Abstract
BackgroundThe prevalence of obesity, an important cardiometabolic risk factor, is rising in women. Lifestyle improvements are the first step in treatment of obesity, but the success depends on factors like timing and motivation. Women are especially receptive to advice about lifestyle before and during pregnancy. Therefore, we hypothesize that the pre-pregnancy period provides the perfect window of opportunity to improve cardiometabolic health and quality of life of obese infertile women, by means of a lifestyle intervention.Methods and findingsBetween 2009–2012, 577 infertile women between 18 and 39 years of age, with a Body Mass Index of ≥ 29 kg/m2, were randomized to a six month lifestyle intervention preceding infertility treatment, or to direct infertility treatment. The goal of the intervention was 5–10% weight loss or a BMI < 29 kg/m2. Cardiometabolic outcomes included weight, waist- and hip circumference, body mass index, systolic and diastolic blood pressure, fasting glucose and insulin, HOMA-IR, hs-CRP, lipids and metabolic syndrome. All outcomes were measured by research nurses at randomization, 3 and 6 months. Self-reported quality of life was also measured at 12 months. Three participants withdrew their informed consent, and 63 participants discontinued the intervention program. Intention to treat analysis was conducted. Mixed effects regression models analyses were performed. Results are displayed as estimated mean differences between intervention and control group. Weight (-3.1 kg 95% CI: -4.0 to -2.2 kg; P < .001), waist circumference (-2.4 cm 95% CI: -3.6 to -1.1 cm; P < .001), hip circumference (-3.0 95% CI: -4.2 to -1.9 cm; P < .001), BMI (-1.2 kg/m2 95% CI: -1.5 to -0.8 kg/m2; P < .001), systolic blood pressure (-2.8 mmHg 95% CI: -5.0 to -0.7 mmHg; P = .01) and HOMA-IR (-0.5 95% CI: -0.8 to -0.1; P = .01) were lower in the intervention group compared to controls. Hs-CRP and lipids did not differ between groups. The odds ratio for metabolic syndrome in the intervention group was 0.53 (95% CI: 0.33 to 0.85; P < .01) compared to controls. Physical QoL scores were higher in the lifestyle intervention group (2.2 95% CI: 0.9 to 3.5; P = .001) while mental QoL scores did not differ.ConclusionsIn obese infertile women, a lifestyle intervention prior to infertility treatment improves cardiometabolic health and self-reported physical quality of life (LIFEstyle study: Netherlands Trial Register: NTR1530).
Highlights
Cardiometabolic disease is the leading cause of death in women worldwide
The study was conducted following the principles of the Declaration of Helsinki and approved by the medical ethics committee of the University Medical Centre Groningen (UMCG) (METc code: 2008/284), as well as by the board of directors of the other participating hospitals (N = 22)
Cardiometabolic data were collected at time of randomization, as well as three months (median was 14 (interquartile range (IQR) 13–15) weeks), and six months (median was 27 (IQR 25–30) weeks) after randomization
Summary
Cardiometabolic disease is the leading cause of death in women worldwide. In the United States, cardiometabolic diseases are responsible for more than 25% of mortality in women [1]. In the last forty years, the global age standardized prevalence of obesity in women, as one of the major modifiable risk factors for cardiometabolic diseases, has more than doubled; from 6.4% (5.1 to 7.8) in 1975 to 14.9% (13.6 to 16.1) in 2014 [2]. Obesity reduces fertility [3, 4] and increases the risk of atherosclerosis, hypertension, dyslipidemia, chronic inflammation, and insulin resistance [5, 6] The clustering of these cardiometabolic risk factors is known as metabolic syndrome (MetS) [7, 8]. MetS doubles the risk of cardiovascular mortality [9, 10] Both cardiometabolic and reproductive morbidity reduce physical and mental quality of life (QoL) [11, 12]. We hypothesize that the pre-pregnancy period provides the perfect window of opportunity to improve cardiometabolic health and quality of life of obese infertile women, by means of a lifestyle intervention
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