title: Intentional Weight Loss and Longevity in Overweight Patients with Type 2 Diabetes: A Population-Based Cohort Study.
abstract: OBJECTIVE
  This study examined the influence of weight loss on long-term morbidity and mortality in overweight (BMI≥25 kg/m2) patients with type 2 diabetes, and tested the hypothesis that therapeutic intentional weight loss supervised by a medical doctor prolongs life and reduces the risk for cardiovascular disease in these patients.
  
  
  METHODS
  This is a 19 year cohort study of patients in the intervention arm of the randomized clinical trial Diabetes Care in General Practice. Weight and prospective intentions for weight loss were monitored every third month for six years in 761 consecutive patients (≥40 years) newly diagnosed with diabetes in general practices throughout Denmark in 1989-92. Multivariable Cox regression was used to estimate the association between weight change during the monitoring period (year 0 to 6) and the outcomes during the succeeding 13 years (year 6 to 19) in 444 patients who were overweight at diagnosis and alive at the end of the monitoring period (year 6). The analysis was adjusted for age, sex, education, BMI at diagnosis, change in smoking, change in physical activity, change in medication, and the Charlson comorbidity 6-year score. Outcomes were from national registers.
  
  
  RESULTS
  Overall, weight loss regardless of intention was an independent risk factor for increased all-cause mortality (P<0.01). The adjusted hazard ratio for all-cause mortality, cardiovascular mortality, and cardiovascular morbidity attributable to an intentional weight loss of 1 kg/year was 1.20 (95%CI 0.97-1.50, P = 0.10), 1.26 (0.93-1.72, P = 0.14), and 1.06 (0.79-1.42, P = 0.71), respectively. Limiting the analysis to include only those patients who survived the first 2 years after the monitoring period did not substantially change these estimates. A non-linear spline estimate indicated a V-like association between weight change and all-cause mortality, suggesting the best prognosis for those who maintained their weight.
  
  
  CONCLUSIONS
  In this population-based cohort of overweight patients with type 2 diabetes, successful therapeutic intentional weight loss, supervised by a doctor over six years, was not associated with reduced all-cause mortality or cardiovascular morbidity/mortality during the succeeding 13 years.
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.|Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Køster-Rasmussen
authors.affiliation: Finsen Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Mette Kildevæld
authors.initials: MK
authors.lastname: Simonsen
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.affiliation: Department of Clinical Research, University of Southern Denmark, Odense, Denmark.|Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Henriksen
authors.affiliation: Research Unit for Dietary Studies, The Parker Institute and Institute of Preventive Medicine, Capital Region, Bispebjerg and Frederiksberg University Hospitals, Frederiksberg, Denmark.|The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia.|The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Berit Lilienthal
authors.initials: BL
authors.lastname: Heitmann
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: de Fine Olivarius
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D033182:Intention; D008136:Longevity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D015996:Survival Rate; D015431:Weight Loss / Q000502:physiology*