Obesity Week 2011

ORLANDO – A simple, three-item measure can accurately identify individuals who are at high risk for developing type 2 diabetes in the subsequent 5 years, Dr. Harold E. Bays said at the annual meeting of the Obesity Society.

In an analysis of data from a longitudinal, population-based survey, respondents who were 55 years or older with a body mass index greater than 30 kg/m² and a family history of diabetes had a 20% risk of developing diabetes during the 5-year follow-up period, while the risk for younger respondents with a BMI of less than 25 and no family history of diabetes was 0.3%, reported Dr. Bays of the Louisville (Ky.) Metabolic and Atherosclerosis Research Center.

Other measures are available to assess the risk of developing type 2 diabetes; however, "most of the tests and models use seven or more risk predictors, which is cumbersome for individuals to use in estimating their risk and may diminish their motivation for seeking medical care," Dr. Bays suggested. "With these three predictors – age, BMI, and family history – patients and physicians may be able to better identify undiagnosed diabetes and initiate preventive measures," he said.

To evaluate the feasibility of a simplified risk-prediction tool, the investigators used data from the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD), which included the results of annual surveys from 2005 to 2009 that were completed by 22,001 respondents screened from a representative sample of the U.S. population, Dr. Bays explained. Respondents aged at least 18 years were included in the current longitudinal analysis if they reported no diagnosis of type 2, type 1, or gestational diabetes at baseline, and if they reported their BMI, age, and family history of diabetes at baseline and 5 years later, he said.

Obesity was defined as a BMI of at least 30, and normal weight was defined as a BMI of less than 25. Individuals aged at least 55 years with self-reported obesity and a family history of diabetes were included in a high-risk group, "which we compared with a low-risk group consisting of respondents younger than 55 years, who reported normal weight and no family history of diabetes," said Dr. Bays. To compare the 290 individuals in the high-risk group with the 408 in the low-risk group, "we used chi-square test for categorical variables and t-tests for continuous variables," he said.

An assessment of the baseline characteristics showed that a greater proportion of the high-risk respondents reported a low household income, a smaller household size, fair or poor health status, asthma, and circulatory problems, compared with the low-risk group, Dr. Bays said. With respect to the disease risk factors, "the results of our analysis showed that nearly 20% of the individuals in the high-risk group received a new diagnosis of type 2 diabetes over the 5 year study period, while those in the low-risk group had an almost negligible 5-year risk, at 0.03%," he said.

The study findings are limited by the fact that diagnoses of diabetes and other comorbid conditions were self-reported and not validated, Dr. Bays noted.

The simplified prediction model is not intended to replace more comprehensive tools, such as the Diabetes Risk Test recommended by the American Diabetes Association for individual risk self-assessment, Dr. Bays stressed. "Our study was not designed to compare the efficacy of the simplified and full tools," he said.

For that matter, he added, "whether one or the other is superior is irrelevant if clinicians are not currently doing any diabetes risk assessment." Clinicians who are already using the full algorithm should probably continue to do so, he said, noting that the simpler option might be incentive for those not currently using anything to jump on board.

Dr. Bays disclosed that he has served as an adviser to AstraZeneca.

ORLANDO – A simple, three-item measure can accurately identify individuals who are at high risk for developing type 2 diabetes in the subsequent 5 years, Dr. Harold E. Bays said at the annual meeting of the Obesity Society.

In an analysis of data from a longitudinal, population-based survey, respondents who were 55 years or older with a body mass index greater than 30 kg/m² and a family history of diabetes had a 20% risk of developing diabetes during the 5-year follow-up period, while the risk for younger respondents with a BMI of less than 25 and no family history of diabetes was 0.3%, reported Dr. Bays of the Louisville (Ky.) Metabolic and Atherosclerosis Research Center.

Other measures are available to assess the risk of developing type 2 diabetes; however, "most of the tests and models use seven or more risk predictors, which is cumbersome for individuals to use in estimating their risk and may diminish their motivation for seeking medical care," Dr. Bays suggested. "With these three predictors – age, BMI, and family history – patients and physicians may be able to better identify undiagnosed diabetes and initiate preventive measures," he said.

