Effect of Lifestyle Intervention on the Occurrence of Metabolic Syndrome and its Components in the Finnish Diabetes Prevention Study PIRJO ILANNE-PARIKKA, MD 1,2 JOHAN G. ERIKSSON, MD, PHD 3,4 JAANA LINDSTR ¨ OM, PHD 3 MARKKU PELTONEN, PHD 3 SIRKKA AUNOLA, PHD 5 HELENA H¨ AM ¨ AL ¨ AINEN, MD, PHD 6 SIRKKA KEIN¨ ANEN-KIUKAANNIEMI , MD, PHD 7,8,9 MAURI LAAKSO,MD 7,8,10 TIMO T. VALLE, MD 3 JORMA LAHTELA, MD, PHD 11 MATTI UUSITUPA, MD, PHD 12 JAAKKO TUOMILEHTO, MD, PHD 3,4 ON BEHALF OF THE FINNISH DIABETES PREVENTION STUDY GROUP OBJECTIVE — The aim of this secondary analysis of the Finnish Diabetes Prevention Study was to assess the effects of lifestyle intervention on metabolic syndrome and its components. RESEARCH DESIGN AND METHODS — A total of 522 middle-aged overweight men and women with impaired glucose tolerance were randomized into an individualized lifestyle intervention group or a standard care control group. National Cholesterol Education Program criteria were used for the definition of metabolic syndrome. RESULTS — At the end of the study, with a mean follow-up of 3.9 years, we found a signif- icant reduction in the prevalence of metabolic syndrome in the intervention group compared with the control group (odds ratio [OR] 0.62 [95% CI 0.40 – 0.95]) and in the prevalence of abdominal obesity (0.48 [0.28 – 0.81]). CONCLUSIONS — The results suggest that lifestyle intervention may also reduce risk of cardiovascular disease in the long run. Diabetes Care 31:805–807, 2008 R ecent studies (1– 4) have shown that lifestyle intervention reduces the risk of progression from im- paired glucose tolerance (IGT) to manifest type 2 diabetes. The aim of this secondary analysis of the Finnish Diabetes Preven- tion Study (DPS) was to assess the effects of lifestyle intervention on metabolic syn- drome and its components. RESEARCH DESIGN AND METHODS — The DPS design, sub- jects, and methods applied have previ- ously been described (2,5,6). Altogether, 522 middle-aged (mean age 55  7 years) and overweight (mean BMI 31.2  4.6 kg/m 2 ) men (n = 172) and women (n = 350) with IGT were randomized into ei- ther an intensive lifestyle intervention group or a standard care control group. Blood samples were collected and an oral glucose tolerance test was performed at baseline and at each annual visit. Updated National Cholesterol Education Program 2005 criteria (7) were used for the defini- tion of metabolic syndrome. Data were analyzed using SPSS (version 11.5; SPSS, Chicago, IL). For those participants who developed diabetes according to the World Health Organization guidelines of 1985 (8) or who dropped out during the study, the measurements from the last ob- servation were used as the final end value. Wilcoxon’s nonparametric test was used to compare the prevalence of metabolic syndrome and its components within the groups. Regression analyses adjusted for sex, age, blood pressure and cholesterol medications, and baseline status were ap- plied to compare the prevalence of meta- bolic syndrome and its components between the groups. RESULTS — The prevalence of meta- bolic syndrome decreased during the first year from 74.0 to 58.0% vs. from 74.0 to 67.7% (P = 0.018 for the change between the groups) in the intervention and con- trol groups, respectively. At the end of the study, 62.6% of subjects in the interven- tion group and 71.2% of subjects in the control group (P = 0.025 for the change between the groups) had metabolic syn- drome, which corresponds to an age- and sex-adjusted odds ratio (OR) of 0.62 (95% CI 0.40 – 0.95) in the intervention group compared with the control group. The prevalence of different compo- nents of metabolic syndrome at year 1 and at the end of the study are shown in Table 1. During the first year, there was a signif- icant decrease in all components except elevated triglycerides in the intervention group, while the control group showed a significant decrease only in the prevalence of elevated blood pressure. From baseline to the end of the study, a significant de- crease in the prevalence of abdominal obesity, elevated blood pressure, low HDL cholesterol, and elevated triglycer- ides was observed in the intervention ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From the 1 Diabetes Center, Finnish Diabetes Association, Tampere, Finland; the 2 Department of Research Administration, Pirkanmaa Hospital District, Tampere, Finland; the 3 Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland; the 4 De- partment of Public Health, University of Helsinki, Helsinki, Finland; the 5 Department of Health and Func- tional Capacity, Laboratory for Population Research, National Public Health Institute, Turku, Finland; the 6 Research Department, Social Insurance Institution, Turku, Finland; the 7 Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland; the 8 Department of Sport Medicine, Oulu Deaconess Institute, Oulu, Finland; the 9 Oulu Health Centre, Oulu, Finland; the 10 Unit of General Practice, Oulu University Hospital, Oulu, Finland; the 11 Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; and the 12 Department of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland. Address correspondence and reprint requests to Pirjo Ilanne-Parikka, Matinkatu 6, FIN 33900 Tampere, Finland. E-mail: pirjo.ilanneparikka@diabetes.fi. Received for publication 15 August 2007 and accepted in revised form 24 December 2007. Published ahead of print at http://care.diabetesjournals.org on 9 January 2008. DOI: 10.2337/dc07-1117. Clinical trial reg. no. NCT00518167, clinicaltrials.gov. Abbreviations: DPS, Finnish Diabetes Prevention Study; IGT, impaired glucose tolerance. © 2008 by the American Diabetes Association. 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. Cardiovascular and Metabolic Risk B R I E F R E P O R T DIABETES CARE, VOLUME 31, NUMBER 4, APRIL 2008 805 Downloaded from http://diabetesjournals.org/care/article-pdf/31/4/805/598511/zdc00408000805.pdf by guest on 01 September 2022