The Prevention and Treatment of Obesity: Application to type 2 diabetes

Maggio, Carol A.; Pi‐Sunyer, F. Xavier

doi:10.2337/diacare.20.11.1744

Cited by 235 publications

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“…The increasing prevalence of obesity over the past two decades is alarming since it translates into increased medical care and disability costs because of the relationship between excess body weight and several risk factors for disease. Obese subjects with type II DM pose a significant challenge for the clinicians responsible for their care (Maggio & Pi-Sunyer, 1997 Hollander et al, 1998). However, successful weight management in this population is often difficult to achieve.…”

Section: Discussionmentioning

confidence: 99%

“…It has been estimated that more than 70% of those with type II DM are overweight, while 33% are obese (National Institute of Health Publication, 1995). It is well known that obesity can worsen the metabolic abnormalities often associated with DM including hyperinsulinemia, hyperglycemia, hypertension, and hyperlipidemia (Colditz et al, 1990;Chan et al, 1994;Ford et al, 1997;Maggio & Pi-Sunyer, 1997). A modest 5-10% weight loss in obese nondiabetic individuals has been shown to result in marked improvements in some of these metabolic disturbances (Wing et al, 1987;Goldstein, 1992;Davidson et al, 1999;Hollander et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

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Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

et al. 2004

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Background: Achieving significant weight loss and glycemic control in diabetic patients remains a challenging task. Objective: This study compared the effects of a soy-based meal replacement (MR) plan vs an individualized diet plan (IDP; as recommended by the American Diabetes Association) on weight loss and metabolic profile. Design/Subjects: A total of 104 subjects were randomized prospectively to the two treatments for a total of 12 months. Results: In all, 77 of the 104 subjects completed the study. Percentage weight loss in MR group (4.5770.81%) was significantly greater (Po0.05) than in IDP group (2.2570.72%). Fasting plasma glucose was significantly reduced in MR group (126.474.9 mg/dl) compared with IDP group (152.576.6 mg/dl, Po0.0001) at 6 months but not at 12 months. Controlling for baseline levels, hemoglobin Alc level improved by 0.4970.22% for those receiving MR when compared to IDP group (Po0.05). A greater number of subjects in MR group reduced their use of sulfonylureas (Po0.0001) and metformin (Po0.05) as compared to IDP group. High-sensitivity C-reactive protein (hs-CRP) decreased À26.3% (P ¼ 0.019) in MR group compared to À7.06% (P ¼ 0.338) in IDP group at 6 months. Similar changes were observed at 12 months with MR groups, with hs-CRP decreasing by À25.0% (P ¼ 0.019) compared to À18.7% (P ¼ 0.179) in IDP group. Conclusion: This study demonstrates that MR is a viable strategy for weight reduction in diabetic patients, resulting in beneficial changes in measures of glycemic control and reduction of medications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

et al. 2004

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“…The lack of overlap of BMI and WHR between factors was unexpected, as both have been associated with hypertension, 35 speci®cally in Asian Indians, and with glucose intolerance, 36 and were correlated with blood pressure and glucose levels within the study sample. In our population, a moderately high factor loading (0.39) was seen for WHR on the blood pressure factor (factor 2) among men only.…”

Section: Discussionmentioning

confidence: 99%

Leptin and other components of the Metabolic Syndrome in Mauritius—a factor analysis

