title: The results of Look AHEAD do not row against the implementation of lifestyle changes in patients with type 2 diabetes.
abstract: The Look AHEAD trial, evaluating the effects of weight loss on cardiovascular (CV) morbidity and mortality in overweight/obese people with type 2 diabetes (T2D), was interrupted after a median 9.5-year follow-up because the incidence of CV events was not different between the Intensive Lifestyle Intervention (ILI) and the control groups, and unlikely to statistically change thereafter. This made health providers and patients wondering about clinical value of diet and physical exercise in diabetic patients. Many factors may have made difficult to ascertain benefits of lifestyle intervention, besides the lower than predicted CV event rates. Among others, LDL-cholesterol was lowered more, with a higher use of statins, in the control group. Anyhow, ILI significantly improved numerous health conditions, including quality of life, CV risk factors and blood glucose control, with more diabetes remissions and less use of insulin. The intervention aimed at weight loss by reducing fat calories, and using meal replacements and, eventually, orlistat, likely underemphasizing dietary composition. There is suggestive evidence, in fact, that qualitative changes in dietary composition aiming at higher consumption of foods rich in fiber and with a high vegetable/animal fat ratio favorably influence CV risk in T2D patients. In conclusion, the Look AHEAD showed substantial health benefits of lifestyle modifications. Prevention of CV events may need higher attention to dietary composition, contributing to stricter control of CV risk factors. As a better health-related quality of life in people with diabetes is an important driver of our clinical decisions, efforts on early implementation of behavioral changes through a multifactorial approach are strongly justified.
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy. Electronic address: annuzzi@unina.it.
authors.forename: G
authors.initials: G
authors.lastname: Annuzzi
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy.
authors.forename: A A
authors.initials: AA
authors.lastname: Rivellese
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bozzetto
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, Naples 80131, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Riccardi
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D002149:Energy Intake; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D008019:Life Style; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000628:therapy; D050177:Overweight / Q000150:complications / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D007328:Insulin
keywords: Cardiovascular disease; Diet; Lifestyle; Look AHEAD trial; Physical activity