To evaluate the feasibility of a simplified risk-prediction tool, the investigators used data from the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD), which included the results of annual surveys from 2005 to 2009 that were completed by 22,001 respondents screened from a representative sample of the U.S. population, Dr. Bays explained. Respondents aged at least 18 years were included in the current longitudinal analysis if they reported no diagnosis of type 2, type 1, or gestational diabetes at baseline, and if they reported their BMI, age, and family history of diabetes at baseline and 5 years later, he said.

Obesity was defined as a BMI of at least 30, and normal weight was defined as a BMI of less than 25. Individuals aged at least 55 years with self-reported obesity and a family history of diabetes were included in a high-risk group, "which we compared with a low-risk group consisting of respondents younger than 55 years, who reported normal weight and no family history of diabetes," said Dr. Bays. To compare the 290 individuals in the high-risk group with the 408 in the low-risk group, "we used chi-square test for categorical variables and t-tests for continuous variables," he said.

An assessment of the baseline characteristics showed that a greater proportion of the high-risk respondents reported a low household income, a smaller household size, fair or poor health status, asthma, and circulatory problems, compared with the low-risk group, Dr. Bays said. With respect to the disease risk factors, "the results of our analysis showed that nearly 20% of the individuals in the high-risk group received a new diagnosis of type 2 diabetes over the 5 year study period, while those in the low-risk group had an almost negligible 5-year risk, at 0.03%," he said.

The study findings are limited by the fact that diagnoses of diabetes and other comorbid conditions were self-reported and not validated, Dr. Bays noted.

The simplified prediction model is not intended to replace more comprehensive tools, such as the Diabetes Risk Test recommended by the American Diabetes Association for individual risk self-assessment, Dr. Bays stressed. "Our study was not designed to compare the efficacy of the simplified and full tools," he said.

For that matter, he added, "whether one or the other is superior is irrelevant if clinicians are not currently doing any diabetes risk assessment." Clinicians who are already using the full algorithm should probably continue to do so, he said, noting that the simpler option might be incentive for those not currently using anything to jump on board.

Dr. Bays disclosed that he has served as an adviser to AstraZeneca.

ORLANDO – A simple, three-item measure can accurately identify individuals who are at high risk for developing type 2 diabetes in the subsequent 5 years, Dr. Harold E. Bays said at the annual meeting of the Obesity Society.

In an analysis of data from a longitudinal, population-based survey, respondents who were 55 years or older with a body mass index greater than 30 kg/m² and a family history of diabetes had a 20% risk of developing diabetes during the 5-year follow-up period, while the risk for younger respondents with a BMI of less than 25 and no family history of diabetes was 0.3%, reported Dr. Bays of the Louisville (Ky.) Metabolic and Atherosclerosis Research Center.

Other measures are available to assess the risk of developing type 2 diabetes; however, "most of the tests and models use seven or more risk predictors, which is cumbersome for individuals to use in estimating their risk and may diminish their motivation for seeking medical care," Dr. Bays suggested. "With these three predictors – age, BMI, and family history – patients and physicians may be able to better identify undiagnosed diabetes and initiate preventive measures," he said.

To evaluate the feasibility of a simplified risk-prediction tool, the investigators used data from the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD), which included the results of annual surveys from 2005 to 2009 that were completed by 22,001 respondents screened from a representative sample of the U.S. population, Dr. Bays explained. Respondents aged at least 18 years were included in the current longitudinal analysis if they reported no diagnosis of type 2, type 1, or gestational diabetes at baseline, and if they reported their BMI, age, and family history of diabetes at baseline and 5 years later, he said.

Obesity was defined as a BMI of at least 30, and normal weight was defined as a BMI of less than 25. Individuals aged at least 55 years with self-reported obesity and a family history of diabetes were included in a high-risk group, "which we compared with a low-risk group consisting of respondents younger than 55 years, who reported normal weight and no family history of diabetes," said Dr. Bays. To compare the 290 individuals in the high-risk group with the 408 in the low-risk group, "we used chi-square test for categorical variables and t-tests for continuous variables," he said.

An assessment of the baseline characteristics showed that a greater proportion of the high-risk respondents reported a low household income, a smaller household size, fair or poor health status, asthma, and circulatory problems, compared with the low-risk group, Dr. Bays said. With respect to the disease risk factors, "the results of our analysis showed that nearly 20% of the individuals in the high-risk group received a new diagnosis of type 2 diabetes over the 5 year study period, while those in the low-risk group had an almost negligible 5-year risk, at 0.03%," he said.

