Cardiometabolic Gains Unrelated to Weight Loss–Adjusted Body Fat or Distribution Changes in Adults With and Without Diabetes

Objective: This study assessed whether changes in body composition or fat distribution after weight loss are associated with cardiometabolic improvements, independent of weight loss magnitude. Methods: We analyzed data from a 1-year lifestyle intervention in adults with obesity and type 2 diabetes (Study I) and a 12-week hypocaloric diet intervention in adults with overweight/obesity without diabetes (Study II). Body composition was assessed by DXA and fat distribution by either abdominal computed tomography (Study I) or DXA-derived trunk to total fat ratio (Study II). Insulin sensitivity was assessed by glucose clamp (Study I) and HOMA-IR (both studies). Additional markers included glucose, lipids, and blood pressure. Changes in body composition and fat distribution were adjusted for baseline values and weight loss using regression analysis. Results: Body weight decreased by 9.8% in Study I and 5.3% in Study II, with fat mass accounting for 64% (95% CI: 0.51%–0.77%) and 77% (95% CI: 0.68%–0.86%) of weight lost, respectively. Clamp-derived insulin sensitivity increased by 50% (Study I), and HOMA-IR decreased by 26% in both studies. No cardiometabolic changes were associated with weight loss–adjusted changes in body fat percentage or fat distribution. Conclusions: Cardiometabolic improvements from weight loss appear independent of changes in body fat percentage or fat distribution.