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PLoS One. 2016 Jan 5;11(1):e0146095. doi: 10.1371/journal.pone.0146095. eCollection 2016.

Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community--An Intervention Follow-Up Study on Reunion Island.

Fianu A1,2,3,4, Bourse L1,2, Naty N1,2, Le Moullec N5, Lepage B3,4, Lang T3,4,6, Favier F1,2.

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Centre d'Investigation Clinique de la Réunion (CIC 1410), Institut National de la Santé et de la Recherche Médicale (Inserm), Saint-Pierre, la Réunion, France.
Centre d'Investigation Clinique de la Réunion (CIC 1410), Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.
Unité Mixte de Recherche 1027 (UMR1027), Université Toulouse III Paul-Sabatier, Toulouse, France.
Unité Mixte de Recherche 1027 (UMR1027), Institut National de la Santé et de la Recherche Médicale (Inserm), Toulouse, France.
Service d'Endocrinologie, Diabétologie et de Nutrition, Centre Hospitalier Universitaire la Réunion (CHU la Réunion), Saint-Pierre, la Réunion, France.
Centre Hospitalo-Universitaire Toulouse, Toulouse, France.


In type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-term effectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socio-economic community. On Reunion Island, 445 adults living in deprived areas, aged 18-40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001-2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shot medical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010-2011). The outcomes were the nine-year changes from baseline in BW, body mass index (BMI) and WC measurements, separately. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m²) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant for WC -2.4 cm (95% confidence interval: -4.7 to -0.0 cm, p = 0.046), non-significant for BW -2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI -0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). A specific long-term effect was the increased likelihood of reduction in adiposity: BW loss, BMI reduction, and WC reduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two major drivers of T2D.

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