Body Size and Shape Changes and the Risk of Diabetes in the Diabetes Prevention Program
- Wilfred Y. Fujimoto1,
- Kathleen A. Jablonski2,
- George A. Bray3,
- Andrea Kriska4,
- Elizabeth Barrett-Connor5,
- Steven Haffner6,
- Robert Hanson7,
- James O. Hill8,
- Van Hubbard9,
- E. Stamm10,
- F. Xavier Pi-Sunyer11 and
- for the Diabetes Prevention Program Research Group
- 1Department of Medicine, University of Washington, Seattle, Washington
- 2Biostatistics Center, George Washington University, Rockville, Maryland
- 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
- 6Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- 7Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, 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, Maryland
- 10Department of Radiology, University of Colorado Health Sciences Center, Denver, Colorado
- 11Department 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
Abstract
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.
Footnotes
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Published ahead of print at http://diabetes.diabetesjournals.org on 30 March 2007. DOI: 10.2337/db07-0009.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted March 7, 2007.
- Received January 3, 2007.
- DIABETES
