Lifestyle-Induced Visceral Fat Loss as a Key Target for Durable Cardiometabolic Health: MRI-Assessed 5- and 10-Year Follow-Up After 2 Clinical Trials.

We examined the long-term postintervention cardiometabolic profile associated with these changes.

我们检查了与这些变化相关的长期干预后的心血管代谢特征。

Methods

We invited participants from CENTRAL (2012-2014) and DIRECT-PLUS (2017-2018), which evaluated dietary patterns (low-fat, healthy dietary guidelines and Mediterranean diet variants, including standard, low-carbohydrate, and polyphenol-enriched "green" Mediterranean diets) combined with structured physical activity.

我们邀请了来自CENTRAL（2012-2014年）和DIRECT-PLUS（2017-2018年）的参与者，这两个项目评估了结合结构化体力活动的饮食模式（低脂、健康饮食指南以及包括标准、低碳水化合物和富含多酚的“绿色”地中海饮食在内的地中海饮食变体）。

Participants underwent additional magnetic resonance imaging of visceral adipose tissue, deep subcutaneous adipose tissue (SAT), superficial SAT, intrahepatic fat, and intrapancreatic fat, along with clinical follow-up measurements, 5 and 10 years after completion of the trials.

参与者在试验完成后5年和10年接受了额外的内脏脂肪组织、深层皮下脂肪组织（SAT）、浅层SAT、肝内脂肪和胰内脂肪的磁共振成像，以及临床随访测量。

Results

We reached 366 out of 381 eligible participants (96%) for follow-up.

我们对381名符合条件的参与者中的366名进行了随访（96%）。

Despite complete weight regain, waist circumference and abdominal fat depots, including visceral adipose tissue, deep SAT, and superficial SAT, partially preserved their intervention-induced achievements at long-term follow-up (false discovery rate ≤0.01 for all).

尽管体重完全恢复，但在长期随访中，腰围和腹部脂肪库，包括内脏脂肪组织、深层皮下脂肪和浅层皮下脂肪，部分保留了干预引起的成果（所有假发现率≤0.01）。

In contrast, postintervention reductions of intrahepatic fat and intrapancreatic fat were fully and excessively gained during follow-up, respectively (false discovery rate ≤0.01 for both).

相比之下，干预后肝内脂肪和胰腺内脂肪的减少在随访期间完全恢复甚至过度增加（错误发现率均≤0.01）。

Each 10% intervention-induced loss of visceral adipose tissue, superficial SAT, and intrapancreatic fat were associated with long-term postintervention improvements in Metabolic Score for Insulin Resistance, composite risk score, and Metabolic Syndrome Severity Score (meta-analysismodels adjusted to weight change, Mediterranean diet adherence and physical activity scores at follow-up, and further measures; all P<0.05).

每减少10%的内脏脂肪、表层皮下脂肪和胰腺内脂肪，与长期干预后胰岛素抵抗代谢评分、综合风险评分和代谢综合征严重程度评分的改善相关（荟萃分析模型调整了随访时的体重变化、地中海饮食依从性和体力活动评分以及其他措施；所有P<0.05）。

Only 10% visceral adipose tissue loss, however, was independently associated with a 28% lower risk of incident type 2 diabetes (hazard ratio, 0.72 [95% CI, 0.54-0.94]; multivariable model) during follow-up.

然而，只有10%的内脏脂肪组织损失与随访期间新发2型糖尿病风险降低28%独立相关（风险比，0.72 [95% 置信区间，0.54-0.94]；多变量模型）

Conclusions

This 5- and 10-year follow-up of 18-month clinical trials suggests that diet and physical activity lifestyle interventions may yield long-term improvements in cardiometabolic measures despite weight regain.

这项对18个月临床试验的5年和10年随访表明，饮食和体力活动生活方式干预可能带来长期的心血管代谢改善，即使体重有所回升。

A 10% reduction in visceral fat due to lifestyle interventions may reduce future type 2 diabetes risk by nearly 30%.

通过生活方式干预减少10%的内脏脂肪，可能会将未来2型糖尿病的风险降低近30%。

Visceral fat loss rather than weight loss emerges as a key target for durable cardiometabolic health.

内脏脂肪的减少而非体重减轻，成为持久的心血管代谢健康的关键目标。

registration

URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01530724 and NCT03020186.

网址: https://www.clinicaltrials.gov; 唯一标识符: NCT01530724 和 NCT03020186。