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PubMed1996

The role of insulin resistance in Korean patients with coronary atherosclerosis.

To determine whether dietary modification improves insulin resistance and coronary atherosclerosis, we randomly assigned 14 Korean patients to an experimental group (low-fat, low-cholesterol diet, high polyunsaturated/saturated fatty acid ratio, and calorie restriction) or to a control group (no dietary change). Coronary artery lesions were analyzed by quantitative coronary angiography, and postglucose insulin responses were measured. At baseline, there were no significant differences in body weight, BMI, waist-to-hip ratio (WHR), and plasma lipid and insulin levels between the two groups. After completion of the 1-year diet program, the experimental group showed significant reductions in body weight (66.0 +/- 3.2 to 61.6 +/- 3.8 kg [means +/- SE], P < 0.01) and WHR (O.96 +/- 0.01 to 0.93 +/- 0.01, P < 0.05). Total cholesterol (5.45 +/- 0.45 to 4.50 +/- 0.44 mmol/l, P < 0.05), LDL cholesterol (3.71 +/- 0.36 to 2.98 +/- 0.37 mmol/l, P < 0.05), and triglyceride (1.91 +/- 0.28 to 1.29 +/- 0.17 mmol/l, P < 0.05) were also significantly reduced in the experimental group. The mean insulin response during an oral glucose tolerance test was also significantly decreased (258.6 +/- 26.4 to 181.8 +/- 6.6 pmol/l, P < 0.05). In contrast, there were no significant changes in these parameters in the control group. When only coronary artery lesions > 50% stenosed were analyzed, the average percentage diameter stenosis regressed from 63.2 to 56.8% in the experimental group. However, there were no significant changes in the control group. Our trial suggests that decreases in body weight and WHR and an improvement in insulin resistance with a low-fat, low cholesterol diet and caloric restriction may reduce risk factors and reverse coronary atherosclerotic lesions in 1 year.

Body Composition↗

PubMed1987

Psychological response to an acute coronary event and its effect on subsequent rehabilitation and lifestyle change.

We assessed anxiety, depression, body image, motivation, and coping ability in 264 patients admitted with a first myocardial infarction. They were followed over 1 year to determine the relationship between psychological factors and subsequent return to work, smoking cessation, weight reduction, and adoption of a leisure exercise program. Females showed a poorer reaction to illness than did males. The better-educated, and patients in white-collar occupations showed less depression and expressed greater motivation. Anxiety and poor body image, however, tended to be least common in the intermediate educational and occupational group. All psychological factors predicted leisure exercise change, and all but anxiety predicted smoking cessation. Poor body image was linked with failure to reduce weight. Low expressed motivation was the only factor predicting delayed return to work.

Adaptation, Psychological↗

PubMed1976

Self-training of new eating behavior for weight reduction.

The problems of obesity are well documented, but few medical treatment programs have proven successful. Recently developed behavioral techniques have offered promise in the treatment of obesity. However, the time invested by a therapist limited their practical use and adoption by the general physician. A pilot study was conducted which employed a brief period of explanation of behavior modification techniques, development of an individualized program of eating behavior and recording of weight changes to provide feedback on progress. The program is carried out by patients at home with a minimum of physician supervision. The results indicate that such an approach is feasible and successful. Comparing this program to other programs is difficult because of the variability in reporting data and results.

Adult↗

PubMedDate not supplied

Participation rates, weight loss, and blood pressure changes among obese women in a nutrition-exercise program.

Since 1985, a black urban community in Atlanta has planned, implemented, and evaluated a cardiovascular risk reduction project. The Community Health Assessment and Promotion Project (CHAPP) was developed to reduce the high incidence of cardiovascular risk factors in the neighborhood's predominantly black population. Based on data from a needs assessment, a community coalition designed and directed a 10-week exercise and nutrition intervention targeted to obese residents between the ages of 18 and 59 years. The intervention consists of an orientation, attitudes assessment, selection of a specific exercise class, and twice-weekly information on nutrition and community resources. The program uses a wide range of strategies, including individual consultations, reminder telephone calls, incentives, and rewards, and free transportation and child care, to encourage participation. The exercise-nutrition intervention was provided to two separate groups. A total of 70 participants completed the intervention over a 7-month period. Program evaluation has demonstrated high participation rates and significant reductions in weight and blood pressures both immediately after the intervention and on 4-month followup. Since completion of this evaluation study, over 400 additional community members have participated in this intervention.

Adult↗

PubMed1991

[Anthropometric changes and nitrogen balance in patients with morbid obesity treated with very low calorie diet].