et al. 2001

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OBJECTIVE:To use factor analysis to examine the putative role of leptin in the Metabolic Syndrome, and to de®ne better the associations among observed variables and the identi®ed factors. DESIGN: Factor analysis of cross-sectional data from a 1987 survey. SUBJECTS: Non-diabetic residents of Mauritius who participated in population-based surveys in 1987 and 1992 (1414 men and 1654 women). MEASUREMENTS: Fasting and 2 h plasma glucose and insulin following a 75 g oral glucose load; seated blood pressure; body mass index (BMI); waist-to-hip ratio (WHR); and fasting serum triglycerides, HDL-cholesterol, leptin and uric acid concentrations. RESULTS: Principal components factor analysis revealed three factors for men and women that explained between 54 and 55% of the observed variance of the 12 measured variables. General features of these factors were as follows: factor 1, WHR, BMI, leptin, fasting and 2 h insulin, triglycerides, and HDL-cholesterol; factor 2, systolic and diastolic blood pressure, uric acid (men only), and fasting glucose (women only); and factor 3, fasting and 2 h glucose and insulin. Only three variables loaded on more than one factor with a loading !0.4 (fasting and 2 h insulin, fasting glucose in women only). Leptin loaded on one factor only in both men and women. CONCLUSIONS: Since multiple factors underlie the Metabolic Syndrome, and since no observed variable loads on all three factors, more than one mechanism might account for the observed clustering of risk characteristics. Leptin does not unite features of this syndrome due to its loading on one factor only. Uric acid is related to a different factor in men and women. The absence of gender differences in factor loadings argues for similar mechanisms for the Metabolic Syndrome in men and women in Mauritius.

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“…5 The use of very-low-calorie diet (VLCD) prescriptions of between 1700 and 3300 kJ/day (400 and 800 kcal/day), in people with and without Type II diabetes, has shown significant improvements in weight management and glycaemic control. 1,[6][7][8] VLCD therapy generally produces more rapid weight loss and higher short-term success than moderate caloric restriction, yet, as with traditional dietary approaches, these losses are generally not sustained in the long term. 1,6 A recent meta-analysis of 29 US studies examining long-term weight loss maintenance indicated that subjects who undertook an initial weight loss VLCD treatment maintained a greater percentage weight loss of initial body weight at 5 y than subjects using a hypoenergetic balanced diet, 6.2 vs 2.0%, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…1 Modest weight reductions of 5-10% have been associated with improvements in fasting plasma glucose, glycosylated haemoglobin (HbA 1c ), insulin and lipid levels, and blood pressure. 2,3 Dietary prescriptions for weight loss and the treatment of diabetes have been well studied.…”

Section: Introductionmentioning

confidence: 99%

Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial

et al. 2003

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OBJECTIVE:To investigate the effectiveness of intensive innovative methods for implementing dietary prescriptions on weight management and glycaemic control in overweight men with Type II diabetes. DESIGN: A randomised clinical trial with a 12-week intervention period F three isocaloric dietary intervention groups (intermittent energy restriction, pre-portioned meals and self-selected meals) each with weekly dietitian contact F and a followup visit after 18 months. SUBJECTS: A total of 51 men with Type II diabetes (mean age 54 y, mean body mass index (BMI) 31.7 kg/m 2 ). MEASUREMENTS: Weight, body composition, waist circumference, glycaemic control (HbA 1c ) and blood lipids. RESULTS: For all subjects, intensive diet therapy over the 12-week intervention period resulted in a mean reduction in energy intake of 236072780 kJ/day (5647665 kcal/day) and significant reductions in weight (6.474.6 kg), waist circumference (8.174.6 cm), percent body fat (1.971.5%), HbA 1c (1.071.4%) and triglyceride levels (0.370.6 mmol/l) compared to baseline levels. Intervention group did not affect clinical outcomes, with the exception of percent body fat. A total of 27 (52.9%) subjects attended the 18-month follow-up visit. At this visit, none of the improvements in clinical parameters was maintained, with all parameters returning to preintervention levels. CONCLUSIONS: A dietary prescription of 6000-7000 kJ/day (1400-1700 kcal/day) was effective in achieving a 6% weight loss and improving glycaemic control. The method of implementation made no difference to the outcomes between groups at 12 weeks or 18 months. Thus, we propose that it was the intensive weekly contact with a health professional in combination with moderate energy restriction that facilitated the successful short-term results seen.

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The Prevention and Treatment of Obesity: Application to type 2 diabetes

Cited by 235 publications

References 0 publications

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

Leptin and other components of the Metabolic Syndrome in Mauritius—a factor analysis

Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial

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