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Johnson KC, Anderson A, Beavers KM, Crandall CJ, Hazuda HP, Lewis CE, Lipkin E, Schwartz AV, Pi-Sunyer FX, Zhao Q. The long-term effect of intentional weight loss on changes in bone mineral density in persons with type 2 diabetes: results from the Look AHEAD randomized trial. Arch Osteoporos 2023; 18:97. [PMID: 37452151 PMCID: PMC10348976 DOI: 10.1007/s11657-023-01303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Intentional weight loss has been shown to increase bone loss short term but the long-term effects are not known. Data from the Look AHEAD clinical trial shows that a long term intentional weight loss intervention was associated with greater bone loss at the hip in men. PURPOSE Intentional weight loss has been shown to increase bone loss short term and increase frailty fracture risk, but the long-term effects on bone mineral density (BMD) are not known. METHODS Data from a subgroup from the Look AHEAD (LA) multicenter, randomized clinical trial was used to evaluate whether a long term intentional weight loss intervention would increase bone loss. In a preplanned substudy, BMD was assessed at 5 of the 16 LA clinical centers using dual-energy X-ray absorptiometry at baseline, year 8, and the observational visit 12.6-16.3 years after randomization (year 12-16). RESULTS At year 8, bone density loss (%) was greater in the Intensive Lifestyle Intervention (ILI) group compared with the control group (DSE) for the femoral neck (p = 0.0122) but this finding was not observed at the year 12-16 visit. In analyses stratified by gender, bone density loss (%) was greater at the total hip for men in the ILI group than the DSE group at both the year 8 and year 12-16 visits (year 8 p = 0.0263 and year 12-16 p = 0.0062). This finding was not observed among women. CONCLUSION Long term intentional weight loss was associated with greater bone loss at the hip in men. These results taken with the previously published Look AHEAD data from the entire clinical trial showing increased frailty fracture risk with weight loss in the ILI group suggest that when intentional weight loss is planned, consideration of bone density preservation and fracture prevention strategies is warranted. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00017953. June 21, 2001.
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Affiliation(s)
- Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | | | - Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest Univesity, Winston-Salem, NC, USA
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Helen P Hazuda
- Univesity of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Cora E Lewis
- Depatment of Epidemiology, Univeristy of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Lipkin
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Ann V Schwartz
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - F X Pi-Sunyer
- Department of Medicine, Columbia University, New York, NY, USA
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Domalpally A, Whittier SA, Pan Q, Dabelea DM, Darwin CH, Knowler WC, Lee CG, Luchsinger JA, White NH, Chew EY, Gadde KM, Culbert IW, Arceneaux J, Chatellier A, Dragg A, Champagne CM, Duncan C, Eberhardt B, Greenway F, Guillory FG, Herbert AA, Jeffirs ML, Kennedy BM, Levy E, Lockett M, Lovejoy JC, Morris LH, Melancon LE, Ryan DH, Sanford DA, Smith KG, Smith LL, St.Amant JA, Tulley RT, Vicknair PC, Williamson D, Zachwieja JJ, Polonsky KS, Tobian J, Ehrmann DA, Matulik MJ, Temple KA, Clark B, Czech K, DeSandre C, Dotson B, Hilbrich R, McNabb W, Semenske AR, Caro JF, Furlong K, Goldstein BJ, Watson PG, Smith KA, Mendoza J, Simmons M, Wildman W, Liberoni R, Spandorfer J, Pepe C, Donahue RP, Goldberg RB, Prineas R, Calles J, Giannella A, Rowe P, Sanguily J, Cassanova-Romero P, Castillo-Florez S, Florez HJ, Garg R, Kirby L, Lara O, Larreal C, McLymont V, Mendez J, Perry A, Saab P, Veciana B, Haffner SM, Hazuda HP, Montez MG, Hattaway K, Isaac J, Lorenzo C, Martinez A, Salazar M, Walker T, Hamman RF, Nash PV, Steinke SC, Testaverde L, Truong J, Anderson DR, Ballonoff LB, Bouffard A, Bucca B, Calonge BN, Delve L, Farago M, Hill JO, Hoyer SR, Jenkins T, Jortberg BT, Lenz D, Miller M, Nilan T, Perreault L, Price DW, Regensteiner JG, Schroeder EB, Seagle H, Smith CM, VanDorsten B, Horton ES, Munshi M, Lawton KE, Jackson SD, Poirier CS, Swift K, Arky RA, Bryant M, Burke JP, Caballero E, Callaphan KM, Fargnoli B, Franklin T, Ganda OP, Guidi A, Guido M, Jacobsen AM, Kula LM, Kocal M, Lambert L, Ledbury S, Malloy MA, Middelbeek RJ, Nicosia M, Oldmixon CF, Pan J, Quitingon M, Rainville R, Rubtchinsky S, Seely EW, Sansoucy J, Schweizer D, Simonson D, Smith F, Solomon CG, Spellman J, Warram J, Kahn SE, Fattaleh B, Montgomery BK, Colegrove C, Fujimoto W, Knopp RH, Lipkin EW, Marr M, Morgan-Taggart I, Murillo A, O’Neal K, Trence D, Taylor L, Thomas A, Tsai EC, Dagogo-Jack S, Kitabchi AE, Murphy ME, Taylor L, Dolgoff J, Applegate WB, Bryer-Ash M, Clark D, Frieson SL, Ibebuogu U, Imseis R, Lambeth H, Lichtermann LC, Oktaei H, Ricks H, Rutledge LM, Sherman AR, Smith CM, Soberman JE, Williams-Cleaves B, Patel A, Nyenwe EA, Hampton EF, Metzger BE, Molitch ME, Johnson MK, Adelman DT, Behrends C, Cook M, Fitzgibbon M, Giles MM, Heard D, Johnson CK, Larsen D, Lowe A, Lyman M, McPherson D, Penn SC, Pitts T, Reinhart R, Roston S, Schinleber PA, Wallia A, Nathan DM, McKitrick C, Turgeon H, Larkin M, Mugford M, Abbott K, Anderson E, Bissett L, Bondi K, Cagliero E, Florez JC, Delahanty L, Goldman V, Grassa E, Gurry L, D’Anna K, Leandre F, Lou P, Poulos A, Raymond E, Ripley V, Stevens C, Tseng B, Olefsky JM, Barrett-Connor E, Mudaliar S, Araneta MR, Carrion-Petersen ML, Vejvoda K, Bassiouni S, Beltran M, Claravall LN, Dowden JM, Edelman SV, Garimella P, Henry RR, Horne J, Lamkin M, Janesch SS, Leos D, Polonsky W, Ruiz R, Smith J, Torio-Hurley J, Pi-Sunyer FX, Lee JE, Hagamen S, Allison DB, Agharanya N, Aronoff NJ, Baldo M, Crandall JP, Foo ST, Luchsinger JA, Pal C, Parkes K, Pena MB, Rooney ES, Van Wye GE, Viscovich KA, de Groot M, Marrero DG, Mather KJ, Prince MJ, Kelly SM, Jackson MA, McAtee G, Putenney P, Ackermann RT, Cantrell CM, Dotson YF, Fineberg ES, Fultz M, Guare JC, Hadden A, Ignaut JM, Kirkman MS, Phillips EO, Pinner KL, Porter BD, Roach PJ, Rowland ND, Wheeler ML, Aroda V, Magee M, Ratner RE, Youssef G, Shapiro S, Andon N, Bavido-Arrage C, Boggs G, Bronsord M, Brown E, Love Burkott H, Cheatham WW, Cola S, Evans C, Gibbs P, Kellum T, Leon L, Lagarda M, Levatan C, Lindsay M, Nair AK, Park J, Passaro M, Silverman A, Uwaifo G, Wells-Thayer D, Wiggins R, Saad MF, Watson K, Budget M, Jinagouda S, Botrous M, Sosa A, Tadros S, Akbar K, Conzues C, Magpuri P, Ngo K, Rassam A, Waters D, Xapthalamous K, Santiago JV, Brown AL, Das S, Khare-Ranade P, Stich T, Santiago A, Fisher E, Hurt E, Jones T, Kerr M, Ryder L, Wernimont C, Golden SH, Saudek CD, Bradley V, Sullivan E, Whittington T, Abbas C, Allen A, Brancati FL, Cappelli S, Clark JM, Charleston JB, Freel J, Horak K, Greene A, Jiggetts D, Johnson D, Joseph H, Loman K, Mathioudakis N, Mosley H, Reusing J, Rubin RR, Samuels A, Shields T, Stephens S, Stewart KJ, Thomas L, Utsey E, Williamson P, Schade DS, Adams KS, Canady JL, Johannes C, Hemphill C, Hyde P, Atler LF, Boyle PJ, Burge MR, Chai L, Colleran K, Fondino A, Gonzales Y, Hernandez-McGinnis DA, Katz P, King C, Middendorf J, Rubinchik S, Senter W, Crandall J, Shamoon H, Brown JO, Trandafirescu G, Powell D, Adorno E, Cox L, Duffy H, Engel S, Friedler A, Goldstein A, Howard-Century CJ, Lukin J, Kloiber S, Longchamp N, Martinez H, Pompi D, Scheindlin J, Violino E, Walker EA, Wylie-Rosett J, Zimmerman E, Zonszein J, Orchard T, Venditti E, Wing RR, Jeffries S, Koenning G, Kramer MK, Smith M, Barr S, Benchoff C, Boraz M, Clifford L, Culyba R, Frazier M, Gilligan R, Guimond S, Harrier S, Harris L, Kriska A, Manjoo Q, Mullen M, Noel A, Otto A, Pettigrew J, Rockette-Wagner B, Rubinstein D, Semler L, Smith CF, Weinzierl V, Williams KV, Wilson T, Mau MK, Baker-Ladao NK, Melish JS, Arakaki RF, Latimer RW, Isonaga MK, Beddow R, Bermudez NE, Dias L, Inouye J, Mikami K, Mohideen P, Odom SK, Perry RU, Yamamoto RE, Anderson H, Cooeyate N, Dodge C, Hoskin MA, Percy CA, Enote A, Natewa C, Acton KJ, Andre VL, Barber R, Begay S, Bennett PH, Benson MB, Bird EC, Broussard BA, Bucca BC, Chavez M, Cook S, Curtis J, Dacawyma T, Doughty MS, Duncan R, Edgerton C, Ghahate JM, Glass J, Glass M, Gohdes D, Grant W, Hanson RL, Horse E, Ingraham LE, Jackson M, Jay P, Kaskalla RS, Kavena K, Kessler D, Kobus KM, Krakoff J, Kurland J, Manus C, McCabe C, Michaels S, Morgan T, Nashboo Y, Nelson JA, Poirier S, Polczynski E, Piromalli C, Reidy M, Roumain J, Rowse D, Roy RJ, Sangster S, Sewenemewa J, Smart M, Spencer C, Tonemah D, Williams R, Wilson C, Yazzie M, Bain R, Fowler S, Temprosa M, Larsen MD, Brenneman T, Edelstein SL, Abebe S, Bamdad J, Barkalow M, Bethepu J, Bezabeh T, Bowers A, Butler N, Callaghan J, Carter CE, Christophi C, Dwyer GM, Foulkes M, Gao Y, Gooding R, Gottlieb A, Grimes KL, Grover-Fairchild N, Haffner L, Hoffman H, Jablonski K, Jones S, Jones TL, Katz R, Kolinjivadi P, Lachin JM, Ma Y, Mucik P, Orlosky R, Reamer S, Rochon J, Sapozhnikova A, Sherif H, Stimpson C, Hogan Tjaden A, Walker-Murray F, Venditti EM, Kriska AM, Weinzierl V, Marcovina S, Aldrich FA, Harting J, Albers J, Strylewicz G, Eastman R, Fradkin J, Garfield S, Lee C, Gregg E, Zhang P, O’Leary D, Evans G, Budoff M, Dailing C, Stamm E, Schwartz A, Navy C, Palermo L, Rautaharju P, Prineas RJ, Alexander T, Campbell C, Hall S, Li Y, Mills M, Pemberton N, Rautaharju F, Zhang Z, Soliman EZ, Hu J, Hensley S, Keasler L, Taylor T, Blodi B, Danis R, Davis M, Hubbard* L, Endres** R, Elsas** D, Johnson** S, Myers** D, Barrett N, Baumhauer H, Benz W, Cohn H, Corkery E, Dohm K, Gama V, Goulding A, Ewen A, Hurtenbach C, Lawrence D, McDaniel K, Pak J, Reimers J, Shaw R, Swift M, Vargo P, Watson S, Manly J, Mayer-Davis E, Moran RR, Ganiats T, David K, Sarkin AJ, Groessl E, Katzir N, Chong H, Herman WH, Brändle M, Brown MB, Altshuler D, Billings LK, Chen L, Harden M, Knowler WC, Pollin TI, Shuldiner AR, Franks PW, Hivert MF. Association of Metformin With the Development of Age-Related Macular Degeneration. JAMA Ophthalmol 2023; 141:140-147. [PMID: 36547967 PMCID: PMC9936345 DOI: 10.1001/jamaophthalmol.2022.5567] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022]
Abstract
Importance Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD. Objective To investigate the association between metformin use and age-related macular degeneration (AMD). Design, Setting, and Participants The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for developing diabetes. Participants with retinal imaging at a follow-up visit 16 years posttrial (2017-2019) were included. Analysis took place between October 2019 and May 2022. Interventions Participants were randomly distributed between 3 interventional arms: lifestyle, metformin, and placebo. Main Outcomes and Measures Prevalence of AMD in the treatment arms. Results Of 1592 participants, 514 (32.3%) were in the lifestyle arm, 549 (34.5%) were in the metformin arm, and 529 (33.2%) were in the placebo arm. All 3 arms were balanced for baseline characteristics including age (mean [SD] age at randomization, 49 [9] years), sex (1128 [71%] male), race and ethnicity (784 [49%] White), smoking habits, body mass index, and education level. AMD was identified in 479 participants (30.1%); 229 (14.4%) had early AMD, 218 (13.7%) had intermediate AMD, and 32 (2.0%) had advanced AMD. There was no significant difference in the presence of AMD between the 3 groups: 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups. Mean duration of metformin use was similar for those with and without AMD (mean [SD], 8.0 [9.3] vs 8.5 [9.3] years; P = .69). In the multivariate models, history of smoking was associated with increased risks of AMD (odds ratio, 1.30; 95% CI, 1.05-1.61; P = .02). Conclusions and Relevance These data suggest neither metformin nor lifestyle changes initiated for diabetes prevention were associated with the risk of any AMD, with similar results for AMD severity. Duration of metformin use was also not associated with AMD. This analysis does not address the association of metformin with incidence or progression of AMD.
