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)

Abstract

AimsThe PREVIEW lifestyle intervention study (http://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 methodsAll 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.ResultsIn 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.ConclusionsAn 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.

Very low‐energy and low‐energy formula diets: Effects on weight loss, obesity co‐morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice

“…TDR caused gout at a rate of less than one in 1500 in women and one in 120 in men in the PREVIEW study (Christensen et al . ). There were no identified cases of gallstones in 2224 participants in the PREVIEW study but a large study from Sweden that showed the rate for hospitalisation for investigation and treatment of gallstones was three times higher after a VLED than after a 1200 kcal/day LED, although most cases occurred in the food re‐introduction phase (Johansson et al .…”

“…The largest dataset from the Prevention of diabetes through lifestyle intervention and population studies in Europe and around the world ( PREVIEW ) study (Christensen et al . ) (weight loss with TDR in 2224 participants with pre‐diabetes) showed that the most common complaints were constipation (15%), fatigue/muscle weakness (9%), headache (8%) and dizziness (4%); in the DROPLET trial, the same side effects were reported (in 138 participants) but at half that frequency (8%, 5%, 3% and 2%, respectively) (Astbury et al . ).…”

“…Adverse event frequency is more extensively documented than 4 years ago (Leeds 2014). The largest dataset from the Prevention of diabetes through lifestyle intervention and population studies in Europe and around the world (PREVIEW) study (Christensen et al 2018) (weight loss with TDR in 2224 participants with pre-diabetes) showed that the most common complaints were constipation (15%), fatigue/muscle weakness (9%), headache (8%) and dizziness (4%); in the DROPLET trial, the same side effects were reported (in 138 participants) but at half that frequency (8%, 5%, 3% and 2%, respectively) ). Constipation has long been recognised as a consequence of the large reduction in residual substrate entering the colon for fermentation and stool-bulking when using TDR.…”

Tachycardia: The hidden cardiovascular risk factor in uncomplicated arterial hypertension

“…Given the link between obesity and higher resting BP and HR values and resultant autonomic impairment characterized by reduced parasympathetic activity and relative predominance of sympathetic activity [80], body weight reduction is considered as a crucial non-pharmacological approach in the treatment of tachycardia, metabolic abnormalities and elevated BP. In this context, clinically important are findings of the very recent PREVIEW lifestyle intervention study which followed-up 2,500,000 patients with obesity and pre-diabetes who underwent a low-energy diet for 8 weeks [81]. In this study men and women responded differently in terms of HR reduction (-6.4 ± 1.1 in men vs. 4.9 ± 1.1 bpm in women).…”

“…In this study men and women responded differently in terms of HR reduction (-6.4 ± 1.1 in men vs. 4.9 ± 1.1 bpm in women). In addition to rapid weight loss, an 8-week low energy diet was associated with improvements in numerous parameters including insulin resistance, metabolic syndrome Z-score, C-peptide, fat mass, high density lipoprotein cholesterol, fat-free mass, hip circumference and pulse pressure [81]. Further proof for HR reduction following weight loss 2 years after gastric bypass surgery comes from the Utah Obesity Study [82].…”