title: Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial.
abstract: BACKGROUND
  The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK.
  
  
  METHODS
  We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565.
  
  
  RESULTS
  Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44).
  
  
  CONCLUSIONS
  Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases.
  
  
  BACKGROUND
  National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: raj.bhopal@ed.ac.uk.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Bhopal
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Douglas
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Sunita
authors.initials: S
authors.lastname: Wallia
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: John F
authors.initials: JF
authors.lastname: Forbes
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Lean
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Jason M R
authors.initials: JM
authors.lastname: Gill
authors.affiliation: Metabolic Unit, Anne Ferguson Building, Western General Hospital, Edinburgh, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: McKnight
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Wild
authors.affiliation: Centre for Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Anu
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Ruby
authors.initials: R
authors.lastname: Bhopal
authors.affiliation: Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.
authors.forename: Joel B E
authors.initials: JB
authors.lastname: Smith
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Isabella
authors.initials: I
authors.lastname: Butcher
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Murray
mesh_terms: D000328:Adult; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000517:prevention & control*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007194:India / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D006113:United Kingdom