Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW)

Pia Christensen, Thomas Meinert Larsen, Margriet Westerterp-Plantenga, Ian Macdonald, J Alfredo Martinez, Svetoslav Handjiev, Sally Poppitt, Sylvia Hansen, Christian Ritz, Arne Astrup, Laura Pastor-Sanz, Finn Sandø-Pedersen, Kirsi H Pietiläinen, Jouko Sundvall, Mathijs Drummen, Moira A Taylor, Santiago Navas-Carretero, Teodora Handjieva-Darlenska, Shannon Brodie, Marta P Silvestre, Maija Huttunen-Lenz, Jennie Brand-Miller, Mikael Fogelholm, Anne Raben, Pia Christensen, Thomas Meinert Larsen, Margriet Westerterp-Plantenga, Ian Macdonald, J Alfredo Martinez, Svetoslav Handjiev, Sally Poppitt, Sylvia Hansen, Christian Ritz, Arne Astrup, Laura Pastor-Sanz, Finn Sandø-Pedersen, Kirsi H Pietiläinen, Jouko Sundvall, Mathijs Drummen, Moira A Taylor, Santiago Navas-Carretero, Teodora Handjieva-Darlenska, Shannon Brodie, Marta P Silvestre, Maija Huttunen-Lenz, Jennie Brand-Miller, Mikael Fogelholm, Anne Raben

Abstract

Aims: The PREVIEW lifestyle intervention study (ClinicalTrials.gov Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women.

Materials and methods: All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI ≥ 25 kg/m2 ) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score.

Results: In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 ± 0.15 in men and by 1.35 ± 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia.

Conclusions: An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.

Keywords: dietary intervention; obesity; pre-diabetes; prevention; weight loss.

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form and make the following declarations. P. C. received travel grants to attend scientific meetings from The Cambridge Weight Plan, UK, outside the submitted work. T. M. L. reports personal fees from Sense Kost, outside the submitted work. M. W.‐P. has nothing to disclose. I. M. has nothing to disclose. J. A. M. has nothing to disclose. S. H. has nothing to disclose. S. P. holds the Fonterra Chair in Human Nutrition at the University of Auckland. S. H. has nothing to disclose. C. R. has nothing to disclose. A. A. reports personal fees from Basic Research, USA; Beachbody, USA; BioCare Copenhagen, Denmark; Crossfit, USA; Danish Agriculture and Food Council; Dutch Beer Institute, The Netherlands; Feast Kitchen A/S, Denmark; Groupe Éthique et Santé, France; McCain Foods Limited, USA; Nestlé Research Center, Switzerland; Novo Nordisk, Denmark; Pfizer, Germany; Saniona, Denmark; Sanofi‐Aventis, Germany; S‐Biotek, Denmark; Scandinavian Airlines System, Denmark; TetraPak, Sweden; Weight Watchers, USA; Zaluvida, Switzerland; Gelesis, USA; Personalized Weight Management Research Consortium ApS, Denmark and grants from Arla Foods, Denmark; Danish Dairy Research Council; Gelesis, USA; and Global Dairy Platform, outside the submitted work; has patents pending (University of Copenhagen, methods of inducing weight loss, treating obesity and preventing weight gain; licensee, Gelesis, USA) and (Biomarkers, predicting degree of weight loss (licensee Nestec SA, Switzerland); is co‐inventor of a number of other patents owned by the University in accordance with Danish law; receives royalties for the books “Verdens Bedste Kur”/Politikens Forlag, Denmark, 2012 (subsequently published in English as “World's Best Diet”/Penguin, Australia and “The Nordic Way”/Random House, USA), and “Spis dig slank efter dit blodsukker” (Eat according to your blood sugar and be slim)/Politikens Forlag, Denmark, 2017; is co‐author of several books in the pipeline about personlized nutrition for weight loss; is co‐owner and member of the board of the consultancy company Dentacom Aps, Denmark; is co‐founder and co‐owner and member of the board of UCPH spin‐outs Mobile Fitness A/S & Flaxslim ApS. L. P.‐S. has nothing to disclose. F. S.‐P. has nothing to disclose. K. H. P. was supported by the Academy of Finland (grants 272376, 314383 and 266286), the Finnish Diabetes Research Foundation, Novo Nordisk Foundation and Helsinki University Hospital Government funds. M. D. has nothing to disclose. M. A. T. has nothing to disclose. S. N.‐C. has nothing to disclose. T. H.‐D. has nothing to disclose. S. B. has nothing to disclose. M. P. S. has nothing to disclose. M. H.‐L. has nothing to disclose. J. B.‐M. has nothing to disclose. M. F. has nothing to disclose. A. R. has nothing to disclose.

© 2018 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Trial flow chart. Pre‐screening, screening, individuals starting initial weight‐loss phase and follow‐up of study participants

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