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Long-term Impact of Weight Loss Intervention on Changes in Cognitive Function: Exploratory Analyses from the Action for Health in Diabetes Randomized Controlled Clinical Trial.
J Gerontol A Biol Sci Med Sci 2018; 73(4):484-491JG

Abstract

Background

Diabetes adversely impacts cognition. Lifestyle change can improve diabetes control and potentially improve cognition. We examined whether weight loss through reduced caloric intake and increased physical activity was associated with slower cognitive aging in older adults with type 2 diabetes mellitus.

Methods

The Look AHEAD randomized controlled clinical trial delivered 10 years of intensive lifestyle intervention (ILI) that yielded long-term weight losses. During 5 years spanning the end of intervention and postintervention follow-up, repeated cognitive assessments were obtained in 1,091 individuals who had been assigned to ILI or a control condition of diabetes support and education (DSE). We compared the means and slopes of scores on cognitive testing over these repeated assessments.

Results

Compared with DSE, assignment to ILI was associated with a -0.082 SD deficit in mean global cognitive function across repeated assessments (p = .010). However, overweight (body mass index [BMI] < 30 kg/m2) ILI participants had 0.099 (95% confidence interval [CI]: -0.006, 0.259) better mean global cognitive function compared with overweight DSE participants, while obese (BMI ≥ 30 kg/m2) ILI participants had -0.117 (-0.185, -0.049) SD worse mean composite cognitive function scores (interaction p = .014) compared to obese DSE participants. For both overweight and obese participants, cognitive decline was marginally (-0.014 SD/y overall) steeper for ILI participants (p = .068), with 95% CI for differences in slopes excluding 0 for measures of attention and memory.

Conclusions

The behavioral weight loss intervention was associated with small relative deficits in cognitive function among individuals who were obese and marginally greater cognitive decline overall compared to control. ClinicalTrials.gov Identifier: NCT00017953.

Authors+Show Affiliations

Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.Brain and Metabolism Imaging in Chronic Disease Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA.Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.Healthy Aging Research Program, University of Pittsburgh, PA.Institute for Dementia Research and Prevention, Pennington Biomedical Research Center, Baton Rouge, LA.Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia.Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.Center for Human Nutrition, University of Colorado Anschutz Medical Campus, Denver.Joslin Diabetes Center, Harvard Medical School, Boston, MA.Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI.No affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

28958022

Citation

Espeland, Mark A., et al. "Long-term Impact of Weight Loss Intervention On Changes in Cognitive Function: Exploratory Analyses From the Action for Health in Diabetes Randomized Controlled Clinical Trial." The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, vol. 73, no. 4, 2018, pp. 484-491.
Espeland MA, Carmichael O, Hayden K, et al. Long-term Impact of Weight Loss Intervention on Changes in Cognitive Function: Exploratory Analyses from the Action for Health in Diabetes Randomized Controlled Clinical Trial. J Gerontol A Biol Sci Med Sci. 2018;73(4):484-491.
Espeland, M. A., Carmichael, O., Hayden, K., Neiberg, R. H., Newman, A. B., Keller, J. N., ... Wing, R. R. (2018). Long-term Impact of Weight Loss Intervention on Changes in Cognitive Function: Exploratory Analyses from the Action for Health in Diabetes Randomized Controlled Clinical Trial. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 73(4), pp. 484-491. doi:10.1093/gerona/glx165.
Espeland MA, et al. Long-term Impact of Weight Loss Intervention On Changes in Cognitive Function: Exploratory Analyses From the Action for Health in Diabetes Randomized Controlled Clinical Trial. J Gerontol A Biol Sci Med Sci. 2018 03 14;73(4):484-491. PubMed PMID: 28958022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term Impact of Weight Loss Intervention on Changes in Cognitive Function: Exploratory Analyses from the Action for Health in Diabetes Randomized Controlled Clinical Trial. AU - Espeland,Mark A, AU - Carmichael,Owen, AU - Hayden,Kathleen, AU - Neiberg,Rebecca H, AU - Newman,Anne B, AU - Keller,Jeffery N, AU - Wadden,Thomas A, AU - Rapp,Stephen R, AU - Hill,James O, AU - Horton,Edward S, AU - Johnson,Karen C, AU - Wagenknecht,Lynne, AU - Wing,Rena R, AU - ,, PY - 2016/12/19/received PY - 2017/08/23/accepted PY - 2017/9/29/pubmed PY - 2019/3/7/medline PY - 2017/9/29/entrez SP - 484 EP - 491 JF - The journals of gerontology. Series A, Biological sciences and medical sciences JO - J. Gerontol. A Biol. Sci. Med. Sci. VL - 73 IS - 4 N2 - Background: Diabetes adversely impacts cognition. Lifestyle change can improve diabetes control and potentially improve cognition. We examined whether weight loss through reduced caloric intake and increased physical activity was associated with slower cognitive aging in older adults with type 2 diabetes mellitus. Methods: The Look AHEAD randomized controlled clinical trial delivered 10 years of intensive lifestyle intervention (ILI) that yielded long-term weight losses. During 5 years spanning the end of intervention and postintervention follow-up, repeated cognitive assessments were obtained in 1,091 individuals who had been assigned to ILI or a control condition of diabetes support and education (DSE). We compared the means and slopes of scores on cognitive testing over these repeated assessments. Results: Compared with DSE, assignment to ILI was associated with a -0.082 SD deficit in mean global cognitive function across repeated assessments (p = .010). However, overweight (body mass index [BMI] < 30 kg/m2) ILI participants had 0.099 (95% confidence interval [CI]: -0.006, 0.259) better mean global cognitive function compared with overweight DSE participants, while obese (BMI ≥ 30 kg/m2) ILI participants had -0.117 (-0.185, -0.049) SD worse mean composite cognitive function scores (interaction p = .014) compared to obese DSE participants. For both overweight and obese participants, cognitive decline was marginally (-0.014 SD/y overall) steeper for ILI participants (p = .068), with 95% CI for differences in slopes excluding 0 for measures of attention and memory. Conclusions: The behavioral weight loss intervention was associated with small relative deficits in cognitive function among individuals who were obese and marginally greater cognitive decline overall compared to control. ClinicalTrials.gov Identifier: NCT00017953. SN - 1758-535X UR - https://www.unboundmedicine.com/medline/citation/28958022/Long_term_Impact_of_Weight_Loss_Intervention_on_Changes_in_Cognitive_Function:_Exploratory_Analyses_from_the_Action_for_Health_in_Diabetes_Randomized_Controlled_Clinical_Trial_ L2 - https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glx165 DB - PRIME DP - Unbound Medicine ER -