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

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

Key Words: Body mass index • Computed tomography • Impaired glucose tolerance • Lifestyle • Metformin • Visceral fat • Waist circumference

OBJECTIVE:: To test the hypothesis that risk of type 2 diabetes is less following reductions in body size and central adiposity.

RESEARCH DESIGN AND METHODS:: 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 (CT) were measured at baseline and at 1 year. Cox proportional hazards models assessed by gender the effect of change in these variables over the first year of intervention upon development of diabetes over subsequent follow-up in a subset of 758 participants.

RESULTS:: 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%), body mass index (BMI, men -8.2%, women -7.8%), and waist (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 (-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.

CONCLUSIONS:: 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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