Weight fluctuations increase cardiovascular and mortality risk in type 2 diabetes patients: JAMA

USA: In a new study conducted by Arnaud D. Kaze and team it was found that higher variability of adiposity indices was related to a substantially increased risk of cardiovascular disease (CVD) events and mortality in people with type 2 diabetes in the control group, but not in the intensive lifestyle intervention group. The findings of this study were published in the Journal of American Medical Association.

Bodyweight fluctuations are linked to an increased risk of negative health effects. It has never been investigated whether intense weight reduction programs impact the link of variability in adiposity measurements with negative health outcomes in people with type 2 diabetes. As a result, the goal of this study was to see if there are any links between long-term variability in adiposity indices and CVD outcomes in individuals with type 2 diabetes and if these links are changed by intensive lifestyle intervention.

Participants in the Action for Health in Diabetes (Look AHEAD) trial who did not have CVD at baseline were included in this prospective cohort study (August 2001 to April 2004). The Look AHEAD project enlisted the participation of 16 sites across the United States. The data was analyzed between December 2020 and June 2021. variability independent of the mean (VIM), The coefficient of variation (CV), and standard deviation were used to examine the variability of body mass index (BMI) and waist circumference (WC) throughout four yearly visits (SD). All-cause mortality, cardiovascular deaths, and CVD events were the main outcomes studied.

The key findings are as follow:

1. There were 216 CVD episodes, 33 CVD fatalities, and 166 deaths among 3604 study participants during a median of 6.7 years.

2. In the control group, the hazard ratios (HRs) for CVD mortality, all-cause mortality, and cardiovascular events were 4.06, 15.28, and 2.16 for the highest quartile (quartile 4) against the lowest quartile (quartile 1) of CV of BMI, respectively.

3. The corresponding HRs in the intervention group were 0.99 and 0.77 for quartile 4 versus quartile 1.

4. In terms of WC, the control group's HRs for quartile 4 vs quartile 1 were 1.84, 6.46, and 1.28, respectively. In the intervention group, the HRs for quartile 4 vs quartile 1 was 1.23, 0.55, and 0.70, respectively.

In conclusion, there was no association of higher variability of adiposity measures with higher risks of adverse outcomes in individuals who underwent intensive weight loss; however, in the standard care group, higher variability of obesity indices was independently associated with increased risks of all-cause mortality, cardiovascular mortality, and cardiovascular events.

Reference:

Kaze AD, Santhanam P, Erqou S, Ahima RS, Bertoni AG, Echouffo-Tcheugui JB. Body Weight Variability and Risk of Cardiovascular Outcomes and Death in the Context of Weight Loss Intervention Among Patients With Type 2 Diabetes. JAMA Netw Open. 2022;5(2):e220055. doi:10.1001/jamanetworkopen.2022.0055