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Affiliation(s)
- Amitha Domalpally
- Wisconsin Reading Center, Department of Ophthalmology, University of Wisconsin School of Medicine and Public and Health, Madison
| | - Samuel A. Whittier
- Wisconsin Reading Center, Department of Ophthalmology, University of Wisconsin School of Medicine and Public and Health, Madison
| | - Qing Pan
- Department of Statistics, George Washington University, Washington, DC
| | - Dana M. Dabelea
- Department of Epidemiology, University of Colorado School of Public Health, Denver
| | - Christine H. Darwin
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Christine G. Lee
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Neil H. White
- Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Emily Y. Chew
- Division of Epidemiology and Clinical Applications–Clinical Trials Branch, National Eye Institute - National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Amber Dragg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Crystal Duncan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Frank Greenway
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Erma Levy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Monica Lockett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Donna H. Ryan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Lisa L. Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Janet Tobian
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Bart Clark
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kirsten Czech
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Wylie McNabb
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jose F. Caro
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kevin Furlong
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jewel Mendoza
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marsha Simmons
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Wendi Wildman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Renee Liberoni
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Constance Pepe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Ronald Prineas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anna Giannella
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Patricia Rowe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Rajesh Garg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Olga Lara
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carmen Larreal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jadell Mendez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Arlette Perry
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Patrice Saab
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Bertha Veciana
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kathy Hattaway
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Juan Isaac
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carlos Lorenzo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Monica Salazar
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tatiana Walker
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | | | - Brian Bucca
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - B. Ned Calonge
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lynne Delve
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Martha Farago
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James O. Hill
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Tonya Jenkins
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Dione Lenz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marsha Miller
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Nilan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - David W. Price
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Helen Seagle
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Medha Munshi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kati Swift
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ronald A. Arky
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Om P. Ganda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ashley Guidi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Mathew Guido
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Lyn M. Kula
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Margaret Kocal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lori Lambert
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sarah Ledbury
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Jocelyn Pan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Ellen W. Seely
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Dana Schweizer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Fannie Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - James Warram
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Steven E. Kahn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Basma Fattaleh
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Michelle Marr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anne Murillo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kayla O’Neal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dace Trence
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lonnese Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - April Thomas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Elaine C. Tsai
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mary E. Murphy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Laura Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Debra Clark
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Uzoma Ibebuogu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Raed Imseis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helen Lambeth
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hooman Oktaei
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Harriet Ricks
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Amy R. Sherman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Clara M. Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Avnisha Patel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | - Michelle Cook
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Mimi M. Giles
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Deloris Heard
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Diane Larsen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anne Lowe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Megan Lyman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Samsam C. Penn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Pitts
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Renee Reinhart
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Roston
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Amisha Wallia
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Mary Larkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Kathy Abbott
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ellen Anderson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Laurie Bissett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristy Bondi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jose C. Florez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Elaine Grassa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lindsery Gurry
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kali D’Anna
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Peter Lou
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Elyse Raymond
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Valerie Ripley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Beverly Tseng
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Karen Vejvoda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | - Javiva Horne
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marycie Lamkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Diana Leos
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rosa Ruiz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jean Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Jane E. Lee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Hagamen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Maria Baldo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sandra T. Foo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Carmen Pal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kathy Parkes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Mary Beth Pena
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Mary de Groot
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Susie M. Kelly
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Gina McAtee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Paula Putenney
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Megan Fultz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - John C. Guare
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Angela Hadden
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kisha L Pinner
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Paris J. Roach
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Vanita Aroda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Michelle Magee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Sue Shapiro
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Natalie Andon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Susan Cola
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Cindy Evans
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Peggy Gibbs
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tracy Kellum
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lilia Leon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Milvia Lagarda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Asha K. Nair
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jean Park
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Gabriel Uwaifo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Renee Wiggins
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Karol Watson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maria Budget
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Medhat Botrous
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anthony Sosa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sameh Tadros
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Khan Akbar
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Kathy Ngo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Amer Rassam
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Debra Waters
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Samia Das
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Tamara Stich
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ana Santiago
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Edwin Fisher
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Emma Hurt
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tracy Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Michelle Kerr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lucy Ryder
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Emily Sullivan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Caroline Abbas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Adrienne Allen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Janice Freel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Alicia Greene
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dawn Jiggetts
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hope Joseph
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kimberly Loman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Henry Mosley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - John Reusing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Alafia Samuels
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Shields
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - LeeLana Thomas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Evonne Utsey
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Penny Hyde
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mark R. Burge
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Chai
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ateka Fondino
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ysela Gonzales
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Patricia Katz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carolyn King
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jill Crandall
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Harry Shamoon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Janet O. Brown
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Elsie Adorno
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Liane Cox
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helena Duffy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Samuel Engel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jennifer Lukin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Stacey Kloiber
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Helen Martinez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dorothy Pompi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Elissa Violino
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Joel Zonszein
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Trevor Orchard
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rena R. Wing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Jeffries
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Gaye Koenning
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - M. Kaye Kramer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marie Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Barr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Miriam Boraz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Clifford
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Rebecca Culyba
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ryan Gilligan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Susan Harrier
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Louann Harris
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Andrea Kriska
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Monica Mullen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Alicia Noel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Amy Otto
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Linda Semler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Tara Wilson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - John S. Melish
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mae K. Isonaga
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ralph Beddow
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Lorna Dias
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jillian Inouye
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kathy Mikami
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sharon K. Odom
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Mary A. Hoskin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carol A. Percy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Alvera Enote
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Camille Natewa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kelly J. Acton
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rosalyn Barber
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Shandiin Begay
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Evelyn C. Bird
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Brian C. Bucca
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sherron Cook
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jeff Curtis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tara Dacawyma
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Roberta Duncan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Cyndy Edgerton
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Justin Glass
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Martia Glass
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dorothy Gohdes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Wendy Grant
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ellie Horse
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Merry Jackson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Priscilla Jay
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Karen Kavena
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - David Kessler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Jason Kurland
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Cherie McCabe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sara Michaels
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tina Morgan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Steven Poirier
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mike Reidy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Debra Rowse
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert J. Roy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Miranda Smart
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Darryl Tonemah
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Raymond Bain
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sarah Fowler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Tina Brenneman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Solome Abebe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Julie Bamdad
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Joel Bethepu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anna Bowers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Nicole Butler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Mary Foulkes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yuping Gao
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert Gooding
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Lori Haffner
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Steve Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tara L. Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Richard Katz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - John M. Lachin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yong Ma
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Pamela Mucik
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert Orlosky
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Reamer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James Rochon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hanna Sherif
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | | | | | - John Albers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - R. Eastman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Judith Fradkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Christine Lee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Edward Gregg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ping Zhang
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dan O’Leary
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Gregory Evans
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Matthew Budoff
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Chris Dailing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ann Schwartz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Caroline Navy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Palermo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Sharon Hall
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yabing Li
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Margaret Mills
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Zhuming Zhang
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Julie Hu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Hensley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Keasler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tonya Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Barbara Blodi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ronald Danis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Matthew Davis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Larry Hubbard*
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ryan Endres**
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Dawn Myers**
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Nancy Barrett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Wendy Benz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Holly Cohn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ellie Corkery
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristi Dohm
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Vonnie Gama
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anne Goulding
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Andy Ewen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Kyle McDaniel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jeong Pak
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James Reimers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ruth Shaw
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maria Swift
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Pamela Vargo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sheila Watson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jennifer Manly
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Ted Ganiats
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristin David
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Erik Groessl
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Naomi Katzir
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helen Chong
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Ling Chen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maegan Harden
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Toni I. Pollin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Paul W. Franks
- for the Diabetes Prevention Program Research (DPPOS) Group
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3
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Hazuda HP, Pan Q, Florez H, Luchsinger JA, Crandall JP, Venditti EM, Golden SH, Kriska AM, Bray GA. Association of Intensive Lifestyle and Metformin Interventions With Frailty in the Diabetes Prevention Program Outcomes Study. J Gerontol A Biol Sci Med Sci 2021; 76:929-936. [PMID: 33428709 DOI: 10.1093/gerona/glaa295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors that results in increased vulnerability to adverse health outcomes with aging. Diabetes and hyperglycemia are established risk factors for frailty. We sought to examine whether the odds of frailty among individuals at high risk of diabetes randomized to treatment with intensive lifestyle (ILS), metformin, or placebo differed after long-term follow-up. METHOD The sample comprised participants in the Diabetes Prevention Program (DPP) clinical trial, who continued follow-up in the DPP Outcomes Study (DPPOS) and completed frailty assessments in DPPOS Years 8 (n = 2385) and 10 (n = 2289), approximately 12 and 14 years after DPP randomization. Frailty was classified using Fried Frailty Phenotype criteria. GEE models adjusting for visit year with repeated measures pooled for Years 8 and 10 were used to estimate pairwise odds ratios (ORs) between ILS, metformin, and placebo for the outcomes of frail and prefrail versus nonfrail. RESULTS Frailty prevalence by treatment group was ILS = 3.0%, metformin = 5.4%, placebo = 5.7% at Year 8, and ILS = 3.6%, metformin = 5.3%, placebo = 5.4% at Year 10. Odds ratios (95% CI) estimated with GEE models were ILS versus placebo, 0.62 (0.42-0.93), p = .022; metformin versus placebo, 0.99 (0.69-1.42), p = .976; and ILS versus metformin, 0.63 (0.42-0.94), p = .022. Odds of being frail versus nonfrail were 37% lower for ILS compared to metformin and placebo. CONCLUSIONS Early ILS intervention, at an average age of about 50 years, in persons at high risk of diabetes may reduce frailty prevalence in later life. Metformin may be ineffective in reducing frailty prevalence. CLINICAL TRIALS REGISTRATION NUMBERS NCT00004992 (DPP) and NCT00038727 (DPPOS).