The study findings are limited by the fact that diagnoses of diabetes and other comorbid conditions were self-reported and not validated, Dr. Bays noted.

The simplified prediction model is not intended to replace more comprehensive tools, such as the Diabetes Risk Test recommended by the American Diabetes Association for individual risk self-assessment, Dr. Bays stressed. "Our study was not designed to compare the efficacy of the simplified and full tools," he said.

For that matter, he added, "whether one or the other is superior is irrelevant if clinicians are not currently doing any diabetes risk assessment." Clinicians who are already using the full algorithm should probably continue to do so, he said, noting that the simpler option might be incentive for those not currently using anything to jump on board.

Dr. Bays disclosed that he has served as an adviser to AstraZeneca.

ORLANDO – Cardiometabolic improvements following gastric bypass surgery persist over time, according to findings from the first prospective, long-term controlled trial to focus on gastric bypass patients.

After 6 years of follow-up, patients in the Utah Obesity Study who underwent the bariatric procedure maintained significant total weight loss and significant improvements in cardiovascular and metabolic measures and other disease end points relative to severely obese patients in the control group who did not undergo the surgery, according to Dr. Ted D. Adams, of the University of Utah in Salt Lake City.

Of the 1,156 morbidly obese subjects enrolled in the study, 418 underwent gastric bypass surgery; 417 sought the procedure but were unable to have it, primarily because of lack of health insurance; and 321 were randomly selected as community controls from the Utah Health Family Tree program.

All the participants underwent physical examinations and health evaluations at baseline, 2 years and 6 years, including a physician interview and detailed medical history; resting electro- and echocardiograms; a submaximal exercise treadmill test and electrocardiogram; pulmonary function; limited polysomnography; resting metabolic rate; anthropometry, resting and exercise blood pressure; comprehensive blood chemistry; urinalysis; and dietary, quality of life, and physical activity questionnaires, Dr. Adams stated, noting that the 6-year follow up was "excellent," at 97%.

"In the surgical group, nearly all of the clinical measures improved significantly between the baseline and 2-year exams, and they remained significantly improved, compared with baseline at 6 years," Dr. Adams said. In contrast, he noted, "the clinical variables in the combined control groups changed minimally if at all over the 6-year period."

With respect to weight loss, the total weight reduction from baseline in the surgery group was 35% at 2 years and 28% at 6 years, while the average weight loss in the nonsurgical control subjects was negligible, Dr. Adams reported. Further, the rate of diabetes remission at 6 years was 75% in the surgical group and 1% in the combined controls, and the incidence of diabetes in the surgical and control groups at 6 years was 2% and 16%, respectively, he said.

Cardiac morphology measures were also significantly improved at 6 months in the surgical group, Dr. Adams said. Echocardiography showed reduced left atrial volume and left ventricular mass, improvements that could potentially lead to reduction in obesity-related heart failure over time, he pointed out. The left atrial volume increased in the control group. Significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density-lipoprotein cholesterol, and insulin resistance were maintained at 6 years in the surgical group, as were higher levels of high-density lipoprotein cholesterol, he said.

The findings complement other cohort studies in bariatric surgery, Dr. Adams stated. The cohort will continue to be followed to provide additional insight in the long-term durability of the improvements, he said.

Dr. Adams had no conflicts of interest to disclose.

ORLANDO – Cardiometabolic improvements following gastric bypass surgery persist over time, according to findings from the first prospective, long-term controlled trial to focus on gastric bypass patients.

After 6 years of follow-up, patients in the Utah Obesity Study who underwent the bariatric procedure maintained significant total weight loss and significant improvements in cardiovascular and metabolic measures and other disease end points relative to severely obese patients in the control group who did not undergo the surgery, according to Dr. Ted D. Adams, of the University of Utah in Salt Lake City.

Of the 1,156 morbidly obese subjects enrolled in the study, 418 underwent gastric bypass surgery; 417 sought the procedure but were unable to have it, primarily because of lack of health insurance; and 321 were randomly selected as community controls from the Utah Health Family Tree program.

