Background: Understanding and preventing cardiovascular disease among parents is important for reducing intergenerational transfer of cardiovascular disease. Prior research has not examined the effect of lifestyle interventions among parents compared to non-parents. We performed a retrospective analysis of the Look AHEAD (Action for Health in Diabetes) trial to assess outcome differences between participants with children younger than 18 years living in the home (referred to as parents) and those without (referred to as non-parents).
Methods: Look AHEAD randomized adults aged 45-75 years with type 2 diabetes and BMI>25kg/m2 to an intensive lifestyle intervention aimed at weight loss, or to a diabetes support and education (control) arm. We examined effects of the intervention at 12 months on objectively measured change in weight (percent of baseline) and cardiovascular risk factors, and change in self-reported dietary intake. To determine whether parenting modified these outcomes, we used linear regression (continuous outcomes) or logistic regression (categorical outcomes) with a multiplicative interaction term for parenting status and treatment arm, adjusted for sociodemographic and clinical characteristics. Modeled results of the interaction are presented.
Results: Among 4,547 participants at baseline, 699 (15%) were parents. Parents were younger than non-parents (54.1 vs 59.0 years, p<0.001); more likely to be black (20.2% vs 15.4%) or Hispanic (19.3% vs 12.5%), p<0.001; and more likely to have a professional degree (6.7% vs 5.0%) or no high school education (8.5% vs 5.7%), p<0.001. Age-adjusted baseline prevalence of chronic disease was similar for parents and non-parents. In response to the intervention (treatment minus control arm), parents lost less weight than non-parents, (-7.1% vs -8.3%, p=0.019); and had less improvement in waist circumference (-5.6cm vs -7.2cm, p=0.008). There were trends towards parents having less improvement in triglycerides (-6.0mg/dl vs -17.7mg/dl, p=0.060) and servings of sweets/fats consumed per day (-0.4 vs -0.6, p=0.055).
Conclusions: In a clinical trial of an intensive lifestyle intervention for patients with type 2 diabetes, participants with children living in the home had less favorable response to the intervention for change in weight and waist circumference. More research is needed to understand the association of parenthood with health behaviors to optimize cardiovascular risk reduction interventions for parents.