Long Term Effect of Intensive Lifestyle Intervention on Cerebral Blood Flow. Issue 1 (30th October 2017)

• Record Type: Journal Article
• Authors: Espeland, Mark A.; Luchsinger, Jose A.; Neiberg, Rebecca H.; Carmichael, Owen; Laurienti, Paul J.; Pi‐Sunyer, Xavier; Wing, Rena R.; Cook, Delilah; Horton, Edward; Casanova, Ramon; Erickson, Kirk; Nick Bryan, R.
• Is Part Of: Journal of the American Geriatrics Society. Volume 66:Issue 1(2018)
• Page Start: 120
• Page End: 126
• Publication Date: 2017-10-30
• Subjects: type 2 diabetes mellitus -- intensive lifestyle intervention -- obesity -- cerebral blood flow; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.15159
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract : Objectives: To determine whether long‐term behavioral intervention targeting weight loss through increased physical activity and reduced caloric intake would alter cerebral blood flow (CBF) in individuals with type 2 diabetes mellitus. Design: Postrandomization assessment of CBF. Setting: Action for Health in Diabetes multicenter randomized controlled clinical trial. Participants: Individuals with type 2 diabetes mellitus who were overweight or obese and aged 45 to 76 (N = 310). Interventions: A multidomain intensive lifestyle intervention (ILI) to induce weight loss and increase physical activity for 8 to 11 years or diabetes support and education (DSE), a control condition. Measurements: Participants underwent cognitive assessment and standardized brain magnetic resonance imaging (MRI) (3.0 Tesla) to assess CBF an average of 10.4 years after randomization. Results: Weight changes from baseline to time of MRI averaged −6.2% for ILI and −2.8% for DSE ( P < .001), and increases in self‐reported moderate or intense physical activity averaged 444.3 kcal/wk for ILI and 114.8 kcal/wk for DSE ( P = .03). Overall mean CBF was 6% greater for ILI than DSE ( P = .04), with the largest mean differences between ILI and DSE in the limbic region (3.39 mL/100 g per minute, 95% confidence interval (CI) = 0.07–6.70 mL/100 g per minute) and occipital lobes (3.52 mL/100 g per minute, 95% CI = 0.20–6.84 mL/100 g per minute). In ILI, greater CBF was associated with greater decreases in weight and greater increases in physical activity. The relationship between CBF and scores on a composite measure of cognitive function varied between intervention groups ( P = .02). Conclusions: Long‐term weight loss intervention in overweight and obese adults with type 2 diabetes mellitus is associated with greater CBF.