Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA.
Obesity (Silver Spring). 2021 Aug;29(8):1246-1258. doi: 10.1002/oby.23158. Epub 2021 May 14.
This paper reviews the main findings from the Action for Health in Diabetes (Look AHEAD) Trial, a randomized trial testing the long-term health effects of intensive lifestyle interventions (ILIs) in 5,145 persons with overweight/obesity and type 2 diabetes. Although the primary outcome originally focused on cardiovascular morbidity and mortality, secondary outcomes included a broad range of health parameters related to diabetes and obesity. As the cohort aged, study outcomes were expanded to include health problems affecting geriatric populations, such as cognitive impairment and disability.This review summarizes the history of this trial and presents findings related to a wide range of health outcomes. Studies are reviewed that showed positive impact of ILI on diabetes control and complications, depression, physical health-related quality of life, sleep apnea, incontinence, brain structure, and health care use and costs. Several composite indices were also positively impacted by ILI, including multimorbidity, geriatric syndromes, and disability-free life years. However, there are also some important outcomes that did not show significant differences between the intervention and control, including cardiovascular morbidity and mortality, cancer, cognitive function, and cognitive impairment; for several of these nonsignificant effects, post hoc analyses suggested that there may be differences among subgroups, raising the possibility that ILI may be beneficial to some but potentially harmful to others. The only adverse effects of ILI relative to diabetes support and education were on frailty fractures and the related negative effects on body composition and bone density. Through this review, the manuscript seeks to determine whether weight loss should be encouraged in this population; given the large number of beneficial effects, relative to the small number of adverse effects, the answer appears to be yes.
本文回顾了 Action for Health in Diabetes（Look AHEAD）试验的主要结果，这是一项针对 5145 名超重/肥胖和 2 型糖尿病患者的强化生活方式干预（ILI）长期健康效果的随机试验。虽然最初的主要结果集中在心血管发病率和死亡率上，但次要结果包括与糖尿病和肥胖相关的广泛健康参数。随着队列年龄的增长，研究结果扩展到包括影响老年人群的健康问题，如认知障碍和残疾。本综述总结了该试验的历史，并介绍了与广泛健康结果相关的发现。回顾了研究表明 ILI 对糖尿病控制和并发症、抑郁、身体健康相关生活质量、睡眠呼吸暂停、尿失禁、大脑结构以及医疗保健使用和成本产生积极影响的研究。ILI 还对多项综合指数产生了积极影响，包括多种合并症、老年综合征和无残疾生活年数。然而，也有一些重要的结果在干预组和对照组之间没有显示出显著差异，包括心血管发病率和死亡率、癌症、认知功能和认知障碍；对于其中一些无显著差异的结果，事后分析表明，亚组之间可能存在差异，这增加了 ILI 可能对某些人有益但对其他人可能有害的可能性。ILI 相对于糖尿病支持和教育的唯一不良反应是脆弱性骨折以及对身体成分和骨密度的相关负面影响。通过本综述，本文试图确定是否应鼓励该人群减轻体重；鉴于大量有益的影响，相对于少数不良影响，答案似乎是肯定的。