BACKGROUND: Morbid obesity is associated with increased morbidity and mortality. In these patients, weight reduction reduces associated morbidity and increases life expectancy. The aim of the present study was to evaluate the anthropometric changes in a group of patients treated with a very low caloric diet and to assess nitrogen balance and clinical and biological tolerance. METHODS: Overall 65 patients were prospectively evaluated (12 males and 53 females with a mean age of 45 +/- 7 years. Mean initial weight was 110 +/- 21 kg, with a Quetelet index of 43 +/- 7 kg/m2. They were treated as inpatients during 42 days exclusively with a very low caloric diet. They also followed a physical exercise program during one hour daily. RESULTS: The weight reduction was 15 +/- 4 kg (p less than 0.0001) with a reduction in fat mass of 9 +/- 2 kg (p less than 0.0001) and a reduction in fat-free mass of 6 +/- 3 kg (p less than 0.0001). The Quetelet index was reduced in 5 +/- 1 points (p less than 0.0001). There was also a reduction in the muscle adipose index from 1 +/- 0.2 to 0.7 +/- 0.2. The nitrogen balance remained negative throughout the 42 study days, although with a clear trend towards equilibrium. There were significant reductions in blood glucose, proteinemia, total cholesterol and subfractions. Triglycerides did not show significant changes. Clinical tolerance was excellent in all cases except 4 who withdraw from treatment because of nausea and vomiting. CONCLUSIONS: In this study, very low caloric diet achieved satisfactory weight reduction, basically at the expense of adipose tissue, reflected in a reduction of the muscle adipose index. Nitrogen balance remained negative throughout the treatment but with a trend towards normalization. Tolerance was excellent in 61 of the 65 cases (94%).

Adolescent↗

PubMed2003

Is there a threshold of visceral fat loss that improves the metabolic profile in obese postmenopausal women?

It is presently unclear how much visceral adipose tissue (VAT) loss is needed to induce favorable metabolic changes. Cross-sectional studies have proposed that a threshold level of VAT exceeding 110 cm(2) in women induces deleterious changes in the metabolic profile. It is presently unclear, however, if significant decreases in VAT below this given threshold significantly improve the metabolic profile more as compared to decreases that remain below 110 cm(2). To examine whether achieving versus not achieving the proposed VAT threshold impacts differently on the metabolic profile in postmenopausal women, we examined the effects of a VAT loss below the 110-cm(2) threshold versus those individuals who remained higher than 110 cm(2) after a weight loss program. Twenty-five sedentary obese (baseline % body fat, 47.7% +/- 4.1%; [mean +/- SD]) postmenopausal women aged between 51 and 71 years (59.7 +/- 5.6 years) and displaying high baseline levels of VAT accumulation (223 +/- 45 cm(2)) were submitted to a 1-year weight loss program with weight stabilization periods before and after weight reduction. Based on their loss of VAT after weight loss, subjects were characterized as "attainers" (post VAT levels < 110 cm(2); average, 96 +/- 10 cm(2); n = 10) or "non-attainers" (post VAT levels > 110 cm(2); average, 171 +/- 34 cm(2); n = 15). We compared changes in (1) plasma lipid-lipoprotein levels, (2) insulin sensitivity (euglycemic/hyperinsulinemic clamp), and (3) supine resting blood pressure between groups who achieved these 2 distinct levels of VAT. Attainers showed a 2-fold greater loss of VAT compared to non-attainers (-51.5% v -27.5%, P <.001). Attainers also showed a greater loss of body weight (-19.0% v -12.5%, P <.01) and fat mass (-34.8% v -18.4%, P <.001) after the program compared to non-attainers. Despite significant differences in the loss of total fat and VAT after the weight loss program, attainers and non-attainers showed comparable improvements for plasma high-density lipoprotein-cholesterol (HDL-chol) levels (+62.5% v +50.0%, P = not significant [NS]), cholesterol/HDL-chol ratio (-45.5% v -36.5%, P = NS), insulin sensitivity (+34.1% v +23.2%, P = NS), and resting systolic (-6.9% v -5.1%, P = NS) and diastolic (-11.3% v -11.1%, P = NS) blood pressure. These results do not favor the idea that attaining levels of VAT below a threshold of 110 cm(2) is necessary to favorably improve the metabolic profile in obese postmenopausal women. Achieving or not the proposed threshold of VAT, independently of baseline values, appears to yield similar metabolic improvements in obese postmenopausal women. More moderate losses of VAT appear to yield similar metabolic improvements as large losses.

