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Body Size and Shape Changes and the Risk of Diabetes in the Diabetes Prevention Program

¹ Department of Medicine, University of Washington, Seattle, Washington
² Biostatistics Center, George Washington University, Rockville, Maryland
³ Pennington Biomedical Research Center, Baton Rouge, Louisiana
⁴ Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
⁵ Department of Family and Preventive Medicine, School of Medicine, University of California San Diego, La Jolla, California
⁶ Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
⁷ Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
⁸ Center for Human Nutrition, University of Colorado School of Medicine, Denver, Colorado
⁹ Division of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
¹⁰ Department of Radiology, University of Colorado Health Sciences Center, Denver, Colorado
¹¹ Department of Medicine, Roosevelt-St. Luke's Hospital, New York, New York

Address correspondence and reprint requests to Wilfred Y. Fujimoto, MD, GWU Biostatistics Center DPPOS, 6110 Executive Blvd., Suite 750, Rockville, MD 20852. E-mail: dppmail{at}biostat.bsc.gwu.edu or wilfuji{at}u.washington.edu

Abbreviations: CT, computed tomography; DPP, Diabetes Prevention Program; WHR, waist-to-hip ratio

The researchers conducted this study to test the hypothesis that risk of type 2 diabetes is less following reductions in body size and central adiposity. The Diabetes Prevention Program (DPP) recruited and randomized individuals with impaired glucose tolerance to treatment with placebo, metformin, or lifestyle modification. Height, weight, waist circumference, and subcutaneous and visceral fat at L2-L3 and L4-L5 by computed tomography were measured at baseline and at 1 year. Cox proportional hazards models assessed by sex the effect of change in these variables over the 1st year of intervention upon development of diabetes over subsequent follow-up in a subset of 758 participants. Lifestyle reduced visceral fat at L2-L3 (men –24.3%, women –18.2%) and at L4-L5 (men –22.4%, women –17.8%), subcutaneous fat at L2-L3 (men –15.7%, women –11.4%) and at L4-L5 (men –16.7%, women –11.9%), weight (men –8.2%, women –7.8%), BMI (men –8.2%, women –7.8%), and waist circumference (men –7.5%, women –6.1%). Metformin reduced weight (–2.9%) and BMI (–2.9%) in men and subcutaneous fat (–3.6% at L2-L3 and –4.7% at L4-L5), weight (–3.3%), BMI (–3.3%), and waist circumference (–2.8%) in women. Decreased diabetes risk by lifestyle intervention was associated with reductions of body weight, BMI, and central body fat distribution after adjustment for age and self-reported ethnicity. Reduced diabetes risk with lifestyle intervention may have been through effects upon both overall body fat and central body fat but with metformin appeared to be independent of body fat.

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