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Clinical Research

Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study

International Journal of Obesity volume 47, pages 833–840 (2023)Cite this article

Subjects

Abstract

Background/Objectives

Some individuals with overweight/obesity may be relatively metabolically healthy (MHO) and have a lower risk of cardiovascular disease than those with metabolically unhealthy overweight/obesity (MUO). We aimed to compare changes in body weight and cardiometabolic risk factors and type 2 diabetes incidence during a lifestyle intervention between individuals with MHO vs MUO.

Methods

This post-hoc analysis included 1012 participants with MHO and 1153 participants with MUO at baseline in the randomized trial PREVIEW. Participants underwent an eight-week low-energy diet phase followed by a 148-week lifestyle-based weight-maintenance intervention. Adjusted linear mixed models and Cox proportional hazards regression models were used.

Results

There were no statistically significant differences in weight loss (%) between participants with MHO vs MUO over 156 weeks. At the end of the study, weight loss was 2.7% (95% CI, 1.7%–3.6%) in participants with MHO and 3.0% (2.1%–4.0%) in those with MUO. After the low-energy diet phase, participants with MHO had smaller decreases in triglyceride (mean difference between MHO vs MUO 0.08 mmol·L−1 [95% CI, 0.04–0.12]; P < 0.001) but similar reductions in fasting glucose and HOMA-IR than those with MUO. However, at the end of weight maintenance, those with MHO had greater reductions in triglyceride (mean difference −0.08 mmol·L−1 [−0.12–−0.04]; P < 0.001), fasting glucose, 2-hour glucose (difference −0.28 mmol·L−1 [−0.41–−0.16]; P < 0.001), and HOMA-IR than those with MUO. Participants with MHO had smaller decreases in diastolic blood pressure and HbA1c and greater decreases in HDL cholesterol after weight loss than those with MUO, whereas the statistically significant differences disappeared at the end of weight maintenance. Participants with MHO had lower 3-year type 2 diabetes incidence than those with MUO (adjusted hazard ratio 0.37 [0.20–0.66]; P < 0.001).

Conclusions

Individuals with MUO had greater improvements in some cardiometabolic risk factors during the low-energy diet phase, but had smaller improvements during long-term lifestyle intervention than those with MHO.

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Fig. 1: Changes in cardiometabolic risk factors (n = 2165).
Fig. 2: Conversion from metabolically unhealthy to healthy overweight/obesity (n = 1153).
Fig. 3: Cumulative incidence of type 2 diabetes (n = 2165).

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Data availability

The study protocol and the datasets analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The PREVIEW consortium would like to thank all study participants at every intervention site for their time and commitment and all scientists, advisors, and students for their dedication and contributions to the study. Specifically, we would like to thank Edith Feskens (Wageningen University), Thomas Meinert Larsen and Pia Siig Vestentoft (University of Copenhagen), Margriet S. Westerterp-Plantenga (Maastricht University), and Ian A. Macdonald (University of Nottingham).

Funding

This work was supported by EU framework programme 7 (FP7/2007–2013) grant agreement # 312057; National Health and Medical Research Council - EU Collaborative Grant, AUS 8, ID 1067711); the Glycemic Index Foundation Australia through royalties to the University of Sydney; the New Zealand Health Research Council (grant #14/191) and University of Auckland Faculty Research Development Fund; the Cambridge Weight Plan© donated all products for the low-energy diet phase; the Danish Agriculture & Food Council; the Danish Meat and Research Institute; National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK); Biotechnology and Biological Sciences Research Council (BBSRC) (UK); Engineering and Physical Sciences Research Council (EPSRC) (UK); Nutritics (Dublin) donated all dietary analyses software used by UNOTT; Juho Vainio Foundation (FIN), Academy of Finland (grant numbers: 272376, 314383, 266286, 314135), Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, Finnish Diabetes Research Foundation, University of Helsinki, Government Research Funds for Helsinki University Hospital (FIN), Jenny and Antti Wihuri Foundation (FIN), Emil Aaltonen Foundation (FIN); China Scholarship Council. The funding source had no role in the study design and conduct, data analysis, or manuscript preparation. Open access funding provided by Royal Library, Copenhagen University Library.