Adipose Tissue↗

PubMed2005

Effects of different weight loss protocols on serum leptin levels in obese females.

We investigated the effects of different weight loss protocols on leptin levels in obese females with the aim of addressing the leptin resistance which has been found to be an aggravating factor in obesity. Twenty-four obese females enrolled to one of three 12-week weight loss protocols: orlistat-induced weight loss (OWL, n=8), exercise-induced weight loss (EWL, n=8) and orlistat plus exercise-induced weight loss (OEWL, n=8). Serum leptin levels were measured in duplicate by radioimmunoassay. There were significant reductions (P<0.01) in body weight and fat mass after the 12 week period in all groups: -11.4+/-0.5 kg and -9.8+/-0.5 kg (OEWL), -8.3+/-0.8 kg and -5.7+/-0.9 kg (OWL), -8.9+/-1.2 kg and -7.4+/-1.2 kg (EWL), respectively. Serum leptin levels were also decreased markedly in all groups: -59.2 % (OEWL1), -37.8 % (OWL) and -48.6 % (EWL) (P<0.01 all). In addition, there were marked decreases in leptin levels for each kilogram of fat mass after the 12 week period: -48.2+/-7.2 % (OEWL), -27.8+/-4.8 % (OWL) and -39.3+/-4.3 % (EWL) (P<0.01 all). Decreases in serum leptin levels expressed per kilogram of fat mass were significantly higher in the OEWL group compared to the OWL group (P=0.03). Consequently, an exercise training program in adjunct to pharmacotherapy provides higher weight reduction and fat mass loss in obesity treatment. It also seems to have further beneficial effects on leptin resistance, as indicated by decreases in leptin levels expressed per kilogram of fat mass.

Adult↗

PubMed2002

Physiologic changes after diet combined with structured aerobic exercise or lifestyle activity.

Moderate intensity physical activity achieved through changes in lifestyle may promote weight management. However, little is known about changes in physiologic and metabolic variables when patients lose weight using moderate intensity lifestyle activity instead of traditional structured vigorous aerobic exercise. To compare changes in resting metabolic energy expenditure (REE), fat mass (FM), and fat-free mass (FFM) associated with a 12-week weight loss program combined with either: (1) aerobic exercise (AER); or (2) lifestyle activity (LIFE), we randomized 39 overweight adults (mean body mass index [BMI] = 30.9 +/- 2.8 kg/m(2)) to either diet plus AER (N = 18) or diet plus LIFE (N = 21). Both groups consumed a self-selected diet of 1,200 to 1,800 kcal/d (5,021 to 7,531 kJ/d). The AER group performed vigorous aerobic exercise for up to 45 minutes 3 to 4 d/wk. The LIFE group accumulated 30 minutes of moderate intensity physical activity on most days of the week. Compliance with the respective protocols was monitored on a weekly basis. REE was measured before and after treatment via open-circuit spirometry. The AER group decreased body weight by 8.4% (P<.001)while the LIFE had a reduction of 6.7% (P <.001) after treatment. Over the course of the interventions, the AER and LIFE groups experienced 10.9% (P <.001) and 10.2% (P <.001) reductions in REE, respectively. Aerobic exercise did not prevent reductions in REE to a greater extent than did lifestyle activity in patients consuming a reduced calorie diet. Change in REE was not related to changes in FFM or FM for either group, and there were no differences between groups in reductions of REE, weight, FM, or FFM. A program of diet plus lifestyle physical activity may be a suitable alternative for dieting adults who have difficulty adhering to a program of vigorous activity.

Adipose Tissue↗

PubMed2002

Weight loss-induced rise in plasma pollutant is associated with reduced skeletal muscle oxidative capacity.

In this study, we examined whether weight loss-induced changes in plasma organochlorine compounds (OC) were associated with those in skeletal muscle markers of glycolytic and oxidative metabolism. Vastus lateralis skeletal muscle enzyme activities and plasma OC (Aroclor 1260, polychlorinated biphenyl 153, p,p'-DDE, beta-hexachlorocyclohexane, and hexachlorobenzene) were measured before and after a weight loss program in 17 men and 20 women. Both sexes showed a similar reduction in body weight (approximately 11 kg) in response to treatment, although men lost significantly more fat mass than women (P < 0.05). Enzymatic markers of glycolysis, phosphofructokinase (PFK) activity, and oxidative metabolism, beta-hydroxyacyl-CoA dehydrogenase (HADH), citrate synthase (CS), and cytochrome c oxidase (COX) activities, remained unchanged after weight loss. A significant increase in plasma OC levels was observed in response to weight loss, an effect that was more pronounced in men. No relationship was observed between changes in OC and those in PFK activity in either sex [-0.31 < r < 0.12, not significant (NS)]. However, the greater the increase in plasma OC levels, the greater the reduction in oxidative enzyme (HADH, CS, COX) activities was in response to weight loss in men (-0.75 < r < -0.50, P < 0.05) but not in women (-0.33 < r < 0.33, NS). These results suggest that the weight loss-induced increase in plasma pollutant levels is likely to be associated with reduced skeletal muscle oxidative metabolism in men but not in women.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed1996

