Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study

Zhu, Ruixin; Huttunen-Lenz, Maija; Stratton, Gareth; Handjieva-Darlenska, Teodora; Handjiev, Svetoslav; Sundvall, Jouko; Silvestre, Marta P.; Jalo, Elli; Pietiläinen, Kirsi H.; Adam, Tanja C.; Drummen, Mathijs; Simpson, Elizabeth J.; Taylor, Moira A.; Poppitt, Sally D.; Navas-Carretero, Santiago; Martinez, J. Alfredo; Schlicht, Wolfgang; Fogelholm, Mikael; Brand-Miller, Jennie; Raben, Anne

Abstract

Background/Objectives
Some individuals with overweight/obesity may be relatively metabolically healthy (MHO) and have a lower risk of cardiovascular disease than those with metabolically unhealthy overweight/obesity (MUO). We aimed to compare changes in body weight and cardiometabolic risk factors and type 2 diabetes incidence during a lifestyle intervention between individuals with MHO vs MUO.

Methods
This post-hoc analysis included 1012 participants with MHO and 1153 participants with MUO at baseline in the randomized trial PREVIEW. Participants underwent an eight-week low-energy diet phase followed by a 148-week lifestyle-based weight-maintenance intervention. Adjusted linear mixed models and Cox proportional hazards regression models were used.

Results
There were no statistically significant differences in weight loss (%) between participants with MHO vs MUO over 156 weeks. At the end of the study, weight loss was 2.7% (95% CI, 1.7%–3.6%) in participants with MHO and 3.0% (2.1%–4.0%) in those with MUO. After the low-energy diet phase, participants with MHO had smaller decreases in triglyceride (mean difference between MHO vs MUO 0.08 mmol·L−1 [95% CI, 0.04–0.12]; P < 0.001) but similar reductions in fasting glucose and HOMA-IR than those with MUO. However, at the end of weight maintenance, those with MHO had greater reductions in triglyceride (mean difference −0.08 mmol·L−1 [−0.12–−0.04]; P < 0.001), fasting glucose, 2-hour glucose (difference −0.28 mmol·L−1 [−0.41–−0.16]; P < 0.001), and HOMA-IR than those with MUO. Participants with MHO had smaller decreases in diastolic blood pressure and HbA1c and greater decreases in HDL cholesterol after weight loss than those with MUO, whereas the statistically significant differences disappeared at the end of weight maintenance. Participants with MHO had lower 3-year type 2 diabetes incidence than those with MUO (adjusted hazard ratio 0.37 [0.20–0.66]; P < 0.001).

Conclusions
Individuals with MUO had greater improvements in some cardiometabolic risk factors during the low-energy diet phase, but had smaller improvements during long-term lifestyle intervention than those with MHO.

Citation

Zhu, R., Huttunen-Lenz, M., Stratton, G., Handjieva-Darlenska, T., Handjiev, S., Sundvall, J., Silvestre, M. P., Jalo, E., Pietiläinen, K. H., Adam, T. C., Drummen, M., Simpson, E. J., Taylor, M. A., Poppitt, S. D., Navas-Carretero, S., Martinez, J. A., Schlicht, W., Fogelholm, M., Brand-Miller, J., & Raben, A. (2023). Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study. International Journal of Obesity, 47(9), 833–840. https://doi.org/10.1038/s41366-023-01328-y

• Journal Article Type: Article
• Acceptance Date: Jun 1, 2023
• Online Publication Date: Jul 7, 2023
• Publication Date: 2023-09
• Deposit Date: Aug 18, 2023
• Publicly Available Date: Jan 8, 2024
• Journal: International Journal of Obesity
• Print ISSN: 0307-0565
• Electronic ISSN: 1476-5497
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Issue: 9
• Pages: 833–840
• DOI: https://doi.org/10.1038/s41366-023-01328-y
• Keywords: Nutrition and Dietetics; Endocrinology, Diabetes and Metabolism; Medicine (miscellaneous)
• Public URL: https://nottingham-repository.worktribe.com/output/23005534
• Publisher URL: https://www.nature.com/articles/s41366-023-01328-y
• Additional Information: Received: 13 January 2023; Revised: 15 May 2023; Accepted: 1 June 2023; First Online: 7 July 2023; : AR has received honorariums from the International Sweeteners Association and Unilever. JB-M is President and Director of the Glycemic Index Foundation, oversees of a glycemic index testing service at the University of Sydney and is a co-author of books about diet and diabetes. She is also a member of the Scientific Advisory Board of the Novo Foundation and of ZOE Global. SDP was the Fonterra Chair in Human Nutrition during the PREVIEW intervention. No relevant disclosures from other authors.; : The study was approved by Research Ethics Committees of the Capital Region, Coordinating Ethical Committee of HUS (Helsinki and Uusimaa Hospital District), Medical Ethics Committee of the Maastricht University Medical Centre, UK National Research Ethics Service (NRES) and East Midlands (Leicester) Ethics Committee, Research Ethics Committee of the University of Navarra, Commission on Ethics in Scientific Research with the Medical University-Sofia (KENIMUS), The University of Sydney, Human Research Ethics Committee (HREC), and Health and Disability Ethics Committees (HDEC).