Author information

Authors and Affiliations

  1. Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark

    Ruixin Zhu & Anne Raben

  2. Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany

    Maija Huttunen-Lenz

  3. Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK

    Gareth Stratton

  4. Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria

    Teodora Handjieva-Darlenska & Svetoslav Handjiev

  5. Finnish Institute for Health and Welfare, Helsinki, Finland

    Jouko Sundvall

  6. Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand

    Marta P. Silvestre & Sally D. Poppitt

  7. CINTESIS, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal

    Marta P. Silvestre

  8. Department of Food and Nutrition, University of Helsinki, Helsinki, Finland

    Elli Jalo & Mikael Fogelholm

  9. Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Kirsi H. Pietiläinen

  10. Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Kirsi H. Pietiläinen

  11. Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands

    Tanja C. Adam & Mathijs Drummen

  12. MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK

    Elizabeth J. Simpson & Moira A. Taylor

  13. Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen’s Medical Centre, Nottingham, UK

    Moira A. Taylor

  14. Centre for Nutrition Research, University of Navarra, Pamplona, Spain

    Santiago Navas-Carretero

  15. Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain

    Santiago Navas-Carretero & J. Alfredo Martinez

  16. IdisNA Instituto for Health Research, Pamplona, Spain

    Santiago Navas-Carretero

  17. Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute (Madrid Institute for Advanced Studies), CEI UAM+CSIC, Madrid, Spain

    J. Alfredo Martinez

  18. Department of Nutrition and Physiology, University of Navarra, Pamplona, Spain

    J. Alfredo Martinez

  19. Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany

    Wolfgang Schlicht

  20. School of Life and Environmental Sciences and Charles Perkins Centre, the University of Sydney, Sydney, NSW, Australia

    Jennie Brand-Miller

  21. Clinical Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark

    Anne Raben

Authors
  1. Ruixin Zhu
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  2. Maija Huttunen-Lenz
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  3. Gareth Stratton
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  4. Teodora Handjieva-Darlenska
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Contributions

RZ: Conceptualization, Formal analysis, Investigation, Writing - original draft, Writing - review & editing. AR: Funding acquisition; Conceptualization, Supervision; Investigation, Writing - review & editing. MH-L, GS, TH-D, SH, JS, MPS, EJ, KHP, TCA, MD, Elizabeth J. Simpson, MAT, SDP, SN-C, JAM, WS, MF, JB-M: Investigation, Writing - review & editing.

Corresponding author

Correspondence to Anne Raben.

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Competing interests

AR has received honorariums from the International Sweeteners Association and Unilever. JB-M is President and Director of the Glycemic Index Foundation, oversees of a glycemic index testing service at the University of Sydney and is a co-author of books about diet and diabetes. She is also a member of the Scientific Advisory Board of the Novo Foundation and of ZOE Global. SDP was the Fonterra Chair in Human Nutrition during the PREVIEW intervention. No relevant disclosures from other authors.

Ethical standard

The study was approved by Research Ethics Committees of the Capital Region, Coordinating Ethical Committee of HUS (Helsinki and Uusimaa Hospital District), Medical Ethics Committee of the Maastricht University Medical Centre, UK National Research Ethics Service (NRES) and East Midlands (Leicester) Ethics Committee, Research Ethics Committee of the University of Navarra, Commission on Ethics in Scientific Research with the Medical University-Sofia (KENIMUS), The University of Sydney, Human Research Ethics Committee (HREC), and Health and Disability Ethics Committees (HDEC).

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Zhu, R., Huttunen-Lenz, M., Stratton, G. et al. Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study. Int J Obes 47, 833–840 (2023). https://doi.org/10.1038/s41366-023-01328-y

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