资源匮乏肥胖患者体重变化的调解因素：来自路易斯安那州初级保健中促进成功减肥（PROPEL）集群随机试验的探索性分析。
Mediators of weight change in underserved patients with obesity: exploratory analyses from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) cluster-randomized trial.
机构信息
Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom.
Pennington Biomedical Research Center, Baton Rouge, LA, USA.
出版信息
Am J Clin Nutr. 2022 Oct 6;116(4):1112-1122. doi: 10.1093/ajcn/nqac179.
BACKGROUND
Intensive lifestyle interventions (ILIs) stimulate weight loss in underserved patients with obesity, but the mediators of weight change are unknown.
OBJECTIVES
We aimed to identify the mediators of weight change during an ILI compared with usual care (UC) in underserved patients with obesity.
METHODS
The PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana) trial randomly assigned 18 clinics (n = 803) to either an ILI or UC for 24 mo. The ILI group received an intensive lifestyle program; the UC group had routine care. Body weight was measured; further, eating behaviors (restraint, disinhibition), dietary intake (percentage fat intake, fruit and vegetable intake), physical activity, and weight- and health-related quality of life constructs were measured through questionnaires. Mediation analyses assessed whether questionnaire variables explained between-group variations in weight change during 2 periods: baseline to month 12 (n = 779) and month 12 to month 24 (n = 767).
RESULTS
The ILI induced greater weight loss at month 12 compared with UC (between-group difference: -7.19 kg; 95% CI: -8.43, -6.07 kg). Improvements in disinhibition (-0.33 kg; 95% CI: -0.55, -0.10 kg), percentage fat intake (-0.25 kg; 95% CI: -0.50, -0.01 kg), physical activity (-0.26 kg; 95% CI: -0.41, -0.09 kg), and subjective fatigue (-0.28 kg; 95% CI: -0.46, -0.10 kg) at month 6 during the ILI partially explained this between-group difference. Greater weight loss occurred in the ILI at month 24, yet the ILI group gained 2.24 kg (95% CI: 1.32, 3.26 kg) compared with UC from month 12 to month 24. Change in fruit and vegetable intake (0.13 kg; 95% CI: 0.05, 0.21 kg) partially explained this response, and no variables attenuated the weight regain of the ILI group.
CONCLUSIONS
In an underserved sample, weight change induced by an ILI compared with UC was mediated by several psychological and behavioral variables. These findings could help refine weight management regimens in underserved patients with obesity.This trial was registered at clinicaltrials.gov as NCT02561221.
背景
强化生活方式干预（ILIs）可刺激服务不足的肥胖患者减轻体重，但体重变化的中介因素尚不清楚。
目的
我们旨在确定在服务不足的肥胖患者中，与常规护理（UC）相比，ILIs 期间体重变化的中介因素。
方法
PROPEL（在路易斯安那州的初级保健中促进成功减肥）试验将 18 个诊所（n=803）随机分配到 ILI 或 UC 组，进行 24 个月的治疗。ILI 组接受强化生活方式计划；UC 组接受常规护理。通过问卷测量体重；此外，通过问卷评估饮食行为（抑制、抑制解除）、饮食摄入（脂肪摄入百分比、水果和蔬菜摄入量）、身体活动以及体重和健康相关生活质量结构。中介分析评估了在 2 个时期（n=779）和 12 个月到 24 个月（n=767）之间，问卷变量是否解释了体重变化的组间差异。
结果
与 UC 相比，ILI 在 12 个月时引起的体重减轻更大（组间差异：-7.19kg；95%CI：-8.43，-6.07kg）。在 ILI 期间，抑制解除（-0.33kg；95%CI：-0.55，-0.10kg）、脂肪摄入百分比（-0.25kg；95%CI：-0.50，-0.01kg）、身体活动（-0.26kg；95%CI：-0.41，-0.09kg）和主观疲劳（-0.28kg；95%CI：-0.46，-0.10kg）在 6 个月时的改善部分解释了这种组间差异。ILI 在 24 个月时体重减轻更多，但与 UC 相比，ILI 组从 12 个月到 24 个月体重增加了 2.24kg（95%CI：1.32kg，3.26kg）。水果和蔬菜摄入量的变化（0.13kg；95%CI：0.05kg，0.21kg）部分解释了这种反应，没有变量减弱 ILI 组的体重回升。
结论
在服务不足的人群中，与 UC 相比，ILIs 诱导的体重变化由几个心理和行为变量介导。这些发现可以帮助完善服务不足的肥胖患者的体重管理方案。本试验在 clinicaltrials.gov 注册为 NCT02561221。
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