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Affiliation(s)
- Helen P Hazuda
- University of Texas Health Science Center at San Antonio
| | - Qing Pan
- Biostatistics Center, The George Washington University
| | | | | | | | | | | | | | - George A Bray
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
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4
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Wadden TA, Chao AM, Anderson H, Annis K, Atkinson K, Bolin P, Brantley P, Clark JM, Coday M, Dutton G, Foreyt JP, Gregg EW, Hazuda HP, Hill JO, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Korytkowski M, Lewis CE, Laferrère B, Middelbeek RJ, Munshi MN, Nathan DM, Neiberg RH, Pilla SJ, Peters A, Pi-Sunyer X, Rejeski JW, Redmon B, Stewart T, Vaughan E, Wagenknecht LE, Walkup MP, Wing RR, Wyatt H, Yanovski SZ, Zhang P. Changes in mood and health-related quality of life in Look AHEAD 6 years after termination of the lifestyle intervention. Obesity (Silver Spring) 2021; 29:1294-1308. [PMID: 34258889 PMCID: PMC8903054 DOI: 10.1002/oby.23191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The Action for Health in Diabetes (Look AHEAD) study previously reported that intensive lifestyle intervention (ILI) reduced incident depressive symptoms and improved health-related quality of life (HRQOL) over nearly 10 years of intervention compared with a control group (the diabetes support and education group [DSE]) in participants with type 2 diabetes and overweight or obesity. The present study compared incident depressive symptoms and changes in HRQOL in these groups for an additional 6 years following termination of the ILI in September 2012. METHODS A total of 1,945 ILI participants and 1,900 DSE participants completed at least one of four planned postintervention assessments at which weight, mood (via the Patient Health Questionnaire-9), antidepressant medication use, and HRQOL (via the Medical Outcomes Scale, Short Form-36) were measured. RESULTS ILI participants and DSE participants lost 3.1 (0.3) and 3.8 (0.3) kg [represented as mean (SE); p = 0.10], respectively, during the 6-year postintervention follow-up. No significant differences were observed between groups during this time in incident mild or greater symptoms of depression, antidepressant medication use, or in changes on the physical component summary or mental component summary scores of the Short Form-36. In both groups, mental component summary scores were higher than physical component summary scores. CONCLUSIONS Prior participation in the ILI, compared with the DSE group, did not appear to improve subsequent mood or HRQOL during 6 years of postintervention follow-up.
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Affiliation(s)
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ariana M. Chao
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Harelda Anderson
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona and Shiprock, NM, USA
| | - Kirsten Annis
- Department of Psychiatry, Alpert Medical School at Brown University, The Miriam Hospital, Providence, RI, USA
| | - Karen Atkinson
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veteran Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Paula Bolin
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona and Shiprock, NM, USA
| | | | - Jeanne M. Clark
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gareth Dutton
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - John P. Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Edward W. Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Helen P. Hazuda
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James O. Hill
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Van S. Hubbard
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - John M. Jakicic
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Karen C. Johnson
- Departments of Preventitive Medicine and Psychiatry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Steven E. Kahn
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veteran Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - William C. Knowler
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona and Shiprock, NM, USA
| | - Mary Korytkowski
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Blandine Laferrère
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - David M. Nathan
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca H. Neiberg
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Scott J. Pilla
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Peters
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jack W. Rejeski
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Bruce Redmon
- Department of Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, MN, USA
| | | | | | - Lynne E. Wagenknecht
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael P. Walkup
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Rena R. Wing
- Department of Psychiatry, Alpert Medical School at Brown University, The Miriam Hospital, Providence, RI, USA
| | - Holly Wyatt
- Department of Medicine, School of Medicine,University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Z. Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - Ping Zhang
- Centers for Disease Control and Prevention, DDT Health Economics Workgroup Atlanta, GA, USA
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5
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Martinez P, Birnbaum L, Wang CP, Seshadri S, Hazuda HP. Abstract P642: Original and Revised Framingham Stroke Risk Profile Performance in a South Texas Bi-Ethnic Cohort. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The original Framingham Stroke Risk Profile (oFSRP) was designed to predict first-time, 10-year stroke risk and has been updated as the revised FSRP (rFSRP) to reflect current temporal trends in stroke. We assessed the performance of both profiles in a South Texas bi-ethnic cohort which includes European Americans (EA) and Mexican Americans (MA).
Methods:
Both profiles were calculated from a sample of the San Antonio Longitudinal Study of Aging (SALSA) cohort and included 439 subjects (69.4 +/-3.3 years), 265 (60%) women, and 225 (51%) MA. All subjects were aged 65 and older, stroke-free at baseline examination performed from 1992-1996, and followed for up to 12 years. Calibration of both profiles was assessed using the Hosmer-Lemeshow goodness-of-fit test and by comparing the expected with the observed 10-year stroke risks. C-statistics were calculated for the overall SALSA cohort and subgroups by sex and ethnicity with outcome of first-time stroke.
Results:
After a mean follow-up of 9.3 +/- 2.0 years, a total of 55 (12.6%) stroke events occurred. Predicted stroke risks using the oFSRP and rFSRP were 13.2% and 9.1%, respectively (Table). Overall, neither profile demonstrated good calibration (p<0.001); however, by subgroup analysis, the rFSRP had good calibration for stroke events in men (p=.07), women (p=0.14), MA (p=0.08) and EA (p=0.64) (Table). The rFSRP and oFSRP c-statistics for stroke events were 0.81 (0.79-0.82) and 0.78 (0.75-0.80), respectively.
Conclusions:
Compared to the oFSRP, the rFSRP signaled better fit and discriminative ability for predicting 10-year stroke risk in our SALSA cohort sample. Although the rFSRP downgraded stroke risk, our sample spanned the 1990s and early 2000s and thus, may not represent current healthy lifestyle and stroke prevention trends. Our findings support the use of the rFSRP, rather than the oFSRP, for MA in South Texas and highlight the need for further studies with ongoing multi-ethnic cohorts.
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Affiliation(s)
| | | | - Chen-Pin Wang
- Dept of Population Health Sciences UTHSA, San Antonio, TX
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6
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Zhang P, Atkinson KM, Bray GA, Chen H, Clark JM, Coday M, Dutton GR, Egan C, Espeland MA, Evans M, Foreyt JP, Greenway FL, Gregg EW, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Huckfeldt PJ, Jackson SD, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Killean T, Knowler WC, Korytkowski M, Lewis CE, Maruthur NM, Michaels S, Montez MG, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Rushing JT, Steinburg H, Wadden TA, Wing RR, Wyatt H, Yanovski SZ. Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study. Diabetes Care 2021; 44:67-74. [PMID: 33168654 PMCID: PMC7783933 DOI: 10.2337/dc20-0358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during their first 9 years of study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars. RESULTS Over the 9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.07 and 0.15, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. CONCLUSIONS Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.
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Affiliation(s)
- Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen M Atkinson
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mace Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Gareth R Dutton
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Frank L Greenway
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, U.K
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James O Hill
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Peter J Huckfeldt
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Robert W Jeffery
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - Tina Killean
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Nisa M Maruthur
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Maria G Montez
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - David M Nathan
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Jennifer Patricio
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY
| | - Anne Peters
- Houston Methodist Research Institute, Baylor College of Medicine, Houston, TX
| | - Xavier Pi-Sunyer
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY
| | - Henry Pownall
- Division of Endocrinology and Diabetes, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Redmon
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Julia T Rushing
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Helmut Steinburg
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia, PA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
| | - Holly Wyatt
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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7
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Perkins HS, Freed AA, Cortez JD, Hazuda HP. Inpatient Culture and Satisfaction With Care: A Novel Perspective. Am J Med Sci 2020; 361:226-232. [PMID: 33097197 DOI: 10.1016/j.amjms.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospital professionals must attend to patients' satisfaction with care. Along with technical quality of care, patients' personal characteristics may affect that satisfaction, but standard demographics research often overlooks cultural links. METHODS We, therefore, asked 58 San Antonio, Texas, inpatients their satisfaction with care and examined responses for attitudes related to ethnic-Mexican-American (MA), Euro-American (EA), or African-American (AA)-and gender cultures. RESULTS Many attitudes occurred widely. Most respondents expected doctors to attend them faithfully, inform them honestly, and pursue their needs and wishes singularly. Most also trusted doctors, and expressed satisfaction with doctors' generally exemplary character and service ethic. But most respondents also feared hospital treatments, and some expressed dissatisfaction that doctors had inadequately informed them or ignored their wishes. Only rare attitudes distinguished particular ethnic-gender groups. Unlike other groups few EA or AA men expressed dissatisfactions. But some MA and EA women said hospitals use too many caregivers or coordinate care poorly. Furthermore, most AA women expressed no explicit trust in doctors, and most EA women expressed actual distrust of doctors, often doubting their technical competence or altruism. CONCLUSIONS These findings suggest a novel perspective: a unique inpatient culture, largely unaffected by ethnic group or gender. Patients interpret their hospital experience through that culture. Hospital professionals might respond with both universal measures (addressing patients' fears, dissatisfactions, and distrust) and targeted ones (explicitly asking EA and AA men about dissatisfactions, and AA and EA women about distrust). Such culturally grounded measures may help maintain or increase inpatients' satisfaction.
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Affiliation(s)
- Henry S Perkins
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas; Ecumenical Center for Religion and Health, San Antonio, Texas; Ecumenical Center for Religion and Health, Cincinnati, Ohio.
| | - Alisa A Freed
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas; South Shore Medical Center, South Shore Health System, Norwell, Massachusetts
| | - Josie D Cortez
- Intercultural Development Research Association, San Antonio, Texas
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas
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8
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Espeland MA, Gaussoin SA, Bahnson J, Vaughan EM, Knowler WC, Simpson FR, Hazuda HP, Johnson KC, Munshi MN, Coday M, Pi-Sunyer X. Impact of an 8-Year Intensive Lifestyle Intervention on an Index of Multimorbidity. J Am Geriatr Soc 2020; 68:2249-2256. [PMID: 33267558 PMCID: PMC8299520 DOI: 10.1111/jgs.16672] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Type 2 diabetes mellitus and obesity are sometimes described as conditions that accelerate aging. Multidomain lifestyle interventions have shown promise to slow the accumulation of age-related diseases, a hallmark of aging. However, they have not been assessed among at-risk individuals with these two conditions. We examined the relative impact of 8 years of a multidomain lifestyle intervention on an index of multimorbidity. DESIGN Randomized controlled clinical trial comparing an intensive lifestyle intervention (ILI) that targeted weight loss through caloric restriction and increased physical activity with a control condition of diabetes support and education (DSE). SETTING Sixteen U.S. academic centers. PARTICIPANTS A total of 5,145 volunteers, aged 45 to 76, with established type 2 diabetes mellitus and overweight or obesity who met eligibility criteria for a randomized controlled clinical trial. MEASUREMENTS A multimorbidity index that included nine age-related chronic diseases and death was tracked over 8 years of intervention delivery. RESULTS Among individuals assigned to DSE, the multimorbidity index scores increased by an average of .98 (95% confidence interval [CI] = .94-1.02) over 8 years, compared with .89 (95% CI = .85-.93) among those in the multidomain ILI, which was a 9% difference (P = .003). Relative intervention effects were similar among individuals grouped by baseline body mass index, age, and sex, and they were greater for those with lower levels of multimorbidity index scores at baseline. CONCLUSIONS Increases in multimorbidity over time among adults with overweight or obesity and type 2 diabetes mellitus may be slowed by multidomain ILI. J Am Geriatr Soc 68:2249-2256, 2020.
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Affiliation(s)
- Mark A. Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah A. Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Felicia R. Simpson
- Department of Mathematics, Winston-Salem State University, Winston-Salem, NC 27110
| | - Helen P. Hazuda
- Department of Clinical Epidemiology, University of Texas Health Science Center, San Antonio, TX
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Medha N. Munshi
- Joslin Geriatric Diabetes Program, Joslin Diabetes Center, Boston, MA
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Xavier Pi-Sunyer
- Department of Medicine, Columbia University School of Medicine, New York, NY
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9
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Yeh HC, Bantle JP, Cassidy-Begay M, Blackburn G, Bray GA, Byers T, Clark JM, Coday M, Egan C, Espeland MA, Foreyt JP, Garcia K, Goldman V, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Korytkowski M, Kure A, Lewis CE, Mantzoros C, Meacham M, Montez MG, Nathan DM, Pajewski N, Patricio J, Peters A, Xavier Pi-Sunyer F, Pownall H, Ryan DH, Safford M, Sedjo RL, Steinburg H, Vitolins M, Wadden TA, Wagenknecht LE, Wing RR, Wolff AC, Wyatt H, Yanovski SZ. Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial. Obesity (Silver Spring) 2020; 28:1678-1686. [PMID: 32841523 PMCID: PMC8855671 DOI: 10.1002/oby.22936] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. METHODS Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer. RESULTS After a median follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68-1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80-1.08), incidence of nonobesity-related cancers (HR, 1.02; 95% CI: 0.83-1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68-1.25). CONCLUSIONS An ILI aimed at weight loss lowered incidence of obesity-related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.
