CoChat
Sign Up
Cited by 37Chronic Disease Management StrategiesDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Education

Impact of an 8‐Year Intensive Lifestyle Intervention on an Index of Multimorbidity

Open access
Espeland, Mark A., Gaussoin, Sarah A., Bahnson, Judy, Vaughan, Elizabeth M., Knowler, William C., Simpson, Felicia R., Hazuda, Helen P., Johnson, Karen C. +3 more·2020·Journal of the American Geriatrics Society
DOI 10.1111/jgs.16672PMC PMC8299520
Open this paper in CoChat — free account

Abstract

BACKGROUND/OBJECTIVES: Type 2 diabetes mellitus and obesity are sometimes described as conditions that accelerate aging. Multidomain lifestyle interventions have shown promise to slow the accumulation of age‐related diseases, a hallmark of aging. However, they have not been assessed among at‐risk individuals with these two conditions. We examined the relative impact of 8 years of a multidomain lifestyle intervention on an index of multimorbidity. DESIGN: Randomized controlled clinical trial comparing an intensive lifestyle intervention (ILI) that targeted weight loss through caloric restriction and increased physical activity with a control condition of diabetes support and education (DSE). SETTING: Sixteen U.S. academic centers. PARTICIPANTS: A total of 5,145 volunteers, aged 45 to 76, with established type 2 diabetes mellitus and overweight or obesity who met eligibility criteria for a randomized controlled clinical trial. MEASUREMENTS: A multimorbidity index that included nine age‐related chronic diseases and death was tracked over 8 years of intervention delivery. RESULTS: Among individuals assigned to DSE, the multimorbidity index scores increased by an average of .98 (95% confidence interval [CI] = .94–1.02) over 8 years, compared with .89 (95% CI = .85–.93) among those in the multidomain ILI, which was a 9% difference ( P = .003). Relative intervention effects were similar among individuals grouped by baseline body mass index, age, and sex, and they were greater for those with lower levels of multimorbidity index scores at baseline. CONCLUSIONS: Increases in multimorbidity over time among adults with overweight or obesity and type 2 diabetes mellitus may be slowed by multidomain ILI. J Am Geriatr Soc 68:2249–2256, 2020.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/jgs.16672

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Lifestyle intervention in Look AHEAD produced benefits on aging relevant outcomes, such as reductions in multimorbidity and improvements in physical function and quality of life.

    “In addition, lifestyle intervention produced benefits on aging relevant outcomes, such as reductions in multimorbidity and improvements in physical function and quality of life (92-95).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [94]

    The Results and Discussion (page not available in our copy) show that Look AHEAD’s intensive lifestyle intervention slowed the eight-year increase in multimorbidity scores compared with diabetes support and education; scores rose in both groups, so this was not an absolute reduction. This paper does not report improvements in physical function or quality of life as outcomes of its analysis, although its references include other Look AHEAD work on quality of life. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The Look AHEAD lifestyle intervention produced benefits on aging-relevant outcomes, including reductions in multimorbidity, improved physical function, and enhanced quality of life.

    “The lifestyle intervention also produced benefits on aging-relevant outcomes, including reductions in multimorbidity, improved physical function, and enhanced quality of life”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [105]

    The Results and Discussion (page unavailable) report that Look AHEAD’s intensive lifestyle intervention slowed the increase in a multimorbidity index compared with diabetes support and education. The paper mentions fitness and cites a separate quality-of-life study, but does not report improved physical function or enhanced quality of life as findings of this analysis. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Lifestyle intervention produced benefits on aging-relevant outcomes such as reductions in multimorbidity and improvements in physical function and quality of life.

    “In addition, lifestyle intervention produced benefits on aging relevant outcomes such as reductions in multimorbidity and improvements in physical function and quality of life (85-88).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [87]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 35

