Nutrition-related factors and binge eating behaviour in a sample of Malaysian University students

Binge eating (BE) behaviour is associated with obesity and eating disorders. This cross-sectional study investigates BE behaviour and its relationship with nutrition-related factors among university students. A total of 170 (69% females) university students in Malaysia aged 19 to 24 years participated in this study. BE behaviour was assessed with the use of Binge Eating Scale (BES) questionnaire. Socio-demographic background and nutritional status (anthropometric measurements, body mass index (BMI) and dietary intake) were also measured. BE behaviour reported by 10% percent of the participants. BE behaviour was associated with increased energy intake, elevated BMI and sex (Adjusted R2 = 0.116, p < 0.001). Differences in sex-specific factors in predicting the risk of BE behaviour were evident. In male participants, an increased in energy intake, elevated BMI and had a higher waist circumference associated with the risk of BE behaviour (Adjusted R2 = 0.411, p < 0.001). In female participants, only a higher waist circumference associated with BE behaviour (Adjusted R2 = 0.028, p < 0.05). The finding suggests that understanding sex-specific factors are necessary to prevent BE. These are the potential targets for tailored eating behaviour intervention among university students

Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese Patients with Type 2 Diabetes

Partial or complete remission from type 2 diabetes was recently observed after bariatric surgeries. Limited data is available about the possibility of inducing diabetes remission through intensive weight reduction. We retrospectively evaluated diabetes remissions after one year of the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week intensive program for diabetes weight management in real-world clinical practice. Among 120 obese patients with type 2 diabetes who completed the program, 88 patients returned for follow-up at one year. Nineteen patients (21.6%) had major improvement in their glycemic control, defined as achieving an A1C <6.5% after one year. Four patients (4.5%) achieved either partial or complete diabetes remission defined as A1C <6.5% and <5.7%, respectively, on no antihyperglycemic medications for one year; 2 achieved partial remission (2.3%) and 2 achieved complete remission (2.3%). At the time of intervention, patients who achieved diabetes remission had shorter diabetes duration (<5 years) and lower A1C (<8%) and were treated with fewer than 2 oral medications. They achieved a weight reduction of >7% after 12 weeks. These results indicate that a subset of obese patients with type 2 diabetes is appropriate for intensive lifestyle intervention with the aim of inducing diabetes remission

238-OR: Long-Term Effects of Intensive Lifestyle Intervention on Cardiovascular Risk Factors in Patients with Diabetes in Real-World Clinical Practice: A 10-Year Longitudinal Study

We previously reported that maintenance of significant weight loss for up to 5 years was attainable in real-world clinical practice among patients with diabetes and obesity and had a positive impact on cardiovascular risk factors. This was predicted by the ability to achieve ≥7% weight loss at 1 year through intensive lifestyle intervention (ILI). In this longitudinal study of the same cohort, we report the 10-year follow-up results. The study included 129 patients with diabetes and obesity enrolled in a 12-week ILI program designed for real-world clinical practice. At 1 year, we divided participants into group A, who maintained &amp;lt;7% weight loss (61 patients, 47.3%), and group B, who maintained ≥7% weight loss (68 patients, 52.7%). We prospectively followed them for 10 years. The total cohort lost on average 10.8±4.6 Kg (-9.7%) at 12 weeks and maintained an average weight loss of 7.7±10 Kg (-6.9%) at 10 years. Group A maintained 4.3±9.5 Kg (-4.3%) and group B maintained 10.8±9.3 Kg (-9.3%) of weight loss at 10 years (P&amp;lt;0.001). In group A, A1C decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but rebounded to 7.7±1.4% at one year and 8.0±1.9% at 10 years. In group B, A1C decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks and rose to 6.8±1.2% at one year and 7.3±1.5% at 10 years (P&amp;lt;0.05 between groups). Despite weight regain, group A maintained significant improvements in LDL and HDL cholesterol, had no change in BP, but significant worsening of serum triglycerides (TG) at 10 years. Group B maintained similar improvements in lipid profile, had a non-significant increase in serum TG at 10 years, but lower BP for the initial 18 months. In conclusion, significant weight reduction in patients with diabetes can be maintained for up to 10 years in real-world clinical practice. A1C and TG worsened with weight regain, while other lipid improvements were maintained. Sustained weight loss is associated with significantly better A1C at 10 years. Disclosure H. Zhang: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A. Mottalib: None. S. Ashrafzadeh: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck &amp; Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC. </jats:sec

742-P: Magnitude of A1C Improvement in Relation to Weight Loss after Intensive Lifestyle Intervention in Real-World Diabetes Practice: Thirteen Years of Observation

