Brain and White Matter Hyperintensity Volumes After 10 Years of Random Assignment to Lifestyle Intervention

Mark A Espeland, Kirk Erickson, Rebecca H Neiberg, John M Jakicic, Thomas A Wadden, Rena R Wing, Lisa Desiderio, Guray Erus, Meng-Kang Hsieh, Christos Davatzikos, Barbara J Maschak-Carey, Paul J Laurienti, Kathryn Demos-McDermott, R Nick Bryan, Action for Health in Diabetes Brain Magnetic Resonance Imaging (Look AHEAD Brain) Ancillary Study Research Group, Mark A Espeland, Kirk Erickson, Rebecca H Neiberg, John M Jakicic, Thomas A Wadden, Rena R Wing, Lisa Desiderio, Guray Erus, Meng-Kang Hsieh, Christos Davatzikos, Barbara J Maschak-Carey, Paul J Laurienti, Kathryn Demos-McDermott, R Nick Bryan, Action for Health in Diabetes Brain Magnetic Resonance Imaging (Look AHEAD Brain) Ancillary Study Research Group

Abstract

Objective: Type 2 diabetes increases the accumulation of brain white matter hyperintensities and loss of brain tissue. Behavioral interventions to promote weight loss through dietary changes and increased physical activity may delay these adverse consequences. We assessed whether participation in a successful 10-year lifestyle intervention was associated with better profiles of brain structure.

Research design and methods: At enrollment in the Action for Health in Diabetes clinical trial, participants had type 2 diabetes, were overweight or obese, and were aged 45-76 years. They were randomly assigned to receive 10 years of lifestyle intervention, which included group and individual counseling, or to a control group receiving diabetes support and education through group sessions on diet, physical activity, and social support. Following this intervention, 319 participants from three sites underwent standardized structural brain magnetic resonance imaging and tests of cognitive function 10-12 years after randomization.

Results: Total brain and hippocampus volumes were similar between intervention groups. The mean (SE) white matter hyperintensity volume was 28% lower among lifestyle intervention participants compared with those receiving diabetes support and education: 1.59 (1.11) vs. 2.21 (1.11) cc (P = 0.02). The mean ventricle volume was 9% lower: 28.93 (1.03) vs. 31.72 (1.03) cc (P = 0.04). Assignment to lifestyle intervention was not associated with consistent differences in cognitive function compared with diabetes support and education.

Conclusions: Long-term weight loss intervention may reduce the adverse impact of diabetes on brain structure. Determining whether this eventually delays cognitive decline and impairment requires further research.

Trial registration: ClinicalTrials.gov NCT00017953.

© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

References

    1. Manschot SM, Brands AMA, van der Grond J, et al. .; Utrecht Diabetic Encephalopathy Study Group . Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes. Diabetes 2006;55:1106–1113
    1. Ravona-Springer R, Luo X, Schmeidler J, et al. . Diabetes is associated with increased rate of cognitive decline in questionably demented elderly. Dement Geriatr Cogn Disord 2010;29:68–74
    1. Tamura Y, Araki A. Diabetes mellitus and white matter hyperintensity. Geriatr Gerontol Int 2015;15(Suppl. 1):34–42
    1. Biessels GJ, Reijmer YD. Brain changes underlying cognitive dysfunction in diabetes: what can we learn from MRI? Diabetes 2014;63:2244–2252
    1. Cukierman-Yaffe T, Gerstein HC, Williamson JD, et al. .; Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators . Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial. Diabetes Care 2009;32:221–226
    1. Feil DG, Pearman A, Victor T, et al. . The role of cognitive impairment and caregiver support in diabetes management of older outpatients. Int J Psychiatry Med 2009;39:199–214
    1. Koekkoek PS, Kappelle LJ, van den Berg E, Rutten GE, Biessels GJ. Cognitive function in patients with diabetes mellitus: guidance for daily care. Lancet Neurol 2015;14:329–340
    1. Ashrafian H, Harling L, Darzi A, Athanasiou T. Neurodegenerative disease and obesity: what is the role of weight loss and bariatric interventions? Metab Brain Dis 2013;28:341–353
    1. Ryan DH, Espeland MA, Foster GD, et al. .; Look AHEAD Research Group . Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24:610–628
    1. Wadden TA, West DS, Delahanty L, et al. .; Look AHEAD Research Group . The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it [published correction appears in Obesity (Silver Spring) 2007;15:1339]. Obesity (Silver Spring) 2006;14:737–752
    1. Wesche-Thobaben JA. The development and description of the comparison group in the Look AHEAD trial. Clin Trials 2011;8:320–329
    1. Launer LJ, Miller ME, Williamson JD, et al. .; ACCORD MIND Investigators . Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol 2011;10:969–977
    1. Doshi J, Erus G, Ou Y, Gaonkar B, Davatzikos C. Multi-atlas skull-stripping. Acad Radiol 2013;20:1566–1576
    1. Doshi J, Erus G, Ou Y, Davatzikos C. Ensemble-based medical image labeling via sampling morphological appearance manifolds. Presented at the MICCAI Challenge Workshop on Segmentation, 22–26 September 2013, at the Toyoda Auditorium at Nagoya University, Nagoya, Japan
    1. Lao Z, Shen D, Liu D, et al. . Computer-assisted segmentation of white matter lesions in 3D MR images using support vector machine. Acad Radiol 2008;15:300–313
    1. Elosua R, Demissie S, Cupples LA, et al. . Obesity modulates the association among APOE genotype, insulin, and glucose in men. Obes Res 2003;11:1502–1508
    1. Espeland MA, Rapp SR, Bray GA, et al. . Long-term impact of behavioral weight loss intervention on cognitive function. J Gerontol A Biol Sci Med Sci 2014;69:1101–1108
    1. Braskie MN, Boyle CP, Rajagopalan P, et al. . Physical activity, inflammation, and volume of the aging brain. Neuroscience 2014;273:199–209
    1. Fleischman DA, Yang J, Arfanakis K, et al. . Physical activity, motor function, and white matter hyperintensity burden in healthy older adults. Neurology 2015;84:1294–1300
    1. Zhu N, Jacobs DR Jr, Schreiner PJ, et al. . Cardiorespiratory fitness and brain volume and white matter integrity: The CARDIA Study. Neurology 2015;84:2347–2353
    1. Prasad S, Sajja RK, Naik P, Cucullo L. Diabetes mellitus and blood-brain barrier dysfunction: an overview. J Pharmacovigil 2014;2:125.
    1. Haltia LT, Viljanen A, Parkkola R, et al. . Brain white matter expansion in human obesity and the recovering effect of dieting. J Clin Endocrinol Metab 2007;92:3278–3284
    1. Peters A, Bosy-Westphal A, Kubera B, et al. . Why doesn’t the brain lose weight, when obese people diet? Obes Facts 2011;4:151–157
    1. Erickson KI, Leckie RL, Weinstein AM. Physical activity, fitness, and gray matter volume. Neurobiol Aging 2014;35(Suppl. 2):S20–S28
    1. Furie KL, Kasner SE, Adams RJ, et al. .; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research . Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:227–276
    1. Kono Y, Yamada S, Yamaguchi J, et al. . Secondary prevention of new vascular events with lifestyle intervention in patients with noncardioembolic mild ischemic stroke: a single-center randomized controlled trial. Cerebrovasc Dis 2013;36:88–97
    1. Moore SA, Hallsworth K, Jakovljevic DG, et al. . Effects of community exercise therapy on metabolic, brain, physical, and cognitive function following stroke: a randomized controlled pilot trial. Neurorehabil Neural Repair 2015;29:623–635
    1. Varosanec M, Uher T, Horakova D, et al. . Longitudinal mixed-effect model analysis of the association between global and tissue-specific brain atrophy and lesion accumulation in patients with clinically isolated syndrome. AJNR Am J Neuroradiol 2015;36:1457–1464
    1. Espeland MA, Bryan RN, Goveas JS, et al. .; WHIMS-MRI Study Group . Influence of type 2 diabetes on brain volumes and changes in brain volumes: results from the Women’s Health Initiative Magnetic Resonance Imaging studies. Diabetes Care 2013;36:90–97
    1. Sjöström L, Peltonen M, Jacobson P, et al. . Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014;311:2297–2304
    1. Gräff J, Kahn M, Samiei A, et al. . A dietary regimen of caloric restriction or pharmacological activation of SIRT1 to delay the onset of neurodegeneration. J Neurosci 2013;33:8951–8960
    1. Wing RR; Look AHEAD Research Group . Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010;170:1566–1575
    1. Dutton GR, Lewis CE. The Look AHEAD Trial: implications for lifestyle intervention in type 2 diabetes mellitus. Prog Cardiovasc Dis 2015;58:69–75
    1. Belalcazar LM, Ballantyne CM, Lang W, et al. .; Look Action for Health in Diabetes Research Group . Metabolic factors, adipose tissue, and plasminogen activator inhibitor-1 levels in type 2 diabetes: findings from the Look AHEAD study. Arterioscler Thromb Vasc Biol 2011;31:1689–1695
    1. Espeland MA, Probstfield J, Hire D, et al. .; Look AHEAD Research Group; ACCORD Study Group . Systolic blood pressure control among individuals with type 2 diabetes: a comparative effectiveness analysis of three interventions. Am J Hypertens 2015;28:995–1009
    1. Kuna ST, Reboussin DM, Borradaile KE, et al. .; Sleep AHEAD Research Group of the Look AHEAD Research Group . Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 2013;36:641–649A
    1. Look AHEAD Research Group Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2014;2:801–809
    1. Araki A, Ito H. Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int 2009;9:105–114
    1. Espeland MA, Glick HA, Bertoni A, et al. .; Look AHEAD Research Group . Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care 2014;37:2548–2556
    1. Burggren A, Brown J. Imaging markers of structural and functional brain changes that precede cognitive symptoms in risk for Alzheimer’s disease. Brain Imaging Behav 2014;8:251–261

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться