Does the Effect of a 3-Year Lifestyle Intervention on Body Weight and Cardiometabolic Health Differ by Prediabetes Metabolic Phenotype? A Post Hoc Analysis of the PREVIEW Study Diabetes Care 2022;45:2698–2708 | https://doi.org/10.2337/dc22-0549 Ruixin Zhu, 1 Elli Jalo, 2 Marta P. Silvestre, 3,4 Sally D. Poppitt, 3 Teodora Handjieva-Darlenska, 5 Svetoslav Handjiev, 5 Maija Huttunen-Lenz, 6 Kelly Mackintosh, 7 Gareth Stratton, 7 Santiago Navas-Carretero, 8,9,10 Kirsi H. Pietil€ ainen, 11,12 Elizabeth Simpson, 13 Ian A. Macdonald, 13 Roslyn Muirhead, 14 Jennie Brand-Miller, 14 Mikael Fogelholm, 2 Kristine Færch, 15,16 J. Alfredo Martinez, 9,17,18 Margriet S. Westerterp-Plantenga, 19 Tanja C. Adam, 19 and Anne Raben 1,15 OBJECTIVE To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype. RESEARCH DESIGN AND METHODS This post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ‡25 kg  m 22 ; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A 1c (HbA 1c ; <39 mmol  mol 21 ) and 25% had intermediate HbA 1c (39–47 mmol  mol 21 ). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used. RESULTS In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks 23.5% [95% CI, 24.7%, 22.3%]) than those with iIFG (mean 22.5% [23.6%, 21.3%]) relative to baseline (P 5 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits be- tween those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA 1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA 1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks 20.54 mmol  L 21 [95% CI 20.70, 20.39], P < 0.001), and triglycerides (difference 20.07 mmol  L 21 [20.11, 20.03], P < 0.001) during the lifestyle intervention. CONCLUSIONS Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA 1c had greater im- provements than those with intermediate HbA 1c . 1 Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark 2 Department of Food and Nutrition, University of Helsinki, Helsinki, Finland 3 Human Nutrition Unit, Department of Medicine, School of Biological Sciences, University of Auckland, Auckland, New Zealand 4 Center for Health Technology and Services Research (CINTESIS), NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisboa, Portugal 5 Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria 6 Institute for Nursing Science, University of Education Schw€ abisch Gm€ und, Schw€ abisch Gm€ und, Germany 7 Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, U.K. 8 Centre for Nutrition Research, University of Navarra, Pamplona, Spain 9 Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain 10 Instituto de Investigaci on Sanitaria de Navarra (IdiSNA) Instituto for Health Research, Pamplona, Spain 11 Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland CARDIOVASCULAR AND METABOLIC RISK 2698 Diabetes Care Volume 45, November 2022 Downloaded from http://diabetesjournals.org/care/article-pdf/45/11/2698/690190/dc220549.pdf by guest on 09 July 2024