Beavers Kristen M, Case L Douglas, Blackwell Caroline S, Katula Jeffery A, Goff David C, Vitolins Mara Z
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States.
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Obes Res Clin Pract. 2015 May-Jun;9(3):266-73. doi: 10.1016/j.orcp.2014.09.003. Epub 2014 Oct 5.
To assess the extent to which initial, intentional weight loss-associated improvements in glucose tolerance and insulin action are diminished with weight regain.
138 overweight and obese (BMI: 32.4±3.9kg/m(2)), adults (59.0±9.7 years), with pre-diabetes were followed through a 6-month weight loss intervention and subsequent 18-month weight maintenance period, or usual care control condition. Longitudinal change in weight (baseline, 6, 24 months) was used to classify individuals into weight pattern categories (Loser/Maintainer (LM), n= 50; Loser/Regainer (LR), n=51; and Weight Stable (WS), n=37). Fasting plasma glucose (FPG), insulin, and insulin resistance (HOMA-IR) were measured at baseline, 6, 12, 18 and 24 months and model adjusted changes, by weight pattern category, were assessed.
LMs and LRs lost 8.3±4.7kg (8.7±4.5%) and 9.6±4.7kg (10.2±4.7%) during the first 6 months, respectively. LM continued to lose 1.1±3.4kg over the next 18 months (9.9±6.5% reduction from baseline; p<0.05), while LRs regained 6.5±3.7kg (3.3±5.3% reduction from baseline; p<0.05). Weight change was directly associated with change in all DM risk factors (all p<0.01). Notably, despite an absolute reduction in body weight (from baseline to 24 months) achieved in the LR group, 24-month changes in FPG, insulin, and HOMA-IR did not differ between WS and LR groups. Conversely, LM saw sustained improvements in all measured DM risk factors.
Significant weight loss followed by weight loss maintenance is associated with sustained improvements in FPG, insulin, and HOMA-IR; conversely, even partial weight regain is associated with regression of initial improvements in these risk factors towards baseline values.
评估体重反弹对最初因刻意减重而改善的糖耐量和胰岛素作用的影响程度。
138名超重和肥胖（BMI：32.4±3.9kg/m²）、患有糖尿病前期的成年人（59.0±9.7岁），接受为期6个月的减重干预及随后18个月的体重维持期，或常规护理对照。根据体重的纵向变化（基线、6个月、24个月）将个体分为体重模式类别（减重/维持体重者（LM），n = 50；减重/体重反弹者（LR），n = 51；体重稳定者（WS），n = 37）。在基线、6个月、12个月、18个月和24个月时测量空腹血糖（FPG）、胰岛素和胰岛素抵抗（HOMA-IR），并评估按体重模式类别调整后的模型变化。
LM组和LR组在最初6个月分别减重8.3±4.7kg（8.7±4.5%）和9.6±4.7kg（10.2±4.7%）。LM组在接下来18个月继续减重1.1±3.4kg（较基线减少9.9±6.5%；p<0.05），而LR组体重反弹6.5±3.7kg（较基线减少3.3±5.3%；p<0.05）。体重变化与所有糖尿病风险因素的变化直接相关（均p<0.01）。值得注意的是，尽管LR组从基线到24个月体重实现了绝对下降，但WS组和LR组在24个月时FPG、胰岛素和HOMA-IR的变化并无差异。相反，LM组所有测量的糖尿病风险因素持续改善。
显著减重后维持体重与FPG、胰岛素和HOMA-IR的持续改善相关；相反，即使部分体重反弹也会使这些风险因素的初始改善向基线值回归。