Therapeutic challenges in the obese diabetic patient with hypertension.

Obesity, diabetes mellitus, and hypertension are common and interrelated medical problems in Westernized, industrialized societies. These medical conditions are associated with an increased risk of cardiovascular disease and are more prevalent among minorities, such as African-American and Hispanic populations. The associated cardiovascular risks of these problems are more thoroughly addressed in another review in this supplement. Obesity markedly enhances the development of type II diabetes. Moreover, it enhances the cardiovascular risk associated with other risk factors, such as hypertension and dyslipidemia. Weight reduction in association with an aerobic exercise program improves metabolic abnormalities and reduces blood pressure in individuals with diabetes and hypertension. Frequently, however, pharmacologic treatment is required to lower blood pressure. Individual therapy with an angiotensin-converting enzyme (ACE) inhibitor is preferred initially in these individuals, with the addition of either a low dose diuretic or a nondihydropyridine calcium antagonist if additional blood pressure reduction is required. These additive agents are recommended, since each has been shown individually to reduce cardiovascular morbidity and to preserve renal function among diabetic patients. Other issues, such as aggressive therapy of lipids and adequate glycemic control, are also important strategies for reducing cardiovascular and renal morbidity and mortality in this very high-risk population.

Antihypertensive Agents↗

PubMed2003

[The effect of controlled physical activity on the body composition of postmenopausal sedentary women].

OBJECTIVE: To evaluate the effect of a controlled physical activity program on the weight and body composition of healthy sedentary postmenopausal women. METHODS: From a group of 138 postmenopausal women volunteers, 18 of them were selected, using a survey that measured the frequency and intensity of their physical activity. These 18 women were classified as "sedentary," having an average daily energy expenditure (in terms of mL of oxygen per kg per minute) that was below 60% of the maximum oxygen consumption for their age. These 18 women underwent a general physical examination, laboratory tests, and spirometry to make certain that they did not have illnesses that would prevent them from participating in the planned controlled physical activity program. The activity program lasted 4 months, with three one-hour sessions per week. Before and after the program the following characteristics were evaluated for each participant: weight, body fat, and the fatty area and the lean area of the arm, the thigh, and the leg. In addition, energy intake was determined based on a record of food consumption, with the frequency of the consumption of specific foods assessed semiquantitatively. The Student's t test was used to compare the averages for all the measurements before and after the exercise program. When the variables did not have a normal distribution, the Wilcoxon signed rank sum test was utilized. RESULTS: At the end the program we found a reduction of 1.2 kg in weight and of 2.0 kg in body fat, while the lean mass increased by 1.0 kg. Also increasing were the lean area of the arm, of the thigh, and of the leg; the areas of fat in those parts of the body decreased. The differences were statistically significant for all the variables observed except for the lean area of the thigh. There were no significant differences between the women's energy intake at the beginning and the end of the program. CONCLUSIONS: The controlled physical activity program improved the body composition of this group of women, decreasing the fat deposits and increasing the lean body mass.

Body Composition↗

PubMed1995

Evaluation of weight reduction in a community intervention for cardiovascular disease risk: changes in body mass index in the Minnesota Heart Health Program.

This paper describes the effectiveness of the Minnesota Heart Health Program (MHHP) in modifying mean body mass index (BMI) in whole communities. The MHHP is a 13-year research and demonstration project designed to reduce cardiovascular risk. One member of each of three pairs of matched communities received 7 years of community intervention activities that included risk factor screening, mass media education, adult education classes, worksite interventions, home correspondence programs, school-based programs, restaurant programs, and point-of-purchase education in supermarkets. Weight gain prevention was emphasized for all adults and weight loss was encouraged among those who were obese or who had elevated risk factors known to be responsive to weight loss (e.g., high blood pressure). A strong upward secular trend in weight was noted in all MHHP communities over time. Intervention effects were evaluated conservatively with community as the unit of analysis. This analysis showed no overall effect of the MHHP intervention program on mean BMI. However, a positive intervention effect was noted early in the intervention among those with elevated cholesterol or a history of obesity-related disease. Possible reasons for this relatively weak community effect are discussed, including secular forces overwhelming intervention effects, an intervention effort not sufficiently focused on obesity, ceiling effects for weight concern in a population that was highly aware of the issue at baseline, and inherent limitations in educational approaches for this recalcitrant public health problem.