  1. [1]Fabbri E, Zoli M, Gonsalez-Freire M, Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. JAMDA 2015; 16: 640– 7. 25958334 PMC5125299
  2. [2]Marengoni A, Angleman S, Melis R, Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 2011; 10: 430– 9. 21402176
  3. [3]Lochner KA, Goodman RA, Posner S, Multiple chronic conditions among Medicare beneficiaries: state-level variations in prevalence, utilization, and cost, 2011. Medicare Res Rev 2013; 3(3): mmrr.003.03.b02. PMC3983735 24753976
  4. [4]Goodman RA, Posner SF, Huang ES, Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Prev Chronic Dis 2013; 10: E66. 23618546 PMC3652713
  5. [5]Tinetti ME, McAvay G, Trentalange M, Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study. BMJ 2015; 351: h4984;doi: 10.1136/bmj.h4984. 26432468 PMC4591503 · DOI
  6. [6]Fabbri E, Tanaka T, An Y, Loss of weight in obese older adults: a biomarker of impending expansion of multimorbidity? J Am Geriatr Soc 2015; 63: 1791– 7. 26311068 PMC5389375
  7. [7]St. Sauver JL, Boyd CM, Grosshardt BR, Risk of developing multimorbidity across all ages in a historical cohort study: differences by sex and ethnicity. BMJ Open 2015; 5: e006413. PMC4322195 25649210
  8. [8]Espinoza SE, Quiben M, Hazuda HP. Distinguishing comorbidity, disability, and frailty. Curr Geriatr Rep 2018; 7(4): 201– 9. 30984516 PMC6457658
  9. [9]Nguyen QD, Wu C, Odden MC, Multimorbidity patterns, frailty, and survival in community-dwelling adults. J Gerontol A Biol Sci Med Sci 2019; 74: 1265– 70. 30169580 PMC6625582
  10. [10]Salive ME. Future research directions for multimorbidity involving cardiovascular diseases. Clin Geriatr Med 2016; 32(2): 399– 407. 27113155 PMC4848458
  11. [12]Singh S, Zieman S, Go AS, Statins for primary prevention in older adults-moving toward evidence-based decision-making. J Am Geriatr Soc 2018; 66(11): 2188– 96. 30277567 PMC6741349
  12. [13]Newman JC, Milman S, Hashmi SK, Strategies and challenges in clinical trials targeting human aging. J Gerontol A Biol Sci Med Sci 2016; 71: 1424– 34. 27535968 PMC5055653
  13. [14]Espeland MA, Crimmins EM, Grosshardt BR, Clinical trials targeting aging and age-related multimorbidity. J Gerontol A Biol Sci Med Sci 2017; 72: 355– 361. 28364543 PMC5777384
  14. [15]Marengoni A, Rizzulo D, Fratiglioni L, The effect of a 2-year intervention consisting of diet, physical exercise, cognitive training, and monitoring or vascular risk on chronic morbidity—the FINGER randomized controlled trial. JAMDA 2018; 19: 355– 60. 29108888
  15. [16]Morley JE. Diabetes and aging: epidemiologic overview. Clin Geriatr Med 2008; 24: 395– 405. 18672179
  16. [17]Ahima RS. Connecting obesity, aging, and diabetes. Nature Med 2009; 15: 996– 7. 19734871
  17. [18]Tchkonia T, Morbeck DE, von Zglinicki T, Fat tissue, aging, and cellular senescence. Aging Cell 2010; 9: 667– 84. 20701600 PMC2941545
  18. [19]The Look AHEAD Research Group. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003; 24: 610– 28. 14500058
  19. [21]Mount DL, Davis C, Kennedy B, Factors influencing enrollment of African Americans in the Look AHEAD Trial. Clin Trials 2012; 9: 80– 9. 22064686 PMC3843916
  20. [22]The Look AHEAD Research Group. The Look AHEAD Study: a description of the lifestyle intervention and the evidence supporting it. Obesity 2006; 14: 737– 52. 16855180 PMC2613279
  21. [24]The Look AHEAD Research Group. The development and description of the diabetes support and education (comparison group) intervention for the Action for Health in Diabetes (Look AHEAD) Trial. Clin Trials 2011; 8: 320– 9.21730080
  22. [25]Barnett K, Mercer SW, Norbury M, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012; 360: 37– 43. 22579043
  23. [27]Calderon-Larranga A, Vetrano DL, Ferrucci L, Multimorbidity and functional impairment - bidirectional interplay, synergistic effects and common pathways. J Intern Med 2019; 285(3): 255– 271. 30357990 PMC6446236
  24. [28]The Look AHEAD Research Group. Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2014; 2: 801– 9. 25127483 PMC4443484
  25. [30]The Look AHEAD Research Group. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care 2014; 37: 1544– 53. 24855155 PMC4030096
  26. [31]Simpson F, Pajewski NP, Nicklas B, Impact of multidomain lifestyle intervention on frailty through the lens of deficit accumulation in adults with Type 2 diabetes mellitus. J Gerontol A Biol Sci Med Sci 2019 (EPub). doi: 10.1093/gerona/glz197 PMC7518562 31559418 · DOI · Paper page
  27. [32]Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722– 7. 17634318
  28. [33]Yarnall AJ, Sayer AA, Clegg C, Rockwood K, Parker S, Hindle JV. New horizons in multimorbidity in older adults. Age Aging 2017; 46: 882– 8. PMC5860018 28985248
  29. [34]Sonnega A, Faul JD, Ofstedal MB, Cohort profile: the Health and Retirement Study (HRS). Int J Epidemiol 2014; 43: 576– 85. 24671021 PMC3997380
  30. [35]Rocca WA, Yawn BP, St. Sauver JL, History of the Rochester Epidemiology Project: half century of medical records linkage in a US population. Mayo Clin Proc 2012; 87: 1202– 13. 23199802 PMC3541925
  31. [36]Women’s Health Initiative Study Group. Design of the Women’s Health Initiative Clinical Trial and Observational Study. Cont Clin Trials 1998; 19: 61– 109. 9492970
  32. [38]Justice JN, Ferrucci L, Newman AB, A framework for selection of blood-based biomarkers for geroscience-guided clinical trials: from the TAME Biomarkers Workgroup. Geroscience 2018; 40: 419– 36. 30151729 PMC6294728
  33. [39]Gregg EW, Lin J, Bardenheier B, Impact of intensive lifestyle intervention on disability-free life expectancy: The Look AHEAD Study. Diabetes Care 2018; 41: 1040– 8. 29545462 PMC5911793
  34. [40]Espeland MA, Glick HA, Bertoni AL, Impact of an intensive lifestyle intervention on use and costs of medical services among overweight and obese adults with type 2 diabetes: The Action for Health in Diabetes. Diabetes Care 2014; 37: 2548– 56. 25147253 PMC4140155
  35. [41]Espeland MA, Rejeski WJ, West DS, Intensive weight loss intervention in individuals ages 65 years or older: Results from the Look AHEAD Trial. J Am Geriatr Soc 2013: 62: 912– 22. PMC4123658 23668423

