title: Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community--An Intervention Follow-Up Study on Reunion Island.
abstract: In type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-term effectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socio-economic community. On Reunion Island, 445 adults living in deprived areas, aged 18-40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001-2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shot medical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010-2011). The outcomes were the nine-year changes from baseline in BW, body mass index (BMI) and WC measurements, separately. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m²) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant for WC -2.4 cm (95% confidence interval: -4.7 to -0.0 cm, p = 0.046), non-significant for BW -2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI -0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). A specific long-term effect was the increased likelihood of reduction in adiposity: BW loss, BMI reduction, and WC reduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two major drivers of T2D.
authors.affiliation: Centre d'Investigation Clinique de la Réunion (CIC 1410), Institut National de la Santé et de la Recherche Médicale (Inserm), Saint-Pierre, la Réunion, France.|Centre d'Investigation Clinique de la Réunion (CIC 1410), Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.|Unité Mixte de Recherche 1027 (UMR1027), Université Toulouse III Paul-Sabatier, Toulouse, France.|Unité Mixte de Recherche 1027 (UMR1027), Institut National de la Santé et de la Recherche Médicale (Inserm), Toulouse, France.
authors.forename: Adrian
authors.initials: A
authors.lastname: Fianu
authors.affiliation: Centre d'Investigation Clinique de la Réunion (CIC 1410), Institut National de la Santé et de la Recherche Médicale (Inserm), Saint-Pierre, la Réunion, France.|Centre d'Investigation Clinique de la Réunion (CIC 1410), Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.
authors.forename: Léa
authors.initials: L
authors.lastname: Bourse
authors.affiliation: Centre d'Investigation Clinique de la Réunion (CIC 1410), Institut National de la Santé et de la Recherche Médicale (Inserm), Saint-Pierre, la Réunion, France.|Centre d'Investigation Clinique de la Réunion (CIC 1410), Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.
authors.forename: Nadège
authors.initials: N
authors.lastname: Naty
authors.affiliation: Service d'Endocrinologie, Diabétologie et de Nutrition, Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Le Moullec
authors.affiliation: Unité Mixte de Recherche 1027 (UMR1027), Université Toulouse III Paul-Sabatier, Toulouse, France.|Unité Mixte de Recherche 1027 (UMR1027), Institut National de la Santé et de la Recherche Médicale (Inserm), Toulouse, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Lepage
authors.affiliation: Unité Mixte de Recherche 1027 (UMR1027), Université Toulouse III Paul-Sabatier, Toulouse, France.|Unité Mixte de Recherche 1027 (UMR1027), Institut National de la Santé et de la Recherche Médicale (Inserm), Toulouse, France.|Centre Hospitalo-Universitaire Toulouse, Toulouse, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lang
authors.affiliation: Centre d'Investigation Clinique de la Réunion (CIC 1410), Institut National de la Santé et de la Recherche Médicale (Inserm), Saint-Pierre, la Réunion, France.|Centre d'Investigation Clinique de la Réunion (CIC 1410), Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.
authors.forename: François
authors.initials: F
authors.lastname: Favier
mesh_terms: D000293:Adolescent; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007195:Indian Ocean Islands / Q000453:epidemiology; D008019:Life Style; D008297:Male; D050177:Overweight / Q000150:complications* / Q000628:therapy; D011204:Poverty Areas; D055105:Waist Circumference; D015431:Weight Loss; D055815:Young Adult