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Affiliation(s)
- Hsin-Chieh Yeh
- Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P Bantle
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria Cassidy-Begay
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - George Blackburn
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Tim Byers
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeanne M Clark
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Caitlin Egan
- Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Katelyn Garcia
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Valerie Goldman
- Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Louise Hesson
- Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edward S Horton
- Department of Medicine, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven E Kahn
- Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Kure
- Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA
| | - Cora E Lewis
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Maria Meacham
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Maria G Montez
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David M Nathan
- Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicholas Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Anne Peters
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Henry Pownall
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Helmut Steinburg
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rena R Wing
- Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Antonio C Wolff
- Department of Oncology, The Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Holly Wyatt
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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10
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Chao AM, Wadden TA, Berkowitz RI, Blackburn G, Bolin P, Clark JM, Coday M, Curtis JM, Delahanty LM, Dutton GR, Evans M, Ewing LJ, Foreyt JP, Gay LJ, Gregg EW, Hazuda HP, Hill JO, Horton ES, Houston DK, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Kure A, Michalski KL, Montez MG, Neiberg RH, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Redmon B, Rejeski WJ, Steinburg H, Walker M, Williamson DA, Wing RR, Wyatt H, Yanovski SZ, Zhang P. Weight Change 2 Years After Termination of the Intensive Lifestyle Intervention in the Look AHEAD Study. Obesity (Silver Spring) 2020; 28:893-901. [PMID: 32320144 PMCID: PMC7437140 DOI: 10.1002/oby.22769] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study evaluated weight changes after cessation of the 10-year intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. It was hypothesized that ILI participants would be more likely to gain weight during the 2-year observational period following termination of weight-loss-maintenance counseling than would participants in the diabetes support and education (DSE) control group. METHODS Look AHEAD was a randomized controlled trial that compared the effects of ILI and DSE on cardiovascular morbidity and mortality in participants with overweight/obesity and type 2 diabetes. Look AHEAD was converted to an observational study in September 2012. RESULTS Two years after the end of the intervention (EOI), ILI and DSE participants lost a mean (SE) of 1.2 (0.2) kg and 1.8 (0.2) kg, respectively (P = 0.003). In addition, 31% of ILI and 23.9% of DSE participants gained ≥ 2% (P < 0.001) of EOI weight, whereas 36.3% and 45.9% of the respective groups lost ≥ 2% of EOI weight (P = 0.001). Two years after the EOI, ILI participants reported greater use of weight-control behaviors than DSE participants. CONCLUSIONS Both groups lost weight during the 2-year follow-up period, but more ILI than DSE participants gained ≥ 2% of EOI weight. Further understanding is needed of factors that affected long-term weight change in both groups.
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Affiliation(s)
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert I Berkowitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Blackburn
- Division of Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Paula Bolin
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mace Coday
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeffrey M Curtis
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Linda M Delahanty
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary Evans
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Linda J Ewing
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Linda J Gay
- Department of Psychiatry, The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helen P Hazuda
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James O Hill
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward S Horton
- Department of Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Denise K Houston
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - John M Jakicic
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W Jeffery
- Divisions of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen C Johnson
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | - William C Knowler
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anne Kure
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | - Katherine L Michalski
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria G Montez
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rebecca H Neiberg
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jennifer Patricio
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University, New York, New York, USA
| | - Anne Peters
- Division of Endocrinology, University of Southern California, Los Angeles, California, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University, New York, New York, USA
| | - Henry Pownall
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Reboussin
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Bruce Redmon
- Divisions of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Jack Rejeski
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Helmut Steinburg
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martha Walker
- Division of Endocrinology, University of Southern California, Los Angeles, California, USA
| | | | - Rena R Wing
- Department of Psychiatry, The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Holly Wyatt
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Lewis CE, Bantle JP, Bertoni AG, Blackburn G, Brancati FL, Bray GA, Cheskin LJ, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gibbs BB, Glasser S, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Kitzman D, Knowler WC, Lipkin E, Michaels S, Montez MG, Nathan DM, Nyenwe E, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Ryan DH, Wadden TA, Wagenknecht LE, Wyatt H, Wing RR, Yanovski SZ. History of Cardiovascular Disease, Intensive Lifestyle Intervention, and Cardiovascular Outcomes in the Look AHEAD Trial. Obesity (Silver Spring) 2020; 28:247-258. [PMID: 31898874 PMCID: PMC6980987 DOI: 10.1002/oby.22676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, there was suggestive evidence of heterogeneity for prespecified baseline CVD history subgroups (interaction P = 0.063). Event rates were higher in the ILI group among those with a CVD history (hazard ratio 1.13 [95% CI: 0.90-1.41]) and lower among those without CVD (hazard ratio 0.86 [95% CI: 0.72-1.02]). METHODS This study conducted post hoc analyses of the rates of the primary composite outcome and components, adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina, as well as three secondary composite cardiovascular outcomes. RESULTS Interaction P values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for nonfatal MI (P = 0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight loss and physical fitness, or hypoglycemic events. In those with a CVD history, statin use was high and similar by group. In those without a CVD history, low-density lipoprotein cholesterol levels were higher (P = 0.003) and statin use was lower (P ≤ 0.001) in the ILI group. CONCLUSIONS Intervention response heterogeneity was significant for nonfatal MI. Response heterogeneity may need consideration in a CVD-outcome trial design.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey M. Curtis
- Southwestern American Indian Center, Phoenix, AZ; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ; St. Joseph’s Hospital and Medical Center, Phoenix
| | - Caitlin Egan
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | | | | | - Helen P. Hazuda
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | - James O. Hill
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | | | - Van S. Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | - Steven E. Kahn
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | | | - William C. Knowler
- Southwestern American Indian Center, Phoenix; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Edward Lipkin
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | - Maria G. Montez
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | | | - Jennifer Patricio
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | - Anne Peters
- University of Southern California; Los Angeles, CA
| | - Xavier Pi-Sunyer
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | | | | | - Donna H. Ryan
- Pennington Biomedical Research Center; Baton Rouge, LA
| | | | | | - Holly Wyatt
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | - Rena R. Wing
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
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12
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Ganapathy V, Jacob ME, Short MI, Gonzales MM, Barrera CS, Seshadri S, Wang CP, Hazuda HP. THE HEALTHY AGING INDEX AND ITS ASSOCIATION WITH MORTALITY IN OLDER MEXICAN AND EUROPEAN AMERICANS. Innov Aging 2019. [PMCID: PMC6846529 DOI: 10.1093/geroni/igz038.3481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mexican Americans (MA) have higher morbidity compared to European Americans (EA); however, the mortality rate remains lower (Hispanic Paradox). The Healthy Aging Index (HAI) captures clinical and subclinical morbidity in older adults and is useful in examining ethnic differences in mortality for a given disease burden. We assessed the association between baseline HAI and all-cause mortality over 12 years of follow-up among older MAs (n=394) and EAs (n=355) in the San Antonio Longitudinal Study of Aging (SALSA) and examined differences between ethnic groups. HAI incorporates non-invasive measures (systolic blood pressure, forced vital capacity, creatinine, fasting plasma glucose (FPG), Mini-Mental State Exam). Missing baseline data for HAI components and covariates were imputed using multiple imputations. Proteinuria was used instead of creatinine due to non-availability. Scores of 0, 1, 2 were given from lowest to highest tertile HAI categories; diagnosis of diabetes, hypertension, and renal failure were included in the highest tertiles. Cox proportional hazards models estimated the association between HAI and mortality, adjusting for confounders. After adjusting for age, gender, education, income, BMI, smoking and ethnicity, HAI was independently associated with mortality (HR 1.25 (1.16-1.35), p-value <0.0001). We found no interaction effect between HAI and ethnicity on mortality ((p-value for interaction = 0.78). In the SALSA sample, HAI is a predictor of mortality after adjusting for confounders in both MAs and EAs. The absence of a significant HAI*ethnicity interaction effect further demonstrated that HAI works equally well as a predictor of mortality in both MAs and EAs.
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Affiliation(s)
- Vinutha Ganapathy
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, U T Health San Antonio, San Antonio, Texas, United States
| | - Mini E Jacob
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, U T Health San Antonio, San Antonio, Texas, United States
| | - Meghan I Short
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, U T Health San Antonio, San Antonio, Texas, United States
| | - Mitzi M Gonzales
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, U T Health San Antonio, San Antonio, Texas, United States
| | - Claudia Satizabal Barrera
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, U T Health San Antonio, San Antonio, Texas, United States
| | | | - Chen-pin Wang
- University of Texas Health Science Center, Texas, United States
| | - Helen P Hazuda
- U T Health San Antonio, San Antonio, Texas, United States
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13
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Houston DK, Neiberg RH, Miller ME, Hill JO, Jakicic JM, Johnson KC, Gregg EW, Hubbard VS, Pi-Sunyer X, Rejeski WJ, Wing RR, Bantle JP, Beale E, Berkowitz RI, Cassidy-Begay M, Clark JM, Coday M, Delahanty LM, Dutton G, Egan C, Foreyt JP, Greenway FL, Hazuda HP, Hergenroeder A, Horton ES, Jeffery RW, Kahn SE, Kure A, Knowler WC, Lewis CE, Martin CK, Michaels S, Montez MG, Nathan DM, Patricio J, Peters A, Pownall H, Regensteiner J, Steinburg H, Wadden TA, White K, Yanovski SZ, Zhang P, Kritchevsky SB. Physical Function Following a Long-Term Lifestyle Intervention Among Middle Aged and Older Adults With Type 2 Diabetes: The Look AHEAD Study. J Gerontol A Biol Sci Med Sci 2019; 73:1552-1559. [PMID: 29053861 DOI: 10.1093/gerona/glx204] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 01/26/2023] Open
Abstract
Background Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention (ILI) on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods Overweight and obese (body mass index ≥ 25 kg/m2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an ILI designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years postrandomization and 1.5 years after the intervention was stopped (n = 3,783). Results Individuals randomized to ILI had lower odds of slow gait speed (<0.8 m/s) compared to those randomized to DSE (adjusted OR [95% CI]: 0.84 [0.71 to 0.99]). Individuals randomized to ILI also had faster gait speed over 4- and 400-m (adjusted mean difference [95% CI]: 0.019 [0.007 to 0.031] m/s, p = .002, and 0.023 [0.012 to 0.034] m/sec, p < .0001, respectively) and higher SPPBexp scores (0.037 [0.011 to 0.063], p = .005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPBexp scores among older versus younger participants (0.081 [0.038 to 0.124] vs 0.013 [-0.021 to 0.047], p = .01). Conclusions An intensive lifestyle intervention has modest but significant long-term benefits on physical function in overweight and obese middle-aged and older adults with type 2 diabetes. ClinicalTrials.gov Identifier NCT00017953.
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Affiliation(s)
| | | | | | - James O Hill
- University of Colorado Denver School of Medicine, Aurora
| | | | | | | | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | | | - Rena R Wing
- Brown University and Miriam Hospital, Providence, Rhode Island
| | | | - Elizabeth Beale
- Keck School of Medicine of University of Southern California, Los Angeles
| | | | | | | | - Mace Coday
- University of Tennessee Health Science Center, Memphis
| | | | - Gareth Dutton
- University of Alabama at Birmingham School of Medicine
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, Providence, Rhode Island
| | | | | | - Helen P Hazuda
- University of Texas Health Science Center at San Antonio
| | | | - Edward S Horton
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Cora E Lewis
- University of Alabama at Birmingham School of Medicine
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Maria G Montez
- University of Texas Health Science Center at San Antonio
| | | | | | - Anne Peters
- Keck School of Medicine of University of Southern California, Los Angeles
| | | | | | | | - Thomas A Wadden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Karen White
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Ping Zhang
- Centers for Disease Control, Atlanta, Georgia
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14
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West DS, Dutton G, Delahanty LM, Hazuda HP, Rickman AD, Knowler WC, Vitolins MZ, Neiberg RH, Peters A, Gee M, Cassidy Begay M. Weight Loss Experiences of African American, Hispanic, and Non-Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial. Obesity (Silver Spring) 2019; 27:1275-1284. [PMID: 31338998 PMCID: PMC6658112 DOI: 10.1002/oby.22522] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups. METHODS Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors. RESULTS All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women. CONCLUSIONS Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.
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Affiliation(s)
- Delia Smith West
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Gareth Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda M Delahanty
- Diabetes Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen P Hazuda
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Amy D Rickman
- Department of Exercise & Rehabilitative Sciences, Slippery Rock University, Slippery Rock, Pennsylvania, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, NIDDK, Phoenix, Arizona, USA
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne Peters
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Molly Gee
- Behavioral Medicine Research Center, Baylor College of Medicine, Houston, Texas, USA
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15
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16
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Hazuda HP, Gaussoin SA, Wing RR, Yanovski SZ, Johnson KC, Coday M, Wadden TA, Horton ES, Van Dorsten B, Knowler WC. Long-term Association of Depression Symptoms and Antidepressant Medication Use With Incident Cardiovascular Events in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes. Diabetes Care 2019; 42:910-918. [PMID: 30833373 PMCID: PMC6489104 DOI: 10.2337/dc18-0575] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Preplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years. Depression symptoms, assessed with the Beck Depression Inventory (BDI), were analyzed both as a continuous and dichotomized variable (BDI score <10 or ≥10). ADM use was coded from participants' prescription medications. Four composite CVD outcomes were defined in the study protocol. Sex-stratified Cox proportional hazards models were adjusted for a range of baseline covariates. RESULTS Depression symptoms were only significantly associated with a composite secondary outcome comprising CVD death, nonfatal myocardial infarction, nonfatal stroke, hospitalized angina, congestive heart failure, peripheral vascular disease, coronary artery bypass graft, and carotid endarterectomy. Significant sex interactions were observed for BDI score and BDI score ≥10. BDI score was significantly associated with higher probability of this composite outcome in men but was not associated with the outcome in women. BDI score ≥10 was positively associated with this composite outcome in men but was negatively associated in women. Exploratory analysis identified a significant BDI ≥10 × ADM use interaction for this composite outcome that differed in men versus women. Men with both BDI score ≥10 and ADM use compared with those with neither had 60% higher probability of the outcome, whereas women with both compared with those with neither had 50% lower probability. CONCLUSIONS Sex differences in the association of depression symptoms and ADM use with incident CVD warrant further investigation.