Cited by

Sorted by citations

Authors
Espeland, M. A., Gaussoin, S. A., Bahnson, J., Vaughan, E. M., Knowler, W. C., Simpson, F. R., Hazuda, H. P., Johnson, K. C., Munshi, M. N., Coday, M., & Pi‐Sunyer, X.
Affiliations
  • Wake Forest University Health Sciences (US)
  • Baylor College of Medicine (US)
  • National Institute of Diabetes and Digestive and Kidney Diseases (US)
  • Winston-Salem State University (US)
  • The University of Texas at San Antonio Health Science Center (US)
  • University of Tennessee Health Science Center (US)
  • Joslin Diabetes Center (US)
  • Columbia University Irving Medical Center (US)
Corresponding author
Espeland, Mark A.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2020-07-17
Volume
68
Issue
10
Pages
2249-2256
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/jgs.16672
PMC
PMC8299520
OpenAlex
W3042270480
Cited by
37
References
6
Citations by year
2026: 5 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 1
FWCI
3.23
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Wake Forest Alzheimer's Disease Research Center (P30AG049638-01A1)
  • Bartter General Clinical Research Center (M01RR01346)
  • Clinical Translational Research Center (UL1 RR 024153)
  • University of Pittsburgh General Clinical Research Center (M01RR000056)
  • Action for Health in Diabetes Extension Study Biostatistics Research Center (3U01DK057136-19S1, DK 046204, DK56992, DK110341, DK57135, DK57008, DK57219, DK57178, DK57154, DK57078, DK57002, DK57131, DK57182, DK57151, DK57171, DK57177, DK56990, DK57149, DK57136)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, obesity, multimorbidity, intensive lifestyle intervention, multidomain lifestyle intervention, caloric restriction, weight loss, physical activity, diabetes support and education, aging, age-related chronic diseases
MeSH terms
Multimorbidity, Aged, Chronic Disease, Diabetes Mellitus, Type 2, Diet, Reducing, Female, Health Status Indicators, Humans, Life Style, Male, Middle Aged, Obesity, Weight Loss, Exercise, Body Mass Index, Treatment Outcome, Caloric Restriction, Weight Reduction Programs

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review