Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial

Look AHEAD Research Group; Hsin-Chieh Yeh; John P Bantle; Maria Cassidy-Begay; George Blackburn; George A Bray; Tim Byers; Jeanne M Clark; Mace Coday; Caitlin Egan; Mark A Espeland; John P Foreyt; Katelyn Garcia; Valerie Goldman; Edward W Gregg; Helen P Hazuda; Louise Hesson; James O Hill; Edward S Horton; John M Jakicic; Robert W Jeffery; Karen C Johnson; Steven E Kahn; William C Knowler; Mary Korytkowski; Anne Kure; Cora E Lewis; Christos Mantzoros; Maria Meacham; Maria G Montez; David M Nathan; Nicholas Pajewski; Jennifer Patricio; Anne Peters; F Xavier Pi-Sunyer; Henry Pownall; Donna H Ryan; Monika Safford; Rebecca L Sedjo; Helmut Steinburg; Mara Vitolins; Thomas A Wadden; Lynne E Wagenknecht; Rena R Wing; Antonio C Wolff; Holly Wyatt; Susan Z Yanovski

doi:10.1002/oby.22936

Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial

Obesity (Silver Spring). 2020 Sep;28(9):1678-1686. doi: 10.1002/oby.22936.

Authors

Look AHEAD Research Group; Hsin-Chieh Yeh¹, John P Bantle², Maria Cassidy-Begay³, George Blackburn⁴, George A Bray⁵, Tim Byers⁶, Jeanne M Clark⁷, Mace Coday⁸, Caitlin Egan⁹, Mark A Espeland¹⁰, John P Foreyt¹¹, Katelyn Garcia¹⁰, Valerie Goldman¹², Edward W Gregg¹³, Helen P Hazuda¹⁴, Louise Hesson¹⁵, James O Hill¹⁶, Edward S Horton¹⁷, John M Jakicic¹⁸, Robert W Jeffery¹⁹, Karen C Johnson⁸, Steven E Kahn²⁰, William C Knowler³, Mary Korytkowski²¹, Anne Kure²⁰, Cora E Lewis²², Christos Mantzoros⁴, Maria Meacham³, Maria G Montez¹⁴, David M Nathan¹², Nicholas Pajewski¹⁰, Jennifer Patricio²³, Anne Peters²⁴, F Xavier Pi-Sunyer²³, Henry Pownall²⁵, Donna H Ryan⁵, Monika Safford²⁶, Rebecca L Sedjo²⁷, Helmut Steinburg²⁸, Mara Vitolins²⁹, Thomas A Wadden¹⁵, Lynne E Wagenknecht³⁰, Rena R Wing⁹, Antonio C Wolff³¹, Holly Wyatt³², Susan Z Yanovski³³

Affiliations

¹ Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
² Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
³ National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA.
⁴ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA.
⁶ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁸ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁹ Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁰ Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹¹ Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹² Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹³ Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
¹⁴ Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
¹⁵ Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶ Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁷ Department of Medicine, Joslin Diabetes Center, Boston, Massachusetts, USA.
¹⁸ Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
²⁰ Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA.
²¹ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²² Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
²³ Columbia University Medical Center, New York, New York, USA.
²⁴ Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
²⁵ Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
²⁶ Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA.
²⁷ Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁸ Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
²⁹ Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³⁰ Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³¹ Department of Oncology, The Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, Maryland, USA.
³² Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³³ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.

Abstract

Objective: This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality.

Methods: Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer.

Results: After a median follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68-1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80-1.08), incidence of nonobesity-related cancers (HR, 1.02; 95% CI: 0.83-1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68-1.25).

Conclusions: An ILI aimed at weight loss lowered incidence of obesity-related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.

Trial registration: ClinicalTrials.gov NCT00017953.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2 / complications*
Female
Humans
Male
Middle Aged
Neoplasms / etiology*
Obesity / therapy*
Weight Loss / physiology*

Associated data

ClinicalTrials.gov/NCT00017953

Abstract

Publication types

MeSH terms

Associated data

Grants and funding