体重减轻引起的体重和胰岛素敏感性的改善不会因随后 12 个月的体重维持干预而放大，但会通过脂肪心房利钠肽系统的适应来预测：一项随机对照试验的 48 个月结果。
Weight loss-induced improvement of body weight and insulin sensitivity is not amplified by a subsequent 12-month weight maintenance intervention but is predicted by adaption of adipose atrial natriuretic peptide system: 48-month results of a randomized controlled trial.
机构信息
Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany.
Charité-Center for Cardiovascular Research (CCR), Berlin, Germany.
出版信息
BMC Med. 2022 Jul 28;20(1):238. doi: 10.1186/s12916-022-02435-9.
BACKGROUND
Behavioral weight loss interventions are frequently hampered by long-term inefficacy. As metabolic improvements and health-related quality of life (HRQoL) are diminished by weight regain, effective long-term strategies are highly desirable. We aimed to analyze whether an additional weight maintenance intervention could delay body weight regain and can induce a long-term improvement of metabolism and HRQoL for up to 48 months in humans. Given the short-term metabolic effects of natriuretic peptides (NP), we also investigated the role of the adipose atrial NP (ANP) system in this long-term context.
METHODS
After a successful 12-week weight reduction program 143 subjects (age>18; BMI≥27 kg/m) were randomized (1:1) to a control group or a 12-month multimodal weight maintenance intervention focusing on nutritional counseling and physical exercises. Secondary trial outcomes including course of BMI, HOMA-IR, glucose response after oGTT (glucose), and HRQoL (SF-36) were analyzed yearly for 48 months. Adipose ANP receptor mRNA expression was analyzed during weight loss.
RESULTS
Initial weight loss (- 4.7±1.5 kg/m) improved glucose, HOMA-IR, and HRQoL. Although BMI was still reduced after 48 months (-1.98 [95% CI -2.61, -1.35] kg/m), benefits on HOMA-IR, glucose, and mental health disappeared after 36 (-0.49 [-1.00, 0.02]), 18 (0.61 [-9.57, 10.79] mg dl min), and 18 months (2.06 [-0.08, 4.20]), respectively, while improved physical health persisted up to months 48 (2.95 [0.49, 5.40]). Weight maintenance intervention inhibited weight regain and delayed impairment of HOMA-IR and glucose (but not HRQoL) for up to 12 months. However, no metabolic long-term effect was seen beyond the intervention period. Lower adipose NPR-C and higher NPR-A mRNA expression after weight loss predicted smaller regain of weight (r=0.398; p<0.05)/fat mass (FM) (r=0.391; p<0.05) and longer improvement of HOMA-IR (r=-0.422; p<0.05), respectively.
CONCLUSIONS
Additional benefits of a behavioral 12-month weight maintenance intervention after weight loss regarding body weight regain and metabolic improvement does not persist beyond the intervention period. However, weight loss-induced modulation of the adipose ANP system is probably involved in the long-term control of body weight regain and insulin sensitivity.
TRIAL REGISTRATION
ClinicalTrials.gov NCT00850629 . Registered on February 25, 2009.
背景
行为性减肥干预通常会因长期效果不佳而受阻。由于体重的增加会降低代谢改善和健康相关生活质量（HRQoL），因此非常需要有效的长期策略。我们旨在分析附加的体重维持干预是否可以延迟体重反弹，并可以在长达 48 个月的时间内诱导代谢和 HRQoL 的长期改善。鉴于利钠肽（NP）的短期代谢作用，我们还研究了脂肪心房 NP（ANP）系统在这种长期情况下的作用。
方法
在成功进行了 12 周的减肥计划后，143 名受试者（年龄>18 岁；BMI≥27 kg/m ）被随机（1：1）分为对照组或为期 12 个月的多模式体重维持干预组，重点是营养咨询和体育锻炼。次要试验结果包括 BMI、HOMA-IR、口服葡萄糖耐量试验（oGTT）后葡萄糖（glucose）和 HRQoL（SF-36）的变化，每年分析 48 个月。在减肥期间分析脂肪 ANP 受体 mRNA 表达。
结果
最初的体重减轻（-4.7±1.5 kg/m）改善了葡萄糖、HOMA-IR 和 HRQoL。尽管 48 个月后 BMI 仍降低（-1.98 [95%CI-2.61，-1.35] kg/m），但 36 个月（-0.49 [-1.00，0.02]）、18 个月（0.61 [-9.57，10.79] mg dl min）和 18 个月（2.06 [-0.08，4.20]）时，HOMA-IR、葡萄糖和心理健康方面的益处消失，而身体健康的改善持续到 48 个月（2.95 [0.49，5.40]）。体重维持干预抑制了体重反弹，并延迟了 HOMA-IR 和葡萄糖的损害（但不是 HRQoL）长达 12 个月。但是，在干预期之后，没有观察到代谢的长期影响。减肥后脂肪 NPR-C 和 NPR-A mRNA 表达降低预测体重（r=0.398；p<0.05）/脂肪量（FM）（r=0.391；p<0.05）的恢复较小，HOMA-IR 的改善时间更长（r=-0.422；p<0.05）。
结论
减肥后进行为期 12 个月的行为性体重维持干预对体重反弹和代谢改善没有持续的额外益处。然而，脂肪 ANP 系统的减肥诱导调节可能参与了体重反弹和胰岛素敏感性的长期控制。
试验注册
ClinicalTrials.gov NCT00850629。于 2009 年 2 月 25 日注册。
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