Lifestyle Intervention, Fat and Lean Mass, and Risk for Heart Failure, MI

An intensive lifestyle intervention was found to be associated with a significant loss of fat mass and lean mass in adults with type 2 diabetes.

This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

An intensive lifestyle intervention was found to be associated with a significant loss of fat mass and lean mass in adults with type 2 diabetes, according to the results of a study presented at the American Heart Association Scientific Sessions 2020 held virtually from November 13 to 17, 2020.

Researchers sought to validate established anthropometric prediction equations among a group of participants in the Look AHEAD: Action for Health in Diabetes study ( Identifier: NCT00017953) and to evaluate the associations between baseline and longitudinal changes in fat mass, lean mass, and waist circumference, and the risk for heart failure and myocardial infarction.

Look AHEAD was a randomized clinical trial in which the effects of an intensive, weight loss-focused lifestyle intervention vs an intervention consisting of diabetes support and education were examined in adults (n=5145) with type 2 diabetes who were overweight or obese. The current study was a post hoc analysis of 5103 of the participants in the Look AHEAD trial who did not have prevalent heart failure at baseline and had relevant baseline data available.

At baseline, 1369 participants had both predicted and dual-energy X-ray absorptiometry (DXA)-based measures of fat and lean mass. Correlation between predicted and DXA-based fat and lean mass were high (R²=0.87 and R²=0.90, respectively). Bias for baseline predicted and DXA-based measures were 0.08 kg for fat mass (95% CI, -0.11 to 0.27) and 0.98 kg for lean mass (95% CI, 0.77-1.19).

Participants who received the intensive lifestyle intervention had higher 1- and 4-year reductions in fat mass and lean mass compared with those who received diabetes support and education. Median fat and lean mass reductions in the intervention group were -4.7 kg (interquartile range [IQR], -7.7 to -2.2 kg) and -2.7 kg (IQR, -4.7 to -1.1 kg) over 1 year of follow-up. Over the 4-year follow-up period, median reductions were -2.0 kg for fat mass (IQR, -5.1 to 0.7 kg) and -1.8 kg for lean mass (IQR, -3.9 to -0.1 kg).

Over 12.4 years of follow-up, 257 participants were hospitalized for incident heart failure (heart failure with preserved ejection fraction, n=129; heart failure with reduced ejection fraction, n=104; missing left ventricular ejection fraction, n=24). Higher baseline fat mass, lean mass, and waist circumference were significantly associated with higher overall heart failure risk in adjusted analyses (hazard ratio [HR] per 10 kg higher fat mass, 1.29; 95% CI, 1.14-1.46; HR per 10 kg higher lean mass, 1.32; 95% CI, 1.15-1.52; HR per 10 cm greater waist circumference, 1.26; 95% CI, 1.16-1.38). After additional adjustment for cardiorespiratory fitness, these associations were attenuated and no longer significant.

Greater short-term reduction in fat mass was associated with a lower risk for heart failure in adjusted analyses. This association remained after further adjustment for other changes in body composition and cardiometabolic parameters.

Over the follow-up period, 351 incident myocardial infarction events occurred in this cohort. Higher baseline fat mass and waist circumference were significantly associated with a paradoxically lower risk for myocardial infarction in multivariable adjusted Cox models (HR per 10 kg higher fat mass, 0.74; 95% CI 0.59-0.92; HR per 10 cm higher waist circumference, 0.88; 95% CI, 0.79-0.99).

Study limitations include a lack of direct measures of fat and lean mass in all study participants, and the potential for selection bias.

“Future studies are needed to confirm these findings and investigate whether interventions targeting preferential reductions in [fat mass] and central adiposity modify the risk [for heart failure] among patients with [type 2 diabetes],” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Patel KV, Bahnson JL, Gaussoin SA, et al; on behalf of the Look AHEAD Research Group. Presented at: AHA Scientific Sessions 2020 Virtual Meeting; November 13-17, 2020. Presentation 207.

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