Adult↗

PubMed1999

Motivating the obese child to move: the role of structured exercise in pediatric weight management.

BACKGROUND: The prevalence of childhood obesity is rapidly increasing. Successful prevention and treatment of childhood obesity depends on increasing the physical activity patterns of obese youth. However, motivating the obese child to participate in physical activity is difficult. METHODS: We designed a four-phase physical activity intervention, consisting of a structured progressive exercise program of moderate intensity, along with motivational methods to increase physical activity and improve body movement awareness. RESULTS: Seventy-three overweight children participated in the weight management program. They had a significant weight loss and reduction in body fat, which was maintained at 1-year follow-up. Subjects also maintained lean body mass and showed improved physical activity patterns. CONCLUSIONS: Progressive exercise, used in conjunction with nutrition and behavior modification, provides successful motivational strategies. These strategies encourage increased physical activity patterns, the adoption of regular structured exercise training, and the loss of excess body fat.

Adolescent↗

PubMed2003

Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study.

BACKGROUND AND PURPOSE: Obesity is well recognized as a risk factor for coronary heart disease and mortality. The relationship between abdominal obesity and ischemic stroke remains less clear. Our aim was to evaluate abdominal obesity as an independent risk factor for ischemic stroke in a multiethnic community. METHODS: A population-based, incident case-control study was conducted July 1993 through June 1997 in northern Manhattan, New York, NY. Cases (n=576) of first ischemic stroke (66% >or=BORDER="0">65 years of age; 56% women; 17% whites; 26% blacks; 55% Hispanics) were enrolled and matched by age, sex, and race-ethnicity to stroke-free community controls (n=1142). All subjects were interviewed and examined and had measurements of waist-to-hip ratio (WHR). Odds ratios (ORs) of ischemic stroke were calculated with gender-specific quartiles (GQs) and gender-specific medians of WHR adjusted for stroke risk factors and body mass index (BMI). RESULTS: Compared with the first quartile, the third and fourth quartiles of WHR had an increased risk of stroke (GQ3: OR, 2.4; 95% CI, 1.5 to 3.9; GQ4: OR, 3.0; 95% CI, 1.8 to 4.8) adjusted for other risk factors and BMI. Those with WHR equal to or greater than the median had an overall OR of 3.0 (95% CI, 2.1 to 4.2) for ischemic stroke even after adjustment for other risk factors and BMI. Increased WHR was associated with a greater risk of stroke in men and women and in all race-ethnic groups. The effect of WHR was stronger among younger persons (test for heterogeneity, P<0.0002) (<65 years of age: OR, 4.4; 95%CI, 2.2 to 9.0; >or=65 years of age: OR, 2.2; 95% CI, 1.4 to 3.2). WHR was associated with an increased risk among those with and without large-artery atherosclerotic stroke. CONCLUSIONS: Abdominal obesity is an independent, potent risk factor for ischemic stroke in all race-ethnic groups. It is a stronger risk factor than BMI and has a greater effect among younger persons. Prevention of obesity and weight reduction need greater emphasis in stroke prevention programs.

Abdomen↗

PubMed2002

Management of obesity in the elderly: special considerations.

Over the last few decades, there has been an unprecedented increase in the prevalence of obesity, especially in economically developed countries. Furthermore, it is becoming an increasingly recognized health problem in the elderly. The precise mechanisms underlying increased adiposity in the elderly are not known. Aging is associated with a host of biologic changes that limit the ability of the individual to regulate energy homeostasis. Thus, it is likely that older individuals may be more likely to develop the two extremes of the spectrum of nutritional abnormalities, namely malnutrition and increased adiposity. These nutritional abnormalities are associated with significant morbidity and mortality. Current guidelines define overweight as a body mass index (BMI) of 25-29.9 kg/m2 and obesity as a BMI of 30 kg/m2 or more. However, the optimal BMI may be different in older individuals. Management strategies should attempt to optimize the nutritional status of older individuals. Age per se cannot be used as a justification for denying medical management of obesity to elderly individuals. Individualized programs with the goal of achieving modest weight reduction in obese patients are likely to result in immediate (e.g. alleviation of arthritic pains and reduction of glucose intolerance) and possibly long-term (e.g. reduction in cardiovascular risk) healthcare benefits. Management should emphasize lifestyle modifications, while the use of pharmacologic agents such as sibutramine and orlistat should be reserved for select groups of patients who do not respond to lifestyle modification.

