Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
J Hum Nutr Diet. 2021 Jun;34(3):472-479. doi: 10.1111/jhn.12839. Epub 2021 Jan 6.
Weight loss maintenance (WLM) is critical for sustaining type 2 diabetes (T2D) remission, but poorly evidenced. We evaluated brief return to formula low-energy-diet (LED) as relapse treatments (RTs) during the WLM phase of the Diabetes Remission Clinical Trial (DiRECT).
This post-hoc evaluation included all participants commencing the WLM phase of DiRECT. The protocol offered RT when regain of >2 kg occurred.
In total, 123/149 (83%) DiRECT intervention participants commenced the WLM phase after 26 (17%) had withdrawn prior to the WLM phase. Most participants [99/123 (80%)] regained >2 kg during the WLM phase, among whom 60/99 (61%) were recorded as using RT and 39/99 (39%) not using any RT. At baseline, RT users had a higher mean (SD) body mass index [35.8 (4.9) kg m vs. 33.8 (3.9) kg m , p = 0.0231] and had greater social deprivation (P = 0.0003) than non-users, although otherwise the groups were similar. Weight loss ≥ 2k g was achieved in 30/93 (32%) of RT attempts. At 2 years, those regaining >2 kg and using RT (n = 60) had mean (SD) weight losses of 7.4 (6.1) kg, with 25 (42%) remissions and 7 (12%) programme withdrawals. Those regaining >2 kg but not using RT (n = 39) had weight losses of 8.8 (6.0) kg, with 21 (54%) remissions and 4 (10%) programme withdrawals (all not significant). Twelve participants were never recorded as having regained >2 kg or using RTs and, at 2 years, their weight losses were 12.9 (9.2) kg, with 4 (33%) remissions and 8 (67%) programme withdrawals.
Most people with T2D experience weight regain >2 kg during the 2 years after substantial weight loss with a LED. Only one-third of RTs corrected their 2-kg regain, resulting in similar weight losses, remissions and programme withdrawals at 2 years compared to those not using RTs; however, both groups had weight losses below those not recorded as regaining >2 kg during WLM.
体重减轻维持（WLM）对于维持 2 型糖尿病（T2D）缓解至关重要，但证据不足。我们评估了在糖尿病缓解临床试验（DiRECT）的 WLM 阶段中，短暂恢复配方低能量饮食（LED）作为复发治疗（RT）的效果。
本事后分析包括开始 DiRECT WLM 阶段的所有参与者。方案规定，体重增加超过 2kg 时就进行 RT。
在 DiRECT 干预的 149 名参与者中，共有 123 名（83%）开始了 WLM 阶段，而 26 名（17%）在 WLM 阶段之前已经退出。在 WLM 阶段，大多数参与者[99/123（80%）]体重增加超过 2kg，其中 60/99（61%）记录使用了 RT，而 39/99（39%）未使用任何 RT。基线时，RT 使用者的平均（SD）体重指数[35.8（4.9）kg m 比 33.8（3.9）kg m ，p=0.0231]更高，社会贫困程度更大（P=0.0003），但其他方面两组相似。30/93（32%）次 RT 尝试实现了体重减轻≥2kg。2 年后，体重增加超过 2kg 且使用 RT 的 60 名参与者（n=60）的体重减轻量为 7.4（6.1）kg，缓解率为 25（42%），方案退出率为 7（12%）。体重增加超过 2kg 但未使用 RT 的 39 名参与者（n=39）体重减轻 8.8（6.0）kg，缓解率为 54%（21 人），方案退出率为 10%（4 人）（均无显著差异）。有 12 名参与者从未记录体重增加超过 2kg 或使用 RT，2 年后体重减轻 12.9（9.2）kg，缓解率为 33%（4 人），方案退出率为 67%（8 人）。
大多数 T2D 患者在 LED 治疗后 2 年内体重会增加超过 2kg。只有三分之一的 RT 纠正了他们的 2kg 体重增加，导致 2 年后的体重减轻、缓解率和方案退出率与未使用 RT 的患者相似；然而，两组的体重减轻都低于 WLM 期间未记录体重增加超过 2kg 的患者。
