PREDICTORS OF LIFESTYLE INTERVENTION OUTCOME AND DROPOUT: THE SLIM STUDY
Résumé
Objectives: To evaluate the effect of a 4.1 year (range 3-6 years) lifestyle intervention according to general public health recommendations on glucose tolerance and dropout in a Dutch population with impaired glucose tolerance (IGT). Methods: In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM), 147 Caucasian IGT subjects were randomized to an intervention group (n=74, 38 male, 36 female (INT)) and control group (n=73, 37 male, 36 female (CON)). Annually, subjects underwent measurements of body weight, anthropometry, glucose tolerance (OGTT), insulin resistance (HOMA-IR), maximal aerobic capacity (VO2 max), blood lipids and blood pressure. INT received individual advice regarding a healthy diet and physical activity. Results: INT decreased their saturated fat intake, increased their carbohydrate intake (p<0.05) and VO2 max (p=0.04) compared to CON. Body weight did not change significantly (p=0.20) between groups. After an initial decrease, 2-Hr glucose levels overall increased in INT (+0.11 mmol/l), but significantly less than CON (+1.18 mmol/l; p=0.04). Diabetes incidence was lower in INT versus CON (30% versus 56%, p=0.04). Change in body weight was associated with change in 2-hr glucose levels (β=0.399 mmol/l/kg, p=0.02). Dropouts had a lower aerobic fitness and social economic status and a higher BMI and 2-hr glucose compared to non-dropouts. Conclusions: Prolonged feasible changes in diet and physical activity prevent deterioration of glucose tolerance and reduce diabetes risk. Low social economic status, low aerobic fitness and high BMI and 2-hr glucose are indicative of dropout to the program.
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