Sustained weight loss

Sustained Weight Loss Linked to Lower Renal Risk in Diabetes

Posted by

0


Patients with overweight/obesity and type 2 diabetes who lose ≥ 7% of their body weight and maintain it for longer may lower their risk for kidney outcomes.

METHODOLOGY:

  • Researchers conducted a post hoc analysis of the Look AHEAD trial including 3601 adults with a body mass index of > 25 kg/m2 and a diagnosis of type 2 diabetes. The mean age was 59 years, and 2140 (59%) were women.
  • Body weight time in target range (TTR), a new indicator of weight management, was defined as the proportion of time during the first 4 years when weight was within the weight-loss target of ≥ 7% from baseline.
  • Body weight TTR during the first 4 years was assessed in three evenly divided categories ranging from > 0% to < 100%, using 0% as the reference group.
  • Patients were randomly assigned to an intensive lifestyle intervention group of reduced caloric intake and increased physical activity or a control diabetes support and education group that focused on exercise, diet, and social support.
  • The primary outcome was the composite kidney outcome, defined as ≥ 30% decrease in estimated glomerular filtration rate to < 60 mL/min/1.73 m2, end-stage kidney disease, or self-reported kidney failure.

TAKEAWAY:

  • During a median follow-up of 8 years, composite kidney outcome was reported in 435 participants.
  • During the first 4 years, body weight TTR was inversely associated with the subsequent risk for composite kidney outcome (adjusted hazard ratio [aHR], 0.81; P < .001).
  • The inverse association between body weight TTR and composite kidney outcome was stronger in the intense intervention group (aHR, 0.77; 95% CI, 0.66-0.89) but not significant in the control group.
  • Compared with participants having a body weight TTR of 0%, the aHRs of composite kidney outcomes were 0.73 (95% CI, 0.54-1.00) for a TTR of > 0% to < 29.9%, 0.71 (95% CI, 0.52-0.99) for a TTR of 29.9% to < 69.7%, and 0.54 (95% CI, 0.36-0.80) for a TTR of 69.7% to < 100%.

IN PRACTICE:

“Even a single-digit sustained weight loss can bring significant renal benefits,” the authors wrote, emphasizing the importance of weight control through caloric restriction and physical activity in patients with overweight/obesity and type 2 diabetes.

SOURCE:

Xianhui Qin of the Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China, was the corresponding author of this study, which was published online on December 11, 2023, in Diabetes Care.

LIMITATIONS:

The participants’ body weight was measured annually, and body weight TTR was computed using the results of at least three body weight measurements taken over the first 4 years. Because weight change is a gradual process, these data may not accurately reflect the actual time spent within the target weight range. Given the novelty of the body weight TTR concept, the authors noted, the findings are hypothesis generating and should be interpreted with greater caution.

Sustained weight loss reduces AF burden in obese patients

Posted by

1


Sustained weight loss in obese patients with atrial fibrillation (AF) reduces AF burden and symptom severity, the 5-year LEGACY* trial has shown. The benefits appeared to be dose dependent.

Patients who lost >10 percent of their body weight and kept it off for 4 years were six times more likely to achieve long-term freedom from arrhythmia without the help of medication or ablation compared with patients who lost less weight (p<0.001). Conversely, significant weight fluctuation over 4 years attenuated the positive impact of weight loss. Weight fluctuation of >5 percent was associated with a two-fold increased risk of arrhythmia recurrence (95% CI, 1.0-4.3; p=0.02). [J Am Coll Cardiol  2015;doi:10.1016/j.jacc.2015.03.002]

“LEGACY demonstrated that sustained weight loss is associated with dose dependent reduction in AF burden and maintenance of sinus rhythm,” said study author Dr. Rajeev Pathak, a cardiologist and electrophysiologist at the University of Adelaide in Adelaide, Australia. “Weight loss and avoidance of weight fluctuation are important strategies for reducing AF burden.”

The study enrolled 355 obese adults (body mass index ≥27 kg/m2) with AF, participating in a weight management program. Yearly weight trend and fluctuation were recorded.

After a median of 4 years, 135 patients lost >10 percent of their body weight, 103 patients lost 3-9 percent, and 117 lost ❤ percent. Arrhythmia-free survival rates were 86.2 percent, 66 percent and 40 percent, respectively.

“Weight loss also led to favourable changes in cardiovascular risk factors such as high blood pressure, obstructive sleep apnoea, and diabetes, along with improvements in the structure and function of the heart,” said Pathak.

Obesity and AF often co-exist. Weight loss in the short term reduces AF burden, but until this research, it is not known whether this benefit can be sustained in the long term, the authors said. LEGACY also addresses the impact of weight fluctuation and the role of weight loss clinics on arrhythmia control.

“A dedicated [weight loss] clinic improves patient engagement and promotes treatment adherence, thus preventing weight regain and fluctuation in AF patients.”