, greater dietary restraint, fewer fat-related dietary behaviors, more sedentary activity level) were independent predictors of successful end-of-study weight loss with the DPP lifestyle program. The DPP core curriculum resulted in significant improvements in many psychological and behavioral targets. Changes in low-fat diet self-efficacy and dietary restraint skills predicted better long-term weight loss, and the association of low-fat diet self-efficacy with weight outcomes was explained by dietary behaviors.
Health care providers who translate the DPP lifestyle intervention should be aware of pretreatment characteristics that may hamper or enhance weight loss, consider prioritizing strategies to improve low-fat diet self-efficacy and dietary restraint skills, and examine whether taking these actions improves weight loss outcomes.
确定与糖尿病预防计划（DPP）体重结局相关的最重要的预处理特征和心理及行为因素的变化。
DPP 生活方式干预参与者中有 25%（n=274）的人完成了问卷，以评估基线和完成 16 节核心课程后 6 个月的体重史和心理及行为因素。使用 t 检验评估从基线到 6 个月的变量变化。使用分层逻辑回归的多变量模型评估研究结束时的体重结局与每个人口统计学、体重减轻史、心理和行为因素的相关性。
研究结束时，40.5%的人达到了 DPP 7%的体重减轻目标。一些基线指标（年龄较大、种族、首次超重时年龄较大、自我实施的体重减轻尝试较少、更大的锻炼自我效能、更大的饮食克制、更少的与脂肪相关的饮食行为、更多的久坐活动水平）是 DPP 生活方式计划成功结束时体重减轻的独立预测因素。DPP 核心课程导致许多心理和行为目标显著改善。低脂饮食自我效能和饮食克制技能的变化预测了更好的长期体重减轻，低脂饮食自我效能与体重结局的相关性可以通过饮食行为来解释。
将 DPP 生活方式干预进行转化的医疗保健提供者应该了解可能阻碍或增强体重减轻的预处理特征，考虑优先考虑改善低脂饮食自我效能和饮食克制技能的策略，并检查采取这些行动是否会改善体重减轻的结局。