All the participants underwent physical examinations and health evaluations at baseline, 2 years and 6 years, including a physician interview and detailed medical history; resting electro- and echocardiograms; a submaximal exercise treadmill test and electrocardiogram; pulmonary function; limited polysomnography; resting metabolic rate; anthropometry, resting and exercise blood pressure; comprehensive blood chemistry; urinalysis; and dietary, quality of life, and physical activity questionnaires, Dr. Adams stated, noting that the 6-year follow up was "excellent," at 97%.

"In the surgical group, nearly all of the clinical measures improved significantly between the baseline and 2-year exams, and they remained significantly improved, compared with baseline at 6 years," Dr. Adams said. In contrast, he noted, "the clinical variables in the combined control groups changed minimally if at all over the 6-year period."

With respect to weight loss, the total weight reduction from baseline in the surgery group was 35% at 2 years and 28% at 6 years, while the average weight loss in the nonsurgical control subjects was negligible, Dr. Adams reported. Further, the rate of diabetes remission at 6 years was 75% in the surgical group and 1% in the combined controls, and the incidence of diabetes in the surgical and control groups at 6 years was 2% and 16%, respectively, he said.

Cardiac morphology measures were also significantly improved at 6 months in the surgical group, Dr. Adams said. Echocardiography showed reduced left atrial volume and left ventricular mass, improvements that could potentially lead to reduction in obesity-related heart failure over time, he pointed out. The left atrial volume increased in the control group. Significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density-lipoprotein cholesterol, and insulin resistance were maintained at 6 years in the surgical group, as were higher levels of high-density lipoprotein cholesterol, he said.

The findings complement other cohort studies in bariatric surgery, Dr. Adams stated. The cohort will continue to be followed to provide additional insight in the long-term durability of the improvements, he said.

Dr. Adams had no conflicts of interest to disclose.

ORLANDO – Cardiometabolic improvements following gastric bypass surgery persist over time, according to findings from the first prospective, long-term controlled trial to focus on gastric bypass patients.

After 6 years of follow-up, patients in the Utah Obesity Study who underwent the bariatric procedure maintained significant total weight loss and significant improvements in cardiovascular and metabolic measures and other disease end points relative to severely obese patients in the control group who did not undergo the surgery, according to Dr. Ted D. Adams, of the University of Utah in Salt Lake City.

Of the 1,156 morbidly obese subjects enrolled in the study, 418 underwent gastric bypass surgery; 417 sought the procedure but were unable to have it, primarily because of lack of health insurance; and 321 were randomly selected as community controls from the Utah Health Family Tree program.

All the participants underwent physical examinations and health evaluations at baseline, 2 years and 6 years, including a physician interview and detailed medical history; resting electro- and echocardiograms; a submaximal exercise treadmill test and electrocardiogram; pulmonary function; limited polysomnography; resting metabolic rate; anthropometry, resting and exercise blood pressure; comprehensive blood chemistry; urinalysis; and dietary, quality of life, and physical activity questionnaires, Dr. Adams stated, noting that the 6-year follow up was "excellent," at 97%.

"In the surgical group, nearly all of the clinical measures improved significantly between the baseline and 2-year exams, and they remained significantly improved, compared with baseline at 6 years," Dr. Adams said. In contrast, he noted, "the clinical variables in the combined control groups changed minimally if at all over the 6-year period."

With respect to weight loss, the total weight reduction from baseline in the surgery group was 35% at 2 years and 28% at 6 years, while the average weight loss in the nonsurgical control subjects was negligible, Dr. Adams reported. Further, the rate of diabetes remission at 6 years was 75% in the surgical group and 1% in the combined controls, and the incidence of diabetes in the surgical and control groups at 6 years was 2% and 16%, respectively, he said.

Cardiac morphology measures were also significantly improved at 6 months in the surgical group, Dr. Adams said. Echocardiography showed reduced left atrial volume and left ventricular mass, improvements that could potentially lead to reduction in obesity-related heart failure over time, he pointed out. The left atrial volume increased in the control group. Significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density-lipoprotein cholesterol, and insulin resistance were maintained at 6 years in the surgical group, as were higher levels of high-density lipoprotein cholesterol, he said.

The findings complement other cohort studies in bariatric surgery, Dr. Adams stated. The cohort will continue to be followed to provide additional insight in the long-term durability of the improvements, he said.

Dr. Adams had no conflicts of interest to disclose.