Increased Waist Circumference with Weight Loss Can Raise CVD Risks
The Diabetes Prevention
Program (DPP) trials is a landmark study that proved
that intensive lifestyle intervention (ILI) can
delay or prevent type 2 diabetes. Because of the
success of the DPP trials, another study called the
Look AHEAD study
was carried out. The purpose of the Look AHEAD study
was to determine if ILI could reduce "cardiovascular
morbidity and mortality in overweight individuals
with type 2 diabetes.” A secondary analysis of the
study was also done to determine the relationship
between cardiovascular disease (CVD), waist
circumference (WC) and weight loss.
The Look AHEAD failed to conclusively show that ILI
could reduce cardiovascular morbidity and mortality
in overweight individuals with type 2 diabetes,
however, the study was a useful study. In the
secondary analysis, the investigators concluded that
even with weight loss, an increase in waist
circumstance can cause an increase in CVD risk.
The analysis consisted of 5,490 participants, where
four groups were formed. One group consisted of
participants that had lost weight and reduced WC, another group that had gained weight and
increased WC, a group that had gained weight and
reduced WC and a group that had lost weight and
increased WC. All changes happened within one year of baseline.
The researchers performing the secondary analysis concluded that
"increased WC during the first year of ILI,
independent of weight change, was associated with
higher risk for subsequent cardiovascular outcomes."
Still, it should be noted that, in general, weight
loss via ILI is associated with a lowering of the
risk of negative cardiovascular outcomes. Further,
in one Look AHEAD follow-on study that used machine-learning methods to analyze the Look
AHEAD data, the investigators concluded that 85% of the Look AHEAD subjects did, in fact, experience
a significant reduction in cardiovascular events as
a result of weight loss.
It is possible to have an increase in CVD risk
with weight loss, if there is a rise in WC. And while
providers should be aware of the possibility of
increased CVD risk with a rise in WC, employing ILI for weight loss is still a
prudent approach to possibly lower CVD risks.
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