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Affiliation(s)
- Helen P Hazuda
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Rena R Wing
- The Miriam Hospital/Brown Medical School, Providence, RI
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Mace Coday
- The University of Tennessee, Memphis, TN
| | | | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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17
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Espinoza S, Hazuda HP. ETHNIC DISPARITY IN FRAILTY BETWEEN MEXICAN AMERICAN (MA) AND EUROPEAN AMERICAN (EA) OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Espinoza
- Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, University of Texas Health Science Center, San Antonio, Texas, United States
| | - H P Hazuda
- Department of Medicine, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA
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18
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Abstract
Purpose of review Over half of the older adults in U.S. have multimorbidity, defined broadly as the presence of 2 or more chronic diseases in an individual. Multimorbidity has significant overlap with disability and frailty. In this review, we broadly review the concepts of multimorbidity, disability, and frailty, as well as their interrelationships, and ability to predict future adverse health outcomes in older adults. Recent findings Depending on the study, the prevalence of individuals with all three of multimorbidity, disability, and frailty ranges from 2-20%. Multimorbidity and patterns of multimorbidity are predictive of functional limitations, disability, health care usage, and mortality. The degree to which multimorbidity predicts these outcomes depends on many factors but partly upon the population examined and the presence of frailty and disability. Summary Multimorbidity is an emerging public health concern that is observed with and predictive of disability and frailty.
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Affiliation(s)
- Sara E Espinoza
- The Department of Medicine, Divisions of Geriatrics, Gerontology & Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.,The Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.,The Sam & Ann Barshop Institute for Longevity & Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Myla Quiben
- Geriatrics Research, Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Helen P Hazuda
- The Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Physical Therapy, University of North Texas Health Science Center
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19
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Noël PH, Wang CP, Finley EP, Espinoza SE, Parchman ML, Bollinger MJ, Hazuda HP. Provider-Related Linkages Between Primary Care Clinics and Community-Based Senior Centers Associated With Diabetes-Related Outcomes. J Appl Gerontol 2018; 39:635-643. [PMID: 29923445 DOI: 10.1177/0733464818782853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care-community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members' discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.
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Affiliation(s)
- Polly Hitchcock Noël
- University of Texas Health San Antonio, USA.,South Texas Veterans Health Care System, Washington, DC, USA
| | - Chen-Pin Wang
- University of Texas Health San Antonio, USA.,South Texas Veterans Health Care System, Washington, DC, USA
| | - Erin P Finley
- University of Texas Health San Antonio, USA.,South Texas Veterans Health Care System, Washington, DC, USA
| | - Sara E Espinoza
- University of Texas Health San Antonio, USA.,South Texas Veterans Health Care System, Washington, DC, USA
| | | | - Mary J Bollinger
- Central Arkansas Veterans Healthcare System, Little Rock, USA.,University of Arkansas for Medical Sciences, Little Rock, USA
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20
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Hazuda HP, Espinoza SE. Prevention of Falls and Frailty in Older Adults with Diabetes. Curr Geri Rep 2017. [DOI: 10.1007/s13670-017-0209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Rapp SR, Luchsinger JA, Baker LD, Blackburn GL, Hazuda HP, Demos-McDermott KE, Jeffery RW, Keller JN, McCaffery JM, Pajewski NM, Evans M, Wadden TA, Arnold SE, Espeland MA. Effect of a Long-Term Intensive Lifestyle Intervention on Cognitive Function: Action for Health in Diabetes Study. J Am Geriatr Soc 2017; 65:966-972. [PMID: 28067945 PMCID: PMC5435531 DOI: 10.1111/jgs.14692] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess whether randomization to 10 years of lifestyle intervention to induce and maintain weight loss improves cognitive function. DESIGN Randomized controlled clinical trial. SETTING Data obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Continuation study (U01 DK057136-15). PARTICIPANTS Overweight and obese individuals with type 2 diabetes mellitus aged 45 to 76 (N = 3,751). INTERVENTION Intensive lifestyle intervention (ILI) for weight loss through reduced caloric intake and increased physical activity compared with a control condition of diabetes support and education (DSE). MEASUREMENTS Certified examiners who were masked to intervention assignment administered a standard battery of cognitive function tests (Modified Mini-Mental State Examination, Rey Auditory Verbal Learning Test, Digit Symbol Coding, Trail-Making Test, Modified Stroop Color-Word Test) to participants 10 to 13 years after enrollment. RESULTS Assignment to lifestyle intervention was not associated with significantly different overall (P = .10) or domain-specific (all P > .10) cognitive function than assignment to diabetes support and education. Results were fairly consistent across prespecified groups, but there was some evidence of trends for differential intervention effects showing modest harm in ILI in participants with greater body mass index and in individuals with a history of cardiovascular disease. Cognitive function was not associated with changes in weight or fitness (all P > .05). CONCLUSION A long-term behavioral weight loss intervention for overweight and obese adults with diabetes mellitus was not associated with cognitive benefit. Trial Registration clinicaltrials.gov Identifier: NCT00017953.
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Affiliation(s)
- Stephen R. Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Jose A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY 10032
| | - Laura D. Baker
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - George L. Blackburn
- Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center, Division of Nutrition, Harvard Medical School, Boston, MA, 02215
| | - Helen P. Hazuda
- Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX 78229
| | - Kathryn E. Demos-McDermott
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, RI 02903
| | - Robert W. Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454
| | | | - Jeanne M. McCaffery
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, RI 02903
| | - Nicholas M. Pajewski
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Mary Evans
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892
| | - Thomas A. Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104
| | - Steven E. Arnold
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charleston, MA 02129
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
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22
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Espeland MA, Luchsinger JA, Baker LD, Neiberg R, Kahn SE, Arnold SE, Wing RR, Blackburn GL, Bray G, Evans M, Hazuda HP, Jeffery RW, Wilson VM, Clark JM, Coday M, Demos-McDermott K, Foreyt JP, Greenway F, Hill JO, Horton ES, Jakicic JM, Johnson KC, Knowler WC, Lewis CE, Nathan DM, Peters A, Pi-Sunyer X, Pownall H, Wadden TA, Rapp SR. Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment. Neurology 2017; 88:2026-2035. [PMID: 28446656 DOI: 10.1212/wnl.0000000000003955] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/21/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight. METHODS Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview. RESULTS Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5-13.5) years after enrollment, when participants' mean age was 69.6 (54.9-87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI. CONCLUSIONS Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes. CLINICALTRIALSGOV IDENTIFIER NCT00017953 (Action for Health in Diabetes). LEVEL OF EVIDENCE This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.
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Affiliation(s)
| | | | - Laura D Baker
- Author affiliations are provided at the end of the article
| | | | - Steven E Kahn
- Author affiliations are provided at the end of the article
| | | | - Rena R Wing
- Author affiliations are provided at the end of the article
| | | | - George Bray
- Author affiliations are provided at the end of the article
| | - Mary Evans
- Author affiliations are provided at the end of the article
| | - Helen P Hazuda
- Author affiliations are provided at the end of the article
| | | | | | - Jeanne M Clark
- Author affiliations are provided at the end of the article
| | - Mace Coday
- Author affiliations are provided at the end of the article
| | | | - John P Foreyt
- Author affiliations are provided at the end of the article
| | - Frank Greenway
- Author affiliations are provided at the end of the article
| | - James O Hill
- Author affiliations are provided at the end of the article
| | | | - John M Jakicic
- Author affiliations are provided at the end of the article
| | | | | | - Cora E Lewis
- Author affiliations are provided at the end of the article
| | - David M Nathan
- Author affiliations are provided at the end of the article
| | - Anne Peters
- Author affiliations are provided at the end of the article
| | | | - Henry Pownall
- Author affiliations are provided at the end of the article
| | | | - Stephen R Rapp
- Author affiliations are provided at the end of the article
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Wing RR, Espeland MA, Clark JM, Hazuda HP, Knowler WC, Pownall HJ, Unick J, Wadden T, Wagenknecht L. Association of Weight Loss Maintenance and Weight Regain on 4-Year Changes in CVD Risk Factors: the Action for Health in Diabetes (Look AHEAD) Clinical Trial. Diabetes Care 2016; 39:1345-55. [PMID: 27271190 PMCID: PMC4955927 DOI: 10.2337/dc16-0509] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/05/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Short-term weight loss improves cardiovascular disease (CVD) risk factors. We sought to determine the longer-term effects of maintaining weight loss or, conversely, regaining weight. RESEARCH DESIGN AND METHODS We used data from Action for Health in Diabetes (Look AHEAD), a randomized trial of intensive lifestyle intervention (ILI) compared to a control condition in overweight/obese individuals with type 2 diabetes. ILI participants were grouped according to weight change patterns, as follows: 1) no weight loss (±3% at years 1 and 4); 2) moderate weight loss (3-8% at years 1 and 4); 3) large weight loss (8-20% at years 1 and 4); 4) moderate loss/full regain (3-8% at year 1/±3% at year 4); 5) large loss/full regain (8-20% at year 1/± 3% year 4); and 6) large loss/partial regain (8-20% at year 1/3-8% at year 4) and changes in CVD risk factors were compared. RESULTS Adjusting for baseline differences and medication use, larger weight losses produced greater improvements in HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides at years 1 and 4 (all P ≤ 0.02). Despite maintenance of weight loss, HbA1c levels worsened between years 1 and 4, and remained below baseline only in those with large weight losses. We found no negative associations of losing and regaining weight relative to not having lost weight. Moreover, those who had large initial weight loss but full regain of weight had greater improvements in HbA1c levels at year 4 than those with smaller or no initial weight loss. CONCLUSIONS Larger initial weight loss should be encouraged in individuals with type 2 diabetes, despite the possibility of regain.
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Marquez B, Anderson A, Wing RR, West DS, Newton RL, Meacham M, Hazuda HP, Peters A, Montez MG, Broyles ST, Walker M, Evans-Hudsnall G. The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes. Obesity (Silver Spring) 2016; 24:568-75. [PMID: 26833676 PMCID: PMC4769665 DOI: 10.1002/oby.21382] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/23/2015] [Accepted: 10/12/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. METHODS Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. RESULTS Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. CONCLUSIONS Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.
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Affiliation(s)
- Becky Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
| | - Andrea Anderson
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital and Brown University, Providence, RI
| | - Delia S. West
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Robert L. Newton
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Maria Meacham
- Southwestern American Indian Center, Phoenix, Arizona and Shiprock, New Mexico
| | - Helen P. Hazuda
- Department of Medicine, Division of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Maria G. Montez
- Department of Medicine, Division of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Stephanie T. Broyles
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Martha Walker
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Heckman-Stoddard BM, Crandall JP, Edelstein SL, Hamman RF, Prorok PC, Ryan A, Dabelea D, Hazuda HP, Horton E, Hoskin MA, Jeffries S, Knowler WC, Mather KJ, Shapiro SM, Walcott FL, Ford LG. Abstract A23: Cancer outcomes in the diabetes prevention program outcomes study. Cancer Prev Res (Phila) 2015. [DOI: 10.1158/1940-6215.prev-14-a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Numerous observational studies have reported decreased cancer incidence and cancer-related mortality in patients with diabetes receiving standard doses of metformin. A recent meta-analysis of these studies suggested a 31% reduction in overall cancer incidence, summary relative risk (0.69; 95% confidence interval, 0.52-0.90), in subjects taking metformin as compared with other antidiabetic drugs. Separate meta-analyses of studies that adjusted for BMI or time-related bias suggested an attenuation of this signal, but still showed a significant reduction in cancer incidence. However, studies published to date are limited by the observational nature of the data and the randomized controlled trials that have been used to examine metformin's potential as an anti-cancer agent in patients with diabetes have had insufficient follow-up for cancer endpoints. These data also do not address the cancer risk in non-diabetic populations, in which the cancer preventive potential of metformin is unknown.
