title: Effects of weight regain following intentional weight loss on glucoregulatory function in overweight and obese adults with pre-diabetes.
abstract: OBJECTIVE
  To assess the extent to which initial, intentional weight loss-associated improvements in glucose tolerance and insulin action are diminished with weight regain.
  
  
  METHODS
  138 overweight and obese (BMI: 32.4±3.9kg/m(2)), adults (59.0±9.7 years), with pre-diabetes were followed through a 6-month weight loss intervention and subsequent 18-month weight maintenance period, or usual care control condition. Longitudinal change in weight (baseline, 6, 24 months) was used to classify individuals into weight pattern categories (Loser/Maintainer (LM), n= 50; Loser/Regainer (LR), n=51; and Weight Stable (WS), n=37). Fasting plasma glucose (FPG), insulin, and insulin resistance (HOMA-IR) were measured at baseline, 6, 12, 18 and 24 months and model adjusted changes, by weight pattern category, were assessed.
  
  
  RESULTS
  LMs and LRs lost 8.3±4.7kg (8.7±4.5%) and 9.6±4.7kg (10.2±4.7%) during the first 6 months, respectively. LM continued to lose 1.1±3.4kg over the next 18 months (9.9±6.5% reduction from baseline; p<0.05), while LRs regained 6.5±3.7kg (3.3±5.3% reduction from baseline; p<0.05). Weight change was directly associated with change in all DM risk factors (all p<0.01). Notably, despite an absolute reduction in body weight (from baseline to 24 months) achieved in the LR group, 24-month changes in FPG, insulin, and HOMA-IR did not differ between WS and LR groups. Conversely, LM saw sustained improvements in all measured DM risk factors.
  
  
  CONCLUSIONS
  Significant weight loss followed by weight loss maintenance is associated with sustained improvements in FPG, insulin, and HOMA-IR; conversely, even partial weight regain is associated with regression of initial improvements in these risk factors towards baseline values.
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States. Electronic address: beaverkm@wfu.edu.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Beavers
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States.
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Blackwell
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Katula
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States.
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States.
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004038:Diet, Reducing; D018450:Disease Progression; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D050177:Overweight / Q000097:blood / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D011236:Prediabetic State / Q000150:complications / Q000503:physiopathology* / Q000517:prevention & control; D012008:Recurrence; D012307:Risk Factors; D015430:Weight Gain; D015431:Weight Loss
keywords: Fasting plasma glucose; Fasting plasma insulin; Pre-diabetes; Weight loss; Weight regain