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Congress report: 3rd International Congress on Abdominal Obesity

Congress report: 3rd International Congress on Abdominal Obesity
  • Endocrinology and metabolism
  • Diabetes

Author

Resource type

Article

Tags

Type 2 diabetes
T2DM
Weight loss
Obesity
Etiology of diabetes
Abdominal waist circumference measurement

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Practical

Bruno Geloneze reports on the 3rd International Congress on Abdominal Obesity

Understanding the pathophysiology of obesity and diabetes is vital to help us choose the best therapeutic approach for our patients. The 3rd International Congress on Abdominal Obesity was held in Québec City, Canada, July 9−12, 2012, and focused on various aspects of abdominal obesity, its consequences and its therapeutic management.

Update on the Look-AHEAD (Action for Health in Diabetes) study

Patients with type 2 diabetes (T2DM) and overweight who received an intensive program of weight reduction achieved better glycemic control and had reduced cardiovascular risk (CVR) compared with those receiving care in line with basic guidelines, according to 4-year data presented from the Look-AHEAD study[1], the first prospective study to evaluate the long-term effects of intentional weight loss on cardiovascular (CV) outcomes in patients with T2DM.

A total of 5145 patients with T2DM and overweight were randomized to one of two groups: the control group received education and basic support for diabetes, while the treatment group underwent intensive lifestyle intervention (ILI). The control group of 2575 patients had diabetes education, nutrition and exercise in 3 to 4 individual sessions per year. The ILI group (n=2570) received group sessions weekly for 6 months providing knowledge and tools to promote weight loss, followed by a period of 6 months focused on maintenance of weight monitored at biweekly meetings. The ILI group continued to attend monthly meetings until the end of the 4 years of the study. The primary outcome of Look-AHEAD was the time to first composite CV event (CV death, nonfatal myocardial infarction (MI), nonfatal stroke, or hospitalization for angina).

The body mass index (BMI) was 36 kg/m2 for both groups. In the ILI group, mean weight loss was 8.6% in the first year, with maintenance loss of 4.7% at the end of 4 years. In the control group, weight loss was 0.7% in the first year and 1.1% at 4 years (P<0.0001 at both times of assessment).

At 4 years of follow up, the ILI group achieved improvements in fitness, glycemic control and CV factors (blood pressure and HDL-cholesterol) compared to the control group:

Significant increase in physical fitness: +5.4 vs. -0.8% changes in performance and physical capacity (p<0.001)
Further reduction in glycated hemoglobin (HbA1c): -0.20 vs. -0.08% (P<0.001)
Increased chance of achieving the treatment goal of HbA1c <7%: 57% vs. 51% (P<0.0001)
Greater increase in HDL: 3.95 vs. 2.58 mg/dL (P<0.0001)

Although the reduction in HbA1c seems small, this finding should be viewed in the context that patients in the ILI group began the study using lower doses of oral anti-diabetic agents (OADs) and insulin.

These data reinforce the need to continue to combine efforts focused on weight loss through dietary and behavioral education at all stages of diabetes therapies, from diagnosis through use of OADs and / or insulin.

Results from the EPIC Norfolk Study

The multinational EPIC study, with more than 500,000 participants, is designed to evaluate the relationship between dietary patterns and the presence of diseases such as diabetes, cancer and CV disease. EPIC-Norfolk[2  is a section of the EPIC study, which included 25,633 people aged between 40 and 74 years in the county of Norfolk in England.

Understanding the etiology of disease

Measures of central obesity are better indicators of CVR than BMI. In this study, waist circumference and waist / hip ratio were better predictors of future cardiac events than BMI.

Analysis of genetic polymorphisms in EPIC-Norfolk have shown that certain genetic combinations predispose to obesity, although other studies have shown that it is the distribution of fat (abdominal or centripetal) that is genetically determined, rather than obesity itself.

Demonstration of response to interventions

The circumference measurements abdominal waist and the waist/hip ratio may overtake BMI as the preferred instruments for estimating the risk of cardiovascular disease. Complementary analyses of the EPIC-Europe cohort showed that physical activity can reduce the abdominal waist circumference independent of changes in BMI. In several intervention studies on lifestyle, such as the Hertfordshire Study, reductions in waist circumference are indicators of improvement in cardiometabolic risk in adults undergoing physical exercise programs.

The overall view from the meeting is that interventions on lifestyle may preferentially reduce abdominal adiposity. Anti-obesity drugs such as orlistat also result in weight loss with preferential reduction of abdominal fat. Furthermore, the PPAR-gamma agent pioglitazone promotes positive effects on the redistribution of body fat with a reduction in waist/hip ratio.

References

1. Wadden TA, Neiberg HR, Wing RR, Clark JM, Delahanty LM, Hill JO, Krakoff J, Otto A, Ryan DH, Vitolins MZ; Look AHEAD Research Group. Four-year weight Losses in the Look AHEAD study: factors Associated with long-term success. Obesity 19 (10) :1987-98, 2011.

2. Golubic R, Ekelund U, Wijndaele K, R Luben, Khaw KT, Wareham NJ, Brage S. Rate of weight gain predicts change in physical activity levels: a longitudinal analysis of the EPIC-Norfolk cohort. Int J Obes 2012 Apr 24. doi: 10.1038/ijo.2012.58. [Epub ahead of print]

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