The Diabetes Prevention Program (DPP) was a national multi-center, randomized, placebo-controlled clinical trial, which enrolled 3234 participants between 1996 and 1999, designed to investigate whether intensive lifestyle modification or treatment with metformin (850mg twice a day) delayed or prevented the onset of type 2 diabetes in a high risk population. The DPP and its follow up study, the Diabetes Prevention Program Outcomes Study (DPPOS), provide a unique opportunity to examine the role of metformin and lifestyle intervention in reducing cancer incidence in an overweight adult population with impaired glucose regulation, before the onset of diabetes. The National Cancer Institute Division of Cancer Prevention, in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the DPPOS investigators, proposed a study to examine the hypothesis that metformin and/or lifestyle intervention can modify total cancer incidence and/or obesity-related cancer incidence (breast, colorectal, endometrium, pancreas, lower esophagus, gall-bladder, and kidney) in DPP/DPPOS participants.
The DPPOS protocol and consent were modified to allow collection of data to support the inclusion of cancer incidence as an endpoint of interest in the study. Participants complete a cancer risk questionnaire that includes family history of cancer, cancer screening activities, and use of aspirin and NSAIDs including dose and frequency. The participants who previously reported a cancer diagnosis, through the SAE reporting process and/or an annual questionnaire, or during a subsequent follow-up visit, are asked to provide physician information to obtain medical records for case adjudication. This protocol will allow for the examination of the effect of metformin and lifestyle intervention on cancer incidence in an initially pre-diabetic population potentially through a median of 20 years of follow-up.
Data from this study will compare incidence of total and obesity-related cancers between the original treatment groups; assess cancer (total and obesity-related) incidence by metformin exposure across all treatment groups, using a “met-years” variable, and explore subgroups to investigate effect modification by sex, age group, race/ethnicity, diabetes status, or weight loss at 1 year or mean weight loss since study baseline.
Citation Format: Brandy M. Heckman-Stoddard, Jill P. Crandall, Sharon L. Edelstein, Richard F. Hamman, Philip C. Prorok, Anne Ryan, Dana Dabelea, Helen P. Hazuda, Edward Horton, Mary A. Hoskin, Susan Jeffries, William C. Knowler, Kieren J. Mather, Susana M. Shapiro, Farzana L. Walcott, Leslie G. Ford. Cancer outcomes in the diabetes prevention program outcomes study. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A23.
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Affiliation(s)
| | | | | | | | | | - Anne Ryan
- 1National Cancer Institute, Rockville, MD,
| | | | - Helen P. Hazuda
- 5University of Texas Health Science Center, San Antonio, TX,
| | | | - Mary A. Hoskin
- 7Southwestern American Indian Center, ACKCO Inc., Phoenix, AZ,
| | | | - William C. Knowler
- 9National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ,
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Espinoza SE, Hazuda HP. Frailty prevalence and neighborhood residence in older Mexican Americans: the San Antonio longitudinal study of aging. J Am Geriatr Soc 2015; 63:106-11. [PMID: 25597562 DOI: 10.1111/jgs.13202] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the association between neighborhood residence and frailty prevalence in older Mexican Americans (MAs). DESIGN Cross-sectional, observational study. SETTING Socioeconomically and ethnically diverse neighborhoods in San Antonio, Texas. PARTICIPANTS Community-dwelling older MA adults (aged ≥ 65) who completed the baseline examination of the San Antonio Longitudinal Study of Aging (SALSA) (1992-1996) (N = 394). MEASUREMENTS Subjects were randomly sampled from three types of neighborhoods that varied in ethnic composition and economic environment: barrio (low-income, exclusively MA), transitional (middle-income, equal proportion MAs and European Americans (EAs)) and suburban (upper-income, predominantly EA). Frailty was classified using the Fried criteria. Frailty odds were estimated according to neighborhood using logistic regression, with the suburban neighborhood as the reference category. Covariates included age, sex, diseases, depressive symptoms, and cognitive function. RESULTS Frailty prevalence was 15.6% in the barrio, 9.4% in the transitional neighborhood, and 3.5% in the suburbs (P = .01). After adjusting for sociodemographic characteristics and disease covariates, odds of frailty were 4.15 times as high for MAs residing in the barrio as for those residing in the suburbs (P = .03). After adjustment for depression and cognition, this association was no longer significant. Diabetes mellitus and depression accounted for the higher odds of frailty in the barrio. Although odds of frailty in the transitional neighborhood were 1.95 times as high as those in the suburbs, the difference was not statistically significant. CONCLUSION The ethnic composition and economic environment of the neighborhoods in which MA older adults reside are strongly associated with their odds of being frail.
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Affiliation(s)
- Sara E Espinoza
- Division ofGeriatrics, Gerontology and Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Geriatrics Research, Education and Clinical Center, South Texas Veterans Healthcare System, San Antonio, Texas
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Fowler SPG, Williams K, Hazuda HP. Diet soda intake is associated with long-term increases in waist circumference in a biethnic cohort of older adults: the San Antonio Longitudinal Study of Aging. J Am Geriatr Soc 2015; 63:708-15. [PMID: 25780952 DOI: 10.1111/jgs.13376] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the relationship between diet soda (DS) intake (DSI) and long-term waist circumference (WC) change (ΔWC) in the biethnic San Antonio Longitudinal Study of Aging (SALSA). DESIGN Prospective cohort study. SETTING San Antonio, Texas, neighborhoods. PARTICIPANTS SALSA examined 749 Mexican-American and European-American individuals aged 65 and older at baseline (baseline, 1992-96); 474 (79.1%) survivors completed follow-up 1 (FU1, 2000-01), 413 (73.4%) completed FU2 (2001-03), and 375 (71.0%) completed FU3 (2003-04). Participants completed a mean of 2.64 follow-up intervals, for 9.4 total follow-up years. MEASUREMENTS DSI, WC, height, and weight were measured at outset and at the conclusion of each interval: baseline, FU1, FU2, and FU3. RESULTS Adjusted for initial WC, demographic characteristics, physical activity, diabetes mellitus, and smoking, mean interval ΔWC of DS users (2.11 cm, 95% confidence interval (CI) = 1.45-2.76 cm) was almost triple that of nonusers (0.77 cm, 95% CI = 0.29-1.23 cm) (P < .001). Adjusted interval ΔWCs were 0.77 cm (95% CI = 0.29-1.23 cm) for nonusers, 1.76 cm (95% CI = 0.96-2.57 cm) for occasional users, and 3.04 cm (95% CI = 1.82-4.26 cm) for daily users (P = .002 for trend). This translates to ΔWCs of 0.80 inches for nonusers, 1.83 inches for occasional users, and 3.16 for daily users over the total SALSA follow-up. In subanalyses stratified for selected covariates, ΔWC point estimates were consistently higher in DS users. CONCLUSION In a striking dose-response relationship, increasing DSI was associated with escalating abdominal obesity, a potential pathway for cardiometabolic risk in this aging population.
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Affiliation(s)
- Sharon P G Fowler
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Espeland MA, Glick HA, Bertoni A, Brancati FL, Bray GA, Clark JM, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Hazuda HP, Hill JO, Hire D, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Killean T, Kitabchi AE, Knowler WC, Kriska A, Lewis CE, Miller M, Montez MG, Murillo A, Nathan DM, Nyenwe E, Patricio J, Peters AL, Pi-Sunyer X, Pownall H, Redmon JB, Rushing J, Ryan DH, Safford M, Tsai AG, Wadden TA, Wing RR, Yanovski SZ, Zhang P. Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care 2014; 37:2548-56. [PMID: 25147253 PMCID: PMC4140155 DOI: 10.2337/dc14-0093] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/06/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. RESEARCH DESIGN AND METHODS A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years. RESULTS ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385-7,175); however, these were not evident among individuals with a history of cardiovascular disease. CONCLUSIONS Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.
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Affiliation(s)
- Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Henry A Glick
- Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA
| | - Alain Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - George A Bray
- Pennington Biomedical Research Center, Baton Rouge, LA
| | | | - Jeffrey M Curtis
- Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | | | - Helen P Hazuda
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James O Hill
- Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO
| | - Don Hire
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward S Horton
- Department of Clinical Epidemiology, Joslin Diabetes Center, Boston, MA
| | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John M Jakicic
- Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Steven E Kahn
- Department of Medicine, University of Washington, Seattle, WA
| | - Tina Killean
- Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
| | - Abbas E Kitabchi
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - William C Knowler
- Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
| | - Andrea Kriska
- Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Cora E Lewis
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marsha Miller
- Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO
| | - Maria G Montez
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Anne Murillo
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Ebenezer Nyenwe
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Jennifer Patricio
- Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY
| | | | - Xavier Pi-Sunyer
- Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY
| | - Henry Pownall
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - J Bruce Redmon
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Julia Rushing
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donna H Ryan
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Monika Safford
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Adam G Tsai
- Division of Internal Medicine, University of Colorado Health Sciences Center, Aurora, CO
| | - Thomas A Wadden
- Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
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Achilike I, Hazuda HP, Fowler SP, Aung K, Lorenzo C. Predicting the development of the metabolically healthy obese phenotype. Int J Obes (Lond) 2014; 39:228-34. [PMID: 24984752 PMCID: PMC4351862 DOI: 10.1038/ijo.2014.113] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 02/17/2014] [Accepted: 05/26/2014] [Indexed: 02/07/2023]
Abstract
Objective The metabolically healthy (MHO) and unhealthy obese (MUHO) differ in terms of cardiovascular risk. However, little is known about predicting the development of these phenotypes and the future stability of the MHO phenotype. Therefore, we examined these two issues in the San Antonio Heart Study. Design Longitudinal, population-based study of cardiometabolic risk factors among Mexican Americans and non-Hispanic whites in San Antonio. Subjects The study sample included 2,368 participants with neither MUHO nor diabetes at baseline. Median follow-up was 7.8 years. MHO was defined as obesity with ≤1 metabolic abnormality; MUHO, as obesity with ≥2 abnormalities. Results At baseline, 1,595 and 498 individuals were non-obese with ≤1 and ≥2 metabolic abnormalities, respectively; 275 were MHO. Among non-obese individuals, independent predictors of incident MHO (OR for 1-SD change [95% CI]) included body mass index (8.12 [5.66 – 11.7]), triglycerides (0.52 [0.39 – 0.68]), and HDL-C (1.41 [1.11 – 1.81]), whereas independent predictors of incident MUHO included BMI (5.97 [4.58 – 7.77]) and triglycerides (1.26 [1.05 – 1.51]). Among participants with ≤1 metabolic abnormality, obesity was associated with greater odds of developing multiple metabolic abnormalities (OR 2.26 [1.74 – 2.95]). Conclusions Triglycerides and HDL-C may be useful for predicting progression to MHO. MHO may not be a stable condition, because it confers an increased risk of developing multiple metabolic abnormalities.
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Affiliation(s)
- I Achilike
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - H P Hazuda
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - S P Fowler
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - K Aung
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - C Lorenzo
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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Rubin RR, Wadden TA, Bahnson JL, Blackburn GL, Brancati FL, Bray GA, Coday M, Crow SJ, Curtis JM, Dutton G, Egan C, Evans M, Ewing L, Faulconbridge L, Foreyt J, Gaussoin SA, Gregg EW, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Lang W, Lewis CE, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Rejeski WJ, Rosenthal RH, Ruelas V, Toledo K, Van Dorsten B, Vitolins M, Williamson D, Wing RR, Yanovski SZ, Zhang P. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care 2014; 37:1544-53. [PMID: 24855155 PMCID: PMC4030096 DOI: 10.2337/dc13-1928] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1-4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores. RESULTS ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75-0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores. CONCLUSIONS ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.
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Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, Crow RS, Curtis JM, Egan CM, Espeland MA, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Harrison B, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Regensteiner JG, Rickman AD, Ryan DH, Safford M, Wadden TA, Wagenknecht LE, West DS, Williamson DF, Yanovski SZ. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369:145-54. [PMID: 23796131 PMCID: PMC3791615 DOI: 10.1056/nejmoa1212914] [Citation(s) in RCA: 1758] [Impact Index Per Article: 159.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).
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Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, Crow RS, Curtis JM, Egan CM, Espeland MA, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Harrison B, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Regensteiner JG, Rickman AD, Ryan DH, Safford M, Wadden TA, Wagenknecht LE, West DS, Williamson DF, Yanovski SZ. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013. [PMID: 23796131 DOI: 10.1056/nejm] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).
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Espeland MA, Rejeski WJ, West DS, Bray GA, Clark JM, Peters AL, Chen H, Johnson KC, Horton ES, Hazuda HP. Intensive weight loss intervention in older individuals: results from the Action for Health in Diabetes Type 2 diabetes mellitus trial. J Am Geriatr Soc 2013; 61:912-922. [PMID: 23668423 DOI: 10.1111/jgs.12271] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare the effects of 4 years of intensive lifestyle intervention on weight, fitness, and cardiovascular disease risk factors in older and younger individuals. DESIGN Randomized controlled clinical trial. SETTING Sixteen U.S. clinical sites. PARTICIPANTS Individuals with type 2 diabetes mellitus: 1,053 aged 65 to 76 and 4,092 aged 45 to 64. INTERVENTIONS An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes mellitus support and education. MEASUREMENTS Standardized assessments of weight, fitness (based on graded exercise testing), and cardiovascular disease risk factors. RESULTS Over 4 years, older individuals had greater intervention-related mean weight losses (6.2%) than younger participants (5.1%; interaction P = .006) and comparable relative mean increases in fitness (0.56 vs 0.53 metabolic equivalents; interaction P = .72). These benefits were seen consistently across subgroups of older adults formed according to many demographic and health factors. Of a panel of age-related health conditions, only self-reported worsening vision was associated with poorer intervention-related weight loss in older individuals. The intensive lifestyle intervention produced mean increases in high-density lipoprotein cholesterol (2.03 mg/dL; P < .001) and decreases in glycated hemoglobin (0.21%; P < .001) and waist circumference (3.52 cm; P < .001) over 4 years that were at least as large in older as in younger individuals. CONCLUSION Intensive lifestyle intervention targeting weight loss and increased physical activity is effective in overweight and obese older individuals to produce sustained weight loss and improvements in fitness and cardiovascular risk factors.
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Affiliation(s)
- Mark A Espeland
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157, USA.
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Garcia CH, Espinoza SE, Lichtenstein M, Hazuda HP. Health literacy associations between Hispanic elderly patients and their caregivers. J Health Commun 2013; 18 Suppl 1:256-72. [PMID: 24093360 PMCID: PMC3815141 DOI: 10.1080/10810730.2013.829135] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Knowing health literacy levels of older patients and their caregivers is important because caregivers assist patients in the administration of medications, manage daily health care tasks, and help make health services utilization decisions. The authors examined the association of health literacy levels between older Hispanic patients and their caregivers among 174 patient-caregiver dyads enrolled from 3 community clinics and 28 senior centers in San Antonio, Texas. Health literacy was measured using English and Spanish versions of the Short-Test of Functional Health Literacy Assessment and categorized as "low" or "adequate." The largest dyad category (41%) consisted of a caregiver with adequate health literacy and patient with low health literacy. Among the dyads with the same health literacy levels, 28% had adequate health literacy and 24% had low health literacy. It is notable that 7% of dyads consisted of a caregiver with low health literacy and a patient with adequate health literacy. Low health literacy is a concern not only for older Hispanic patients but also for their caregivers. To provide optimal care, clinicians must ensure that information is given to both patients and their caregivers in clear effective ways as it may significantly affect patient health outcomes.
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Affiliation(s)
- Cesar H. Garcia
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Address correspondence to Cesar H. Garcia, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7857, San Antonio, TX 78229, USA. E-mail:
| | - Sara E. Espinoza
- Division of Geriatrics, Gerontology, and Palliative Medicine and Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, and the Geriatrics Research, Education, and Clinical Center, South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - Michael Lichtenstein
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Helen P. Hazuda
- Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Perkins HS, Cortez JD, Hazuda HP. Diversity of Patients’ Beliefs about the Soul after Death and Their Importance in End-of-Life Care. South Med J 2012; 105:266-72. [DOI: 10.1097/smj.0b013e3182549eda] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Noël PH, Wang CP, Bollinger MJ, Pugh MJ, Copeland LA, Tsevat J, Nelson KM, Dundon MM, Hazuda HP. Intensity and duration of obesity-related counseling: association with 5-Year BMI trends among obese primary care patients. Obesity (Silver Spring) 2012; 20:773-82. [PMID: 22134198 DOI: 10.1038/oby.2011.335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We examined 5-year trends in BMI among obese primary care patients to determine whether obesity-related education such as nutrition counseling or a weight management program was associated with declines in BMI. Veterans with BMI ≥30 kg/m(2) and ≥1 primary care visits in fiscal year 2002 were identified from the Veterans Health Administration's (VHA) national databases. Outpatient visits from fiscal year 2002-2006 for nutrition counseling, exercise, or weight management were grouped into five categories varying in intensity and duration: (i) intense-and-sustained, (ii) intense-only, (iii) irregular, (iv) limited, and (v) no counseling. Generalized estimating equation assessed associations between obesity-related counseling and BMI trend (annual rate of BMI change fiscal year 2002-2006) among cohort members with complete race/ethnic data (N = 179,881). Multinomial logistic regression compared intensity and duration of counseling among patients whose net BMI increased or decreased by ≥10% vs. remained stable. Compared with patients receiving "intense-and-sustained" counseling, the BMI trend of those receiving "intense-only" or "irregular" counseling was not significantly different, but patients receiving "no counseling" or "limited counseling" had significantly higher rates of decreasing BMI (-0.12 and -0.08 BMI per year; P < 0.01, respectively). This was especially true for veterans in their 50-60s, compared with the oldest veterans who were most likely to lose weight. In contrast, younger veterans (18-35 years) were least likely to lose weight; their BMI tended to increase regardless of counseling intensity and duration. Enhanced efforts are needed to detect and combat increasing weight trajectories among veterans who are already obese, especially among those aged 18-35 who are at greatest risk.
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Affiliation(s)
- Polly H Noël
- VERDICT/South Texas Veterans Health Care System, San Antonio, Texas, USA.
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Abstract
CONTEXT Mexican-Americans have more diabetes than non-Hispanic whites, but the extent to which insulin resistance and insulin secretion explain the ethnic difference is unknown. OBJECTIVE We analyzed selected indices of insulin resistance and secretion for both the ethnic difference and predictive discrimination. DESIGN AND SETTING The San Antonio Heart Study is a longitudinal population-based study with a follow-up period of 7.5 yr. PARTICIPANTS A total of 1540 nondiabetic individuals aged 25-64 yr were enrolled from January 1984 to December 1988. INTERVENTIONS Homeostasis model assessment (HOMA) of insulin resistance and secretion were estimated by available formulas (HOMA-IR and HOMA β-cell) and computer program (HOMA2S and HOMA2B). Matsuda index and insulinogenic index from 0 to 30 and 0 to 120 min (ΔI0-30/ΔG0-30 and ΔI0-120/ΔG0-120) were also calculated. MAIN OUTCOME MEASURE Incident diabetes was defined by the 2003 American Diabetes Association criteria. RESULTS Incident diabetes was in excess in Mexican-Americans [odds ratio 2.26 (95% confidence interval, 1.53-3.34)]. Matsuda index explained a larger proportion of the ethnic difference than did HOMA-IR (49.2 vs. 31.0%; P<0.001). The ethnic difference was not explained by measures of insulin secretion. Matsuda index and ΔI0-30/ΔG0-30 had a better predictive discrimination than their HOMA equivalents and ΔI0-120/ΔG0-120. HOMA estimates by the computer program offered no advantage over simple formulas for HOMA. CONCLUSIONS Insulin resistance accounts for a large and significant proportion of the excess risk of diabetes in Mexican-Americans. Matsuda index is better than HOMA-IR for both explaining the ethnic difference and predicting diabetes.
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Affiliation(s)
- Carlos Lorenzo
- Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, Room 5.594U, San Antonio, Texas 78229, USA.
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Perkins HS, Cortez JD, Hazuda HP. Patients' diverse beliefs about what happens at the time of death. J Hosp Med 2012; 7:110-6. [PMID: 22125098 DOI: 10.1002/jhm.947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/26/2011] [Accepted: 05/07/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Beliefs about what happens at the time of death surely affect a patient's whole dying experience and could help guide end-of-life care. Yet virtually no research describes those beliefs. This exploratory study begins the descriptive process. METHODS Assuming culture is key, we interviewed 26 Mexican-American (MA), 18 Euro-American (EA), and 14 African-American (AA) inpatients about their beliefs concerning what happens at the time of death. RESULTS One belief, that death separates the dead from the living, was widespread. Majorities of all 3 ethnic group samples and of 5 of the 6 gender subsamples expressed this belief, saying the dead "go" or "leave" from this life. Other beliefs differed by ethnic group or gender. For example, more EAs (50%) than others said death is a momentary event, and more MAs (35%) than others said death involves "being taken" by an external force (always God or Jesus). Furthermore, considerably more EA women (45%) than others said some senses persist after death. In contrast, the physiologic signs that participants cited as defining the exact time of death varied from individual to individual with no ethnic or gender pattern, and no one sign predominated. CONCLUSIONS A few beliefs about what happens at the time of death may characterize Americans in general; many other beliefs may characterize only certain ethnic groups, genders, or individuals. To identify such beliefs and to use them to guide end-of-life care, hospitalists and other health professionals may have to elicit them directly from patients or survivors.
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Affiliation(s)
- Henry S Perkins
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA.
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Noël PH, Copeland LA, Perrin RA, Lancaster AE, Pugh MJ, Wang CP, Bollinger MJ, Hazuda HP. VHA Corporate Data Warehouse height and weight data: opportunities and challenges for health services research. ACTA ACUST UNITED AC 2011; 47:739-50. [PMID: 21141302 DOI: 10.1682/jrrd.2009.08.0110] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Within the Veterans Health Administration (VHA), anthropometric measurements entered into the electronic medical record are stored in local information systems, the national Corporate Data Warehouse (CDW), and in some regional data warehouses. This article describes efforts to examine the quality of weight and height data within the CDW and to compare CDW data with data from warehouses maintained by several of VHA's regional groupings of healthcare facilities (Veterans Integrated Service Networks [VISNs]). We found significantly fewer recorded heights than weights in both the CDW and VISN data sources. In spite of occasional anomalies, the concordance in the number and value of records in the CDW and the VISN warehouses was generally 97% to 99% or greater. Implausible variation in same-day and same-year heights and weights was noted, suggesting measurement or data-entry errors. Our work suggests that the CDW, over time and through validation, has become a generally reliable source of anthropometric data. Researchers should assess the reliability of data contained within any source and apply strategies to minimize the impact of data errors appropriate to their study population.
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Affiliation(s)
- Polly Hitchcock Noël
- Department of Veterans Affairs (VA), South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11c6), San Antonio, TX 78229-4404, USA.
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Wang CP, Hazuda HP. Better glycemic control is associated with maintenance of lower-extremity function over time in Mexican American and European American older adults with diabetes. Diabetes Care 2011; 34:268-73. [PMID: 21216857 PMCID: PMC3024332 DOI: 10.2337/dc10-1405] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a major cause of functional decline among older adults, but the role of glycemic control remains unclear. This article assesses whether better glycemic control is associated with better maintenance of lower-extremity function over time in older adults with diabetes. RESEARCH DESIGN AND METHODS Participants (n = 119) in the San Antonio Longitudinal Study of Aging, ages 71-85, who met American Diabetes Association diabetes criteria were followed over a 36-month period. Seven measures of A1C (HbA(1c)) were obtained at 6-month intervals; three measures of lower-extremity function were obtained at 18-month intervals using the Short Physical Performance Battery (SPPB). A two-step analytic approach was used, first, to identify distinct glycemic control classes using latent growth mixture modeling and, second, to examine trajectories of lower-extremity function based on these classes using path analysis. RESULTS Two glycemic control classes were identified: a poorer control class with higher means (all >7%) and higher within-subject variability in HbA(1c) and a better control class with lower means (all <7%) and lower within-subject variability. The short-term and long-term maintenance of lower-extremity function, assessed by the association between the first and second SPPB measures and the first and third SPPB measures, were both greater in the better control class than in the poorer control class. CONCLUSIONS Among older adults with diabetes, better glycemic control may improve both short-term and long-term maintenance of lower-extremity function.
