Weight Loss Improves Predicted 10-Year MACE and Type 2 Diabetes Risk, but Benefits Partially Rebound at 1 Year.

OBJECTIVE: This study aimed to quantify changes in predicted 10-year risk for major adverse cardiovascular events (MACE) and type 2 diabetes (T2D) across weight loss, post-weight loss (Post-WL), and 1-year follow-up and to determine whether trajectories varied by exercise modality. METHODS: Sedentary women with overweight (21-49 years) were randomized to Diet+Aerobic, Diet+Resistance, or Diet-only and completed an 800 kcal/day diet until BMI < 25 kg m-2. Predicted 10-year MACE and T2D risks were calculated using cardiometabolic disease staging equations. Longitudinal changes and adherence effects were analyzed using fractional logit models fit with generalized estimating equations. RESULTS: Among 221 women (115 African American), mean BMI decreased from 28.3 to 23.9 kg m-2, with regain to 25.8 at 1 year. MACE risk decreased from Baseline to Post-WL and rebounded from Post-WL to 1 year in all groups (all p < 0.001). Diet-only achieved greater MACE reduction than Diet+Resistance (p = 0.022). T2D risk decreased in all groups (all p < 0.001) but rebounded in Diet+Aerobic and Diet-only. The Diet+Resistance group maintained a significant net reduction at 1 year (p = 0.003). Follow-up exercise adherence was associated with lower T2D risk rebound (p = 0.024). CONCLUSIONS: Weight loss reduced MACE and T2D risks, but both rebounded with weight regain. Resistance exercise may be beneficial in weight loss interventions to prevent progression to T2D. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00067873.