Aged↗

PubMed2000

Relation of body weight change to changes in atherogenic traits; a study of middle-aged Japanese obese male office workers.

We examined the effect of body weight change on the modification of atherogenic risk factors in 296 middle-aged obese male office workers without medication for hypertension, dyslipidemia, hyperuricemia or diabetes mellitus. During a 1-year education program, 39.2% of the participants could reduce their weight, and the percentage of those who lost 2 kg or more was only 17.7%. Concomitant with the decrease of weight, however, the levels of systolic and diastolic blood pressures, total cholesterol, triglyceride, uric acid and hemoglobin A1c and the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol decreased significantly, whereas the HDL cholesterol level increased significantly. In a multivariate regression analysis, in addition to the initial risk-factor level, weight change was an important factor determining the changes in atherogenic risk factors. Changes in alcohol consumption were significantly associated with the changes in systolic blood pressure and HDL cholesterol levels. Changes in cigarettes smoking also showed significant associations with the changes in triglyceride level and the ratio of total cholesterol to HDL cholesterol. These results suggest that although the education program for controlling weight may have limited success, weight reduction exhibits beneficial changes in the atherogenic risk-factor profile in middle-aged obese men.

Adult↗

PubMed1987

A long-term aerobic exercise program decreases the obesity index and increases the high density lipoprotein cholesterol concentration in obese children.

The effects of long-term supervised aerobic exercise on the body weight, serum lipids and high density lipoprotein cholesterol (HDL-C) were studied in 41 obese children (21 boys, 20 girls) initially aged 11-years-old. The 2 year training program was performed during the daily school life. The intensity of training consisted of running 20 minutes seven times per week at a pace which corresponds to the blood lactate threshold. No dietary intervention was done. The obesity index significantly decreased after 1 year of aerobic exercise in both boys and girls by 55 percent and 48 percent respectively. Since the lean body mass increased throughout the 2 year study while the total body weight decreased, the weight loss is attributed to a decrease in fat. The concentration of HDL-C significantly increased in both boys and girls in the first year, 16 percent and 19 percent respectively and was a slightly lower value in the second year. After 2 years a significant reduction in the girls' serum triglyceride concentration was observed. However, the total cholesterol in serum was unaltered in either boys or girls throughout the 2 year study. In conclusion, a long-term supervised aerobic exercise program in obese children is beneficial and resulted in significant weight reduction with concomitant improvement of lipoprotein metabolism.

Child↗

PubMed2005

Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial.

BACKGROUND: Weight loss and increased physical exercise reduce the risk for diabetes in people with impaired glucose tolerance. Randomized trial evidence on the effect of these interventions on people without impaired glucose tolerance is lacking. OBJECTIVE: To examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without impaired glucose tolerance and in a post hoc subgroup analysis by baseline cigarette smoking status. DESIGN: Randomized, controlled trial. SETTING: 22 clinical centers for the Multiple Risk Factor Intervention Trial (MRFIT). PARTICIPANTS: 12,866 men age 35 to 57 years at risk for cardiovascular disease were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years; this report focuses on 11,827 men without diabetes or impaired glucose tolerance at entry for whom follow-up glucose measurements were available. MEASUREMENTS: Cardiovascular disease risk factors, fasting blood glucose levels, and diabetes medication history were assessed before randomization and annually. INTERVENTION: Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group. RESULTS: 11.5% of the special intervention group and 10.8% of the usual care group developed diabetes over 6 years of follow-up (hazard ratio, 1.08 [95% CI, 0.96 to 1.20]). The special intervention-usual care hazard ratio for diabetes was 1.26 (CI, 1.10 to 1.45) among smokers (63%) and 0.82 (CI, 0.68 to 0.98) among nonsmokers (37%). These estimates differed significantly (P = 0.0003). Weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers. LIMITATIONS: Principal findings are based on a post hoc subgroup analysis. CONCLUSIONS: In nonsmokers, an intervention program that included nutrition counseling to produce reductions in weight, serum cholesterol, and (along with antihypertensive medication) blood pressure reduced the risk for diabetes.

Adult↗