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Affiliation(s)
- Chen-Pin Wang
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, Texas, USA
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Noël PH, Copeland LA, Pugh MJ, Kahwati L, Tsevat J, Nelson K, Wang CP, Bollinger MJ, Hazuda HP. Obesity diagnosis and care practices in the Veterans Health Administration. J Gen Intern Med 2010; 25:510-6. [PMID: 20180155 PMCID: PMC2869413 DOI: 10.1007/s11606-010-1279-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 11/17/2009] [Accepted: 01/26/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND In response to dramatic increases in obesity prevalence, clinical guidelines urge health care providers to prevent and treat obesity more aggressively. OBJECTIVE To describe the proportion of obese primary care patients receiving obesity care over a 5-year period and identify factors predicting receipt of care. DESIGN Retrospective cohort study utilizing VHA administrative data from 6 of 21 VA administrative regions. PATIENTS Veterans seen in primary care in FY2002 with a body mass index (BMI) > or =30 kg/m(2) based on heights and weights recorded in the electronic medical record (EMR), survival through FY2006, and active care (1 or more visits in at least 3 follow-up years FY2003-2006). MAIN MEASURES Receipt of outpatient visits for individual or group education or instruction in nutrition, exercise, or weight management; receipt of prescriptions for any FDA-approved medications for weight reduction; and receipt of bariatric surgery. KEY RESULTS Of 933,084 (88.6%) of 1,053,228 primary care patients who had recorded heights and weights allowing calculation of BMI, 330,802 (35.5%) met criteria for obesity. Among obese patients who survived and received active care (N = 264,667), 53.5% had a recorded obesity diagnosis, 34.1% received at least one outpatient visit for obesity-related education or counseling, 0.4% received weight-loss medications, and 0.2% had bariatric surgery between FY2002-FY2006. In multivariable analysis, patients older than 65 years (OR = 0.62; 95% CI: 0.60-0.64) were less likely to receive obesity-related education, whereas those prescribed 5-7 or 8 or more medication classes (OR = 1.41; 1.38-1.45; OR = 1.94; 1.88-2.00, respectively) or diagnosed with obesity (OR = 4.0; 3.92-4.08) or diabetes (OR = 2.23; 2.18-2.27) were more likely to receive obesity-related education. CONCLUSIONS Substantial numbers of VHA primary care patients did not have sufficient height or weight data recorded to calculate BMI or have recorded obesity diagnoses when warranted. Receipt of obesity education varied by sociodemographic and clinical factors; providers may need to be cognizant of these when engaging patients in treatment.
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Affiliation(s)
- Polly Hitchcock Noël
- VERDICT/South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229-4404, USA.
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Perkins HS, Cortez JD, Hazuda HP. Cultural beliefs about a patient's right time to die: an exploratory study. J Gen Intern Med 2009; 24:1240-7. [PMID: 19798539 PMCID: PMC2771244 DOI: 10.1007/s11606-009-1115-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 06/01/2009] [Accepted: 08/24/2009] [Indexed: 01/27/2023]
Abstract
BACKGROUND Generalist physicians must often counsel patients or their families about the right time to die, but feel ill-prepared to do so. Patient beliefs may help guide the discussions. OBJECTIVE Because little prior research addresses such beliefs, we investigated them in this exploratory, hypothesis-generating study. DESIGN AND SUBJECTS Anticipating culture as a key influence, we interviewed 26 Mexican Americans (MAs), 18 Euro-Americans (EAs), and 14 African Americans (AAs) and content-analyzed their responses. MAIN RESULTS Nearly all subjects regardless of ethnic group or gender said God determines (at least partially) a patient's right time to die, and serious disease signals it. Yet subjects differed by ethnic group over other signals for that time. Patient suffering and dependence on "artificial" life support signaled it for the MAs; patient acceptance of death signaled it for the EAs; and patient suffering and family presence at or before the death signaled it for the AAs. Subjects also differed by gender over other beliefs. In all ethnic groups more men than women said the time of death is unpredictable; but more women than men said the time of death is preset, and family suffering signals it. Furthermore, most MA women--but few others--explicitly declared that family have an important say in determining a patient's right time to die. No confounding occurred by religion. CONCLUSIONS Americans may share some beliefs about the right time to die but differ by ethnic group or gender over other beliefs about that time. Quality end-of-life care requires accommodating such differences whenever reasonable.
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Affiliation(s)
- Henry S Perkins
- Division of General Medicine, Department of Medicine, The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Stern SL, Dhanda R, Hazuda HP. Helplessness predicts the development of hypertension in older Mexican and European Americans. J Psychosom Res 2009; 67:333-7. [PMID: 19773026 PMCID: PMC2751730 DOI: 10.1016/j.jpsychores.2009.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 03/11/2009] [Accepted: 04/22/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The mechanisms by which depression is associated with an elevated risk of cardiovascular disease remain unclear. It is possible that depressive symptoms could increase the risk of hypertension, which in turn could predispose to cardiovascular disease. The goal of this study was to explore whether individual depressive symptoms might predict the incidence of hypertension in a cohort of 240 initially normotensive Mexican-American and European-American elders. METHODS Subjects were 65-78 years old on entering the San Antonio Longitudinal Study of Aging, an epidemiologic survey, at which time they completed the 30-item Geriatric Depression Scale in English or Spanish. Their blood pressure was reassessed a mean of 7.0 years later. Responses to six key scale items (depressed mood, decreased interest, worthlessness, hopelessness, helplessness, and fatigue) were evaluated for the ability to predict incident hypertension. RESULTS In univariate analyses, only helplessness significantly predicted incident hypertension (chi-square 13.5, df=1, P=.0003). In a Cox proportional hazards model adjusted for sex, education, number of comorbid diseases, current drinking, social well-being, and marital status, helplessness remained a very strong predictor [hazard ratio (HR) 4.99, 95% confidence interval (CI) 1.90-13.12, P=.0011]. Total depression score also predicted incident hypertension, but less strongly (HR 1.08, CI 1.00-1.17, P=.0339). CONCLUSION Helplessness may predict the development of hypertension in the elderly. Further research into this relationship might lead to interventions to reduce the risk of cardiovascular disease.
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Affiliation(s)
- Stephen L Stern
- Psychiatry Service, South Texas Veterans Health Care System, San Antonio, TX 78229-4404, USA.
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Perkins HS, Cortez JD, Hazuda HP. Letters. The Journal of Clinical Ethics 2008. [DOI: 10.1086/jce200819314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring) 2008; 16:1894-900. [PMID: 18535548 DOI: 10.1038/oby.2008.284] [Citation(s) in RCA: 300] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have examined the relationship between artificially sweetened beverage (ASB) consumption and long-term weight gain in the San Antonio Heart Study. From 1979 to 1988, height, weight, and ASB consumption were measured among 5,158 adult residents of San Antonio, Texas. Seven to eight years later, 3,682 participants (74% of survivors) were re-examined. Outcome measures were incidence of overweight/obesity (OW/OB(inc)) and obesity (OB(inc)) (BMI > or = 25 and > or = 30 kg/m(2), respectively), and BMI change by follow-up (DeltaBMI, kg/m(2)). A significant positive dose-response relationship emerged between baseline ASB consumption and all outcome measures, adjusted for baseline BMI and demographic/behavioral characteristics. Consuming >21 ASBs/week (vs. none) was associated with almost-doubled risk of OW/OB (odds ratio (OR) = 1.93, P = 0.007) among 1,250 baseline normal-weight (NW) individuals, and doubled risk of obesity (OR = 2.03, P = 0.0005) among 2,571 individuals with baseline BMIs <30 kg/m(2). Compared with nonusers (+1.01 kg/m(2)), DeltaBMIs were significantly higher for ASB quartiles 2-4: +1.46 (P = 0.003), +1.50 (P = 0.002), and +1.78 kg/m(2) (P < 0.0001), respectively. Overall, adjusted DeltaBMIs were 47% greater among artificial sweetener (AS) users than nonusers (+1.48 kg/m(2) vs. +1.01 kg/m(2), respectively, P < 0.0001). In separate analyses--stratified by gender; ethnicity; baseline weight category, dieting, or diabetes status; or exercise-change category--DeltaBMIs were consistently greater among AS users. These differences, though not significant among exercise increasers, or those with baseline diabetes or BMI >30 kg/m(2) (P = 0.069), were significant in all 13 remaining strata. These findings raise the question whether AS use might be fueling--rather than fighting--our escalating obesity epidemic.
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Affiliation(s)
- Sharon P Fowler
- Department of Medicine, Division of Clinical Epidemiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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Abstract
Because conventional frailty screening criteria have been standardized in predominantly European-American (EA) cohorts, applying them to ethnically diverse populations may result in inaccurate estimation of frailty prevalence in ethnic minorities. The objective of this study was to determine whether use of ethnic-specific criteria (EC) to characterize frailty in a bi-ethnic cohort results in significant differences in frailty prevalence when compared with the prevalence obtained using conventional criteria (CC). Data were from a random sample of community-dwelling Mexican Americans (MAs) (n=394) and EAs (n=355) aged 65 to 80 who participated in the baseline examination of the San Antonio Longitudinal Study of Aging. Frailty was defined as three or more of five characteristics: slow walking speed, weak grip strength, low energy expenditure, self-reported exhaustion, and weight loss. For CC, walking speed was standardized to height and sex, grip strength was standardized to body mass index and sex, and energy expenditure was standardized to sex using the pooled sample. For EC, these criteria were applied within each ethnic group. Frailty prevalence in MAs and EAs was compared using chi-square statistic. Using CC, a higher proportion of MAs than EAs were frail (11.3% vs 7.0%, P=.045). Using EC, there was no difference in frailty prevalence between MAs and EAs (9.9% in both ethnic groups). The application of conventional frailty screening criteria in a bi-ethnic cohort results in a higher prevalence of frailty in MAs than in EAs. In determining whether there are ethnic disparities in frailty, future studies should carefully consider whether CC or EC should be applied.
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Affiliation(s)
- Sara E Espinoza
- Department of Medicine, Division of Geriatrics and Gerontology, Barshop Institute for Longevity and Aging StudiesUniversity of Texas Health Science Center at San Antonio, Texas, USA.
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Markland AD, Gerety MB, Goode PS, Kraus SR, Cornell J, Hazuda HP. Urinary incontinence in community-dwelling older Mexican American and European American women. Arch Gerontol Geriatr 2008; 48:232-7. [PMID: 18313155 DOI: 10.1016/j.archger.2008.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 01/12/2008] [Accepted: 01/16/2008] [Indexed: 10/22/2022]
Abstract
The aim was to measure prevalence and correlates of urinary incontinence in community-dwelling Mexican American (MA) and European American (EA) women from a cross-sectional analysis of baseline data from a longitudinal cohort. Participants were MA and EA women, aged 65 years and older, in the San Antonio Longitudinal Study of Aging (SALSA), of whom 421 (97.4%) responded to the question "How often do you have difficulty holding your urine until you can get to a toilet." Measurements included sociodemographic, functional, cognitive, psychosocial, and clinical status variables derived from bilingual interviews and performance-based tests. Urinary incontinence prevalence was 36.6% (n=154). MA women reported less incontinence than did EAs (29% versus 45%, p=0.001). In multivariable analyses in MA women, urinary incontinence correlated with the presence of fecal incontinence (OR 4.0, 95% CI 1.1-14.0) and more dependency in activities of daily living (1.4, 1.1-1.8) after controlling for significant sociodemographic factors. In EA women, only age >75 (4.2, 1.4-12.4) was associated with urinary incontinence. MA women were less likely to report incontinence compared to EAs, despite MAs having increased number of children, less education, higher BMI, and more diabetes. Further research is needed to evaluate risk factors for urinary incontinence among MA women.
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Affiliation(s)
- Alayne D Markland
- Department of Medicine, University of Alabama at Birmingham, Birmingham/Atlanta Geriatric Research, Educational, and Clinical Center, Birmingham Veterans Affairs Medical Center, 35294-0001, USA.
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Perkins HS, Cortez JD, Hazuda HP. Response to Stump, Klugman, and Thornton, "Last hours of life: encouraging end-of-life conversations". J Clin Ethics 2008; 19:303. [PMID: 19004438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Hunt KJ, Williams K, Hazuda HP, Stern MP, Haffner SM. The metabolic syndrome and the impact of diabetes on coronary heart disease mortality in women and men: the San Antonio Heart Study. Ann Epidemiol 2007; 17:870-7. [PMID: 17662617 PMCID: PMC2705872 DOI: 10.1016/j.annepidem.2007.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 04/02/2007] [Accepted: 05/04/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE An explanation for the differential impact of diabetes on coronary heart disease (CHD) mortality in men and women is that diabetes and cardiovascular disease (CVD) share a common antecedent that differentially affects men and women. In the San Antonio Heart Study we examined the relationship between gender, the metabolic syndrome defined by the National Cholesterol Education Program (NCEP-MetS) and diabetes and their ability to predict CHD mortality. METHODS Over 15.5 years, 4996 men and women 25 to 64 years of age experienced 254 cardiovascular deaths, including 121 from CHD (International Classification of Diseases, Ninth Revision codes 410-414). RESULTS At baseline, NCEP-MetS occurred more often in men than in women among those with normal glucose levels (12.3% vs. 9.7%, p < 0.05), but less often in men than in women among those with diabetes (65.7% vs. 74.4%, p < 0.05). Adjusted for age, ethnic group, and a history of CVD, relative to women with neither diabetes nor NCEP-MetS, women with both had a 14-fold (hazard ratio [HR] = 14.3 [95% confidence interval: 6.62, 30.7]) increased risk of CHD mortality, whereas men had only a 4-fold (HR = 4.21 (95% confidence interval: 2.32, 7.65]) increased risk, respectively. CONCLUSION When diabetes occurred with NCEP-MetS, gender was a strong modifier of the joint effect of diabetes and NCEP-MetS on CHD mortality.
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Affiliation(s)
- Kelly J Hunt
- Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA.
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