The effect of intensive lifestyle intervention (ILI) on A1C in real-world clinical practice is inconsistent and is frequently underestimated. It is also presumed that the magnitude of A1C improvement is solely dependent on the amount of weight loss. In this study we report the magnitude of A1C change in a large cohort of patients with diabetes who underwent ILI over 13 years in relation to their baseline A1C and the amount of weight loss. We evaluated 590 diabetic patients (age 52.5±11 years, 58.6% females, A1C 7.7±1.4%, weight 105.54±18.6 Kg, BMI 36.7±5.1 Kg/m2, diabetes duration 10.9±9.8 years, 83.7% with type 2 diabetes), who enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week multidisciplinary ILI designed for real-world clinical practice between September 2005 and May 2018. We stratified patients based on baseline A1C into three groups: group A with A1C 9% (16.95% of participants), group B with A1C from 8 to &amp;lt;9% (19.15% of participants), and group C with A1C &amp;lt;8% (63.9% of participants). After 12 weeks of intervention, body weight decreased by 8.5±4.6 Kg in group A, 8.0±4.6 Kg in group B, and 7.6±5.8 Kg in group C (p=0.22 between groups). A1C decreased by 2.5±1.3% in group A, 1.2±0.8% in group B and 0.5±0.6% in group C (p&amp;lt;0.001 between groups). Pairwise comparisons of A1C changes between groups showed that: group A had 1.3% greater A1C reduction than group B (p=0.0001) and 2% greater A1C reduction than group C (p=0.0001), while group B had 0.7% greater A1C reduction than group C (p=0.0001). Conclusion: ILI may decrease A1C by up to 2.5% in patients with diabetes. In patients with a similar magnitude of weight loss, A1C reduction was more prominent in those with higher baseline A1C levels. This may be valuable for clinicians to set realistic expectations of A1C reduction for their patients in response to ILI, which is usually the primary step in diabetes management. Disclosure A.H. Eldib: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A. Mottalib: None. S. Ashrafzadeh: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck &amp; Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC. </jats:sec

328-OR: Degree of Glycemic Improvement in Patients with Diabetes Enrolled in Real-World Intensive Lifestyle Intervention in Relation to Baseline A1C: Five-Year Longitudinal Observation

We previously reported that weight loss in patients with diabetes and obesity through real-world Intensive Lifestyle Intervention (ILI) is associated with significantly lower A1C for up to 5 years. However, it is unclear if baseline A1C has any impact on the magnitude of glycemic improvement in this population. Over 5 years, we evaluated a cohort of 129 patients with diabetes and obesity (90% type 2 diabetes, 67% female, mean age 53±10 years, diabetes duration 10±9 years, body weight 110±19 Kg, BMI 38±5.3 Kg/m2) enrolled in a 12-week ILI program. According to baseline A1C, we divided participants into group A with A1C&amp;lt;7.5% (73 patients, 56.6%, mean A1C 6.5±0.5%), group B with A1C 7.5-9% (41 patients, 31.8%, mean A1C 8.1±0.4%), and group C with A1C &amp;gt;9% (15 patients, 11.6%, mean A1C 9.8±0.8%). Compared to baseline, body weight decreased at 5 years by 6.6 Kg, 9.6 Kg, and 8.3 Kg in groups A, B, and C, respectively (p&amp;lt;0.05 for all). A1C in group A decreased by 0.5±0.9% at 12 weeks (p&amp;lt;0.0001) but increased over the following 5 years by 0.1±0.1%, 1.2±0.9%, 0.3±0.1%, 0.4±0.1%, and 0.6±0.2%, respectively (p&amp;lt;0.01 at 5 years compared to baseline). A1C in group B decreased by 1.1±0.2% at 12 weeks (p&amp;lt;0.0001), was maintained significantly lower at 1 year by -0.5±0.2% (p&amp;lt;0.001), rose to baseline at 3 years and maintained at the same level for up to 5 years. A1C in group C decreased by 2.4%±0.3% at 12 weeks (p&amp;lt;0.0001), was maintained significantly lower at 1 year by 0.9±0.5% (p&amp;lt;0.001), also rose to baseline at 3 years, and was maintained at the same level for up to 5 years (p&amp;lt;0.05 between groups at 5 years). We conclude that patients with diabetes and obesity who enroll in real-world ILI with baseline A1C ≥7.5% are more likely to maintain improvements in A1C for at least 3 years before returning to baseline values compared to patients with baseline A1C&amp;lt;7.5%. This finding may help clinicians use baseline A1C to set realistic long-term expectations for patients considering ILI. Disclosure M. Tasabehji: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. S. Ashrafzadeh: None. A. Mottalib: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck &amp; Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC. </jats:sec

Weight Management in Patients with Type 1 Diabetes and Obesity

Purpose of review Patients with type 1 diabetes (T1D) are typically viewed as lean individuals. However, recent reports showed that their obesity rate surpassed that of the general population. Patients with T1D who show clinical signs of type 2 diabetes such as obesity and insulin resistance are considered to have “double diabetes.” This review explains the mechanisms of weight gain in patients with T1D and how to manage it. Recent findings Weight management in T1D can be successfully achieved in real-world clinical practice. Summary Nutrition therapy includes reducing energy intake and providing a structured nutrition plan that is lower in carbohydrates and glycemic index and higher in fiber and lean protein. The exercise plan should include combination stretching as well as aerobic and resistance exercises to maintain muscle mass. Dynamic adjustment of insulin doses is necessary during weight management. Addition of anti-obesity medications may be considered. If medical weight reduction is not achieved, bariatric surgery may also be considered