行为体重管理计划后体重恢复对心脏代谢疾病发病率和风险的长期影响:系统回顾和元分析。

IF 6.9 2区 医学 Circulation. Cardiovascular Quality and Outcomes Pub Date : 2023-04-01 Epub Date: 2023-03-28 DOI:10.1161/CIRCOUTCOMES.122.009348
Jamie Hartmann-Boyce, Annika Theodoulou, Jason L Oke, Ailsa R Butler, Anastasios Bastounis, Anna Dunnigan, Rimu Byadya, Linda J Cobiac, Peter Scarborough, F D Richard Hobbs, Falko F Sniehotta, Susan A Jebb, Paul Aveyard
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引用次数: 0

摘要

背景:行为体重管理计划(BWMPs)能在短期内减轻体重,但由于体重通常会反弹,因此长期的心血管代谢影响尚不确定。我们评估了行为体重管理计划后体重反弹对心血管风险因素、糖尿病和心血管疾病的影响:方法:我们利用试验登记册、11 个数据库和前向引文检索(最新检索,12 月 19 日)来确定在任何地理区域以英语发表的文章。研究纳入了针对成人超重/肥胖症患者的BWMP随机试验,这些试验报告了计划结束时和结束后≥12个月的心脏代谢结果。采用混合效应、元回归和时间到事件模型综合分析了强化干预组和比较组之间的差异,以评估体重恢复对心血管疾病发病率和风险的影响:结果:共纳入 124 项试验,这些试验报告了≥1 项心血管代谢结果,中位随访时间为计划结束后 28 个月(11-360 个月)。参与者体重指数基线中位数为 33 kg/m2;年龄中位数为 51 岁。分别有 8 项和 15 项研究臂(分别有 7889 名和 4202 名参与者)对心血管疾病和 2 型糖尿病的发病率进行了研究,有不确切的证据表明,至少在 5 年内,心血管疾病和 2 型糖尿病的发病率都有所降低。相对于比较者,BWMPs 的体重恢复减少了这些差异。计划结束后 1 年和 5 年,总胆固醇/高密度脂蛋白(HDL)比值在这两个时间段均降低了 1.5 点(82 项研究;19 003 名参与者),收缩压分别降低了 1.5 毫米汞柱和 0.4 毫米(84 项研究;30 836 名参与者),HbA1c(%)在这两个时间段均降低了 0.38(94 项研究;28 083 名参与者)。在纳入的研究中,22%的研究被判定为偏倚风险较高;剔除这些研究不会对结果产生有意义的改变:结论:尽管体重会反弹,但体重管理计划能降低心脏代谢风险因素,其效果在计划结束后至少持续 5 年,并随着体重反弹而减弱。有证据表明,减肥计划降低了心血管疾病或糖尿病的发病率,但这一点并不确定。很少有研究对参与者进行≥5年的跟踪调查:URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier:CRD42018105744。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis.

Background: Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease.

Methods: Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk.

Results: One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m2; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results.

Conclusions: Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.

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来源期刊
Circulation. Cardiovascular Quality and Outcomes
Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine
CiteScore
9.80
自引率
2.90%
发文量
357
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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