Curbing 'Middle-aged Spread' Important to Prevent Diabetes

From medscape.com

A public-health strategy that stresses the importance of maintaining a healthy weight in middle age would have twice the impact on lowering the incidence of type 2 diabetes as a strategy that focuses only on getting obese patients to lose weight, researchers report.
They calculated that in a Swedish cohort of more than 33,000 patients aged 30 to 50, 22% of new diabetes cases would be prevented if the individuals did not gain weight during a decade-long follow-up.

In contrast, they estimate that only 8.5% of diabetes cases would be prevented if everyone with a body mass index (BMI) above 30 was referred to a program such as Weight Watchers and, as has been previously reported (BMC Public Health. 2011;11:434), lost an average of 5.6% of their weight.
The study by Adina L Feldman, PhD, and colleagues from the University of Cambridge, United Kingdom, and co-investigators at Umeå University in Sweden, was published February 6 in BMC Public Health.
"We have shown that a population-based strategy that promotes prevention of weight gain in adulthood has the potential to prevent more than twice as many diabetes cases as a strategy that promotes only weight loss in obese individuals at high risk of diabetes," Dr Feldman said in a statement issued by the universities.
"Thus, when it comes to body weight and diabetes, from a public-health perspective it would be advisable to consider both high-risk and population-based strategies for diabetes prevention."
Moreover, although it may be difficult to prevent weight gain in middle age, it is even harder to shed excess pounds later on, the researchers emphasize.

"While primary weight maintenance in adulthood is challenging, it should be considered in contrast to the even more difficult challenge of weight loss and subsequent secondary weight maintenance," they note.

Middle-Age Weight Matters
To investigate how weight maintenance or moderate weight loss affects the incidence of diabetes on a population level, the researchers analysed data from people in northern Sweden who participated in the Västerbotten Intervention Program (VIP).

Dr Feldman and colleagues identified participants who were free of diabetes at baseline when they were 30 years old (4820 participants), 40 years old (14 023), or 50 years old (14 341). Just under half (47%) were men.
They had a mean BMI of 25.0 kg/m², and 55% of participants had a normal BMI of <25.0 kg/m².
During a 10-year follow-up, 29.1% of participants maintained their weight, 56.6% gained weight, and 14.2% lost weight.
A total of 1087 participants (3.3% of the study population) developed type 2 diabetes.
Compared with participants who did not gain weight, those who did (ie, their BMI increased by more than 1 kg/m²) had a 1.5-fold higher risk of developing diabetes (odds ratio [OR], 1.52).

At the same time, participants who lost a moderate amount of weight (their BMI dropped by 1 to 2 kg/m²) had a lower risk of developing diabetes (OR, 0.72).
The researchers estimate that if the mean BMI in a population of middle-aged adults could be shifted down by 1 to 2 kg/m² — corresponding to a weight loss of about 3 to 6 kg — then two in five cases of diabetes could be prevented.
Study limitations include the fact that close to a third of the participants were lost to follow-up (due to death or relocation), and the researchers analysed data only at two time points.

Nevertheless, "there is great potential from a public-health perspective for diabetes prevention in promoting primary weight maintenance for the whole population, in addition to moderate weight loss in individuals with a BMI ≥25.0 kg/m² and the current approach of targeting interventions to individuals in high-risk groups," Dr Feldman and colleagues conclude.

http://www.medscape.com/viewarticle/875472