Weight Loss Improves Predicted 10-Year MACE and Type 2 Diabetes Risk, but Benefits Partially Rebound at 1 Year

Objective

This study aimed to quantify changes in predicted 10-year risk for major adverse cardiovascular events (MACE) and type 2 diabetes (T2D) across weight loss, post–weight loss (Post-WL), and 1-year follow-up and to determine whether trajectories varied by exercise modality.

Methods

Sedentary women with overweight (21–49 years) were randomized to Diet+Aerobic, Diet+Resistance, or Diet-only and completed an 800 kcal/day diet until BMI < 25 kg m⁻². Predicted 10-year MACE and T2D risks were calculated using cardiometabolic disease staging equations. Longitudinal changes and adherence effects were analyzed using fractional logit models fit with generalized estimating equations.

Results

Among 221 women (115 African American), mean BMI decreased from 28.3 to 23.9 kg m⁻², with regain to 25.8 at 1 year. MACE risk decreased from Baseline to Post-WL and rebounded from Post-WL to 1 year in all groups (all p < 0.001). Diet-only achieved greater MACE reduction than Diet+Resistance (p = 0.022). T2D risk decreased in all groups (all p < 0.001) but rebounded in Diet+Aerobic and Diet-only. The Diet+Resistance group maintained a significant net reduction at 1 year (p = 0.003). Follow-up exercise adherence was associated with lower T2D risk rebound (p = 0.024).

Conclusions

Weight loss reduced MACE and T2D risks, but both rebounded with weight regain. Resistance exercise may be beneficial in weight loss interventions to prevent progression to T2D.

Trial Registration

ClinicalTrials.gov identifier: NCT00067873