title: Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the Diabetes Prevention Program.
abstract: OBJECTIVE
  This study examined specific measures of weight loss in relation to incident diabetes and improvement in cardiometabolic risk factors.
  
  
  METHODS
  This prospective, observational study analyzed nine weight measures, characterizing baseline weight, short- versus long-term weight loss, short- versus long-term weight regain, and weight cycling, within the Diabetes Prevention Program (DPP) lifestyle intervention arm (n = 1,000) for predictors of incident diabetes and improvement in cardiometabolic risk factors over 2 years.
  
  
  RESULTS
  Although weight loss in the first 6 months was protective of diabetes (hazard ratio [HR] 0.94 per kg, 95% CI 0.90, 0.98; P < 0.01) and cardiometabolic risk factors (P < 0.01), weight loss from 0 to 2 years was the strongest predictor of reduced diabetes incidence (HR 0.90 per kg, 95% CI 0.87, 0.93; P < 0.01) and cardiometabolic risk factor improvement (e.g., fasting glucose: β = -0.57 mg/dL per kg, 95% CI -0.66, -0.48; P < 0.01). Weight cycling (defined as number of 5-lb [2.25-kg] weight cycles) ranged 0-6 times per participant and was positively associated with incident diabetes (HR 1.33, 95% CI 1.12, 1.58; P < 0.01), fasting glucose (β = 0.91 mg/dL per cycle; P = 0.02), HOMA-IR (β = 0.25 units per cycle; P = 0.04), and systolic blood pressure (β = 0.94 mmHg per cycle; P = 0.01). After adjustment for baseline weight, the effect of weight cycling remained statistically significant for diabetes risk (HR 1.22, 95% CI 1.02, 1.47; P = 0.03) but not for cardiometabolic traits.
  
  
  CONCLUSIONS
  Two-year weight loss was the strongest predictor of reduced diabetes risk and improvements in cardiometabolic traits.
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA dppmail@bsc.gwu.edu.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Delahanty
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Qing
authors.initials: Q
authors.lastname: Pan
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Jablonski
authors.affiliation: MedStar Health Research Institute, Hyattsville, MD, and Georgetown University School of Medicine, Washington, DC.
authors.forename: Vanita R
authors.initials: VR
authors.lastname: Aroda
authors.affiliation: The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Karol E
authors.initials: KE
authors.lastname: Watson
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.affiliation: Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA Center for Human Genetic Research, Department of Medicine, Massachusetts General Hospital, Boston, MA Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Florez
authors.affiliation: Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Leigh
authors.initials: L
authors.lastname: Perreault
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden Department of Nutrition, Harvard School of Public Health, Boston, MA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*; D061217:Weight Reduction Programs
chemical_list: D001786:Blood Glucose