Mark A Espeland1, Owen Carmichael2, Kathleen Hayden3, Rebecca H Neiberg1, Anne B Newman4, Jeffery N Keller5, Thomas A Wadden6, Stephen R Rapp3, James O Hill7, Edward S Horton8, Karen C Johnson9, Lynne Wagenknecht10, Rena R Wing11. 1. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC. 2. Brain and Metabolism Imaging in Chronic Disease Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA. 3. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. 4. Healthy Aging Research Program, University of Pittsburgh, PA. 5. Institute for Dementia Research and Prevention, Pennington Biomedical Research Center, Baton Rouge, LA. 6. Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia. 7. Center for Human Nutrition, University of Colorado Anschutz Medical Campus, Denver. 8. Joslin Diabetes Center, Harvard Medical School, Boston, MA. 9. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis. 10. Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC. 11. Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI.
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) SDworse 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.
RCT Entities:
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 obeseparticipants, 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: Mark A Espeland; Jeffery Probstfield; Donald Hire; J Bruce Redmon; Gregory W Evans; Mace Coday; Cora E Lewis; Karen C Johnson; Sharon Wilmoth; Judy Bahnson; Michael F Dulin; Jennifer B Green; William C Knowler; Abbas Kitabchi; Anne L Murillo; Kwame Osei; Shakaib U Rehman; William C Cushman Journal: Am J Hypertens Date: 2015-02-09 Impact factor: 2.689
Authors: Stephen R Rapp; Jose A Luchsinger; Laura D Baker; George L Blackburn; Helen P Hazuda; Kathryn E Demos-McDermott; Robert W Jeffery; Jeffrey N Keller; Jeanne M McCaffery; Nicholas M Pajewski; Mary Evans; Thomas A Wadden; Steven E Arnold; Mark A Espeland Journal: J Am Geriatr Soc Date: 2017-01-09 Impact factor: 5.562
Authors: Mark A Espeland; Stephen R Rapp; George A Bray; Denise K Houston; Karen C Johnson; Abbas E Kitabchi; Andrea L Hergenroeder; Jeff Williamson; John M Jakicic; Brent van Dorsten; Stephen B Kritchevsky Journal: J Gerontol A Biol Sci Med Sci Date: 2014-03-11 Impact factor: 6.053
Authors: Donna H Ryan; Mark A Espeland; Gary D Foster; Steven M Haffner; Van S Hubbard; Karen C Johnson; Steven E Kahn; William C Knowler; Susan Z Yanovski Journal: Control Clin Trials Date: 2003-10
Authors: Saion Chatterjee; Sanne A E Peters; Mark Woodward; Silvia Mejia Arango; G David Batty; Nigel Beckett; Alexa Beiser; Amy R Borenstein; Paul K Crane; Mary Haan; Linda B Hassing; Kathleen M Hayden; Yutaka Kiyohara; Eric B Larson; Chung-Yi Li; Toshiharu Ninomiya; Tomoyuki Ohara; Ruth Peters; Tom C Russ; Sudha Seshadri; Bjørn H Strand; Rod Walker; Weili Xu; Rachel R Huxley Journal: Diabetes Care Date: 2015-12-17 Impact factor: 19.112
Authors: Mark A Espeland; Kirk Erickson; Rebecca H Neiberg; John M Jakicic; Thomas A Wadden; Rena R Wing; Lisa Desiderio; Guray Erus; Meng-Kang Hsieh; Christos Davatzikos; Barbara J Maschak-Carey; Paul J Laurienti; Kathryn Demos-McDermott; R Nick Bryan Journal: Diabetes Care Date: 2016-03-29 Impact factor: 19.112
Authors: Kathleen M Hayden; Rebecca H Neiberg; Joni K Evans; José A Luchsinger; Owen Carmichael; Gareth R Dutton; Karen C Johnson; Steven E Kahn; Stephen R Rapp; Sevil Yasar; Mark A Espeland Journal: Dement Geriatr Cogn Disord Date: 2021-08-19 Impact factor: 3.346
Authors: Felicia R Simpson; Nicholas M Pajewski; Barbara Nicklas; Stephen Kritchevsky; Alain Bertoni; Frank Ingram; Daniel Ojeranti; Mark A Espeland Journal: J Gerontol A Biol Sci Med Sci Date: 2020-09-25 Impact factor: 6.053
Authors: Mark A Espeland; Gareth R Dutton; Rebecca H Neiberg; Owen Carmichael; Kathleen M Hayden; Karen C Johnson; Robert W Jeffery; Laura D Baker; Delilah R Cook; Dalane W Kitzman; Stephen R Rapp Journal: J Gerontol A Biol Sci Med Sci Date: 2018-10-08 Impact factor: 6.053
Authors: Hussein N Yassine; Andrea Anderson; Roberta Brinton; Owen Carmichael; Mark A Espeland; Siobhan Hoscheidt; Christina E Hugenschmidt; Jeffrey N Keller; Anne Peters; Xavier Pi-Sunyer Journal: Neurobiol Aging Date: 2020-04-08 Impact factor: 4.673
Authors: Chelsea M Stillman; John M Jakicic; Renee J Rogers; Kathryn A Roecklein; Grant Barrett; Chaeryon Kang; Kirk I Erickson Journal: Front Hum Neurosci Date: 2022-08-22 Impact factor: 3.473
Authors: Mark A Espeland; Joni K Evans; Owen Carmichael; Jose A Luchsinger; Santica M Marcovina; Rebecca Neiberg; Karen C Johnson; Steven E Kahn; Kathleen M Hayden Journal: Obesity (Silver Spring) Date: 2022-08-03 Impact factor: 9.298
Authors: Owen T Carmichael; Rebecca H Neiberg; Gareth R Dutton; Kathleen M Hayden; Edward Horton; F Xavier Pi-Sunyer; Karen C Johnson; Stephen R Rapp; Adam P Spira; Mark A Espeland Journal: J Clin Endocrinol Metab Date: 2020-12-01